Select and describe an issue in nursing that impacts nurses at all
levels from bedside to advanced practice. Make sure to provide an
adequate background and its significance to all levels of nursing
using a strong review of the literature. Additionally, this should include
a thorough literature review that provides a good understanding of
what the cause of this problem is; what is suggested to address this
problem. Essentially, this review must support your choices of the
decision-making models and this needs to include how all levels of
nursing practice (the bedside nurse to the APN are impacted by the
problem).
2. Identify how you would expect a nurse leader/manager, a bedside/
staff nurse and an Advanced practice nurse (CNO or NP) to address
Nurse Leader/Manager: A nurse leader's role is to create an environment that supports ethical practice. This involves being a visible and accessible resource for staff, actively listening to their concerns, and working to remove barriers that cause moral distress. The nurse manager should also be proficient in using a decision-making model like the ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation) process for addressing ethical issues on their unit. They can also use their influence to advocate for improved staffing levels or better communication between different departments.
Advanced Practice Nurse (APN) / CNO: An APN or Chief Nursing Officer (CNO) has the most significant leverage for systemic change. They can use their position to create a formal structure for ethical decision-making within the organization, such as establishing an ethics committee or integrating ethical training into staff development. They can also influence organizational policies to prioritize patient care and nurse well-being over financial pressures. An APN or CNO might use a Transformational Leadership Model to inspire a culture where ethical considerations are at the forefront of all decision-making
Sample Answer
Literature Review: Causes and Suggested Solutions
The primary cause of moral distress is a disconnect between a nurse's ethical values and the realities of their work environment. Research by Corley et al. (2001) highlights that frequent exposure to situations where nurses are forced to act against their conscience, such as providing futile care to a terminally ill patient or witnessing inadequate staffing, is a major contributor. These situations create a sense of powerlessness and ethical residue, which can accumulate and cause significant psychological harm.
To address this problem, the literature suggests a multi-faceted approach. First, there needs to be a focus on ethical education and training to help nurses identify and articulate their moral concerns. A study by the American Nurses Association (2021) emphasizes the importance of ethics committees and formal support systems where nurses can discuss these dilemmas. Second, organizations must work to create a culture of psychological safety where nurses feel empowered to voice their concerns without fear of reprisal. Lastly, leadership must be willing to address the systemic issues that cause moral distress, such as understaffing and the pressure to meet financial targets over patient needs. These measures are critical for fostering an environment where ethical practice is not just an ideal, but a reality.
How Different Levels of Nursing Would Address Moral Distress
All levels of nursing are impacted and can contribute to the resolution of moral distress. Their roles and responsibilities, however, differ based on their position within the organization.
Bedside/Staff Nurse: The bedside nurse's role is to first recognize when they are experiencing moral distress. Their initial response should be to advocate for their patient and their own ethical well-being. This can be done by using decision-making models like the MORAL Model (Massage the dilemma, Outline the options, Review the criteria and resolve, Act, Look back and evaluate). A staff nurse might also bring their concerns to their charge nurse or manager, or seek support from a peer or hospital ethics committee.