Moral Distress Essay

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Applying Virtue Ethics to Moral Distress in the ICU


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Urich, Hamric and Grady (2010) describe moral distress as the psychological imbalance associated with knowing the appropriate action to take but being restricted to take the action by certain obstacles. According to the American Association of Critical-Care Nurses (AACN) (n.d.), moral distress has become a major problem among nurses. Moral distress contributes to physical and emotional stress which can trigger feelings of loss of integrity and dissatisfaction with the work environment among nurses. According to Jones (2014), moral distress is among the leading causes of nurses’ drop out from the profession. Moral distress is also a major drawback in the nurses’ relationship with patients, families, and clinicians thus affecting the quality, quantity, and cost of delivering nursing care. Convincing evidence shows that moral distress has a negative impact upon the work environment, and that it is widespread among the nurses. According to Redman (2000), one in every 3 nurses in America experiences moral distress. Some of the effects of moral distress include loss of capacity to deliver care, low patient-nurse contact, and nurses’ psychological problems (AACN, 2015).


This paper focuses on moral distress associated with the dying process in the critical care unit. The process of dying in the intensive care unit is complicated.  The dying process is associated with myriad distressing situations including advance directives, aggressive treatment despite poor prognosis, families difference in opinion as to when to when to let go, poor communication between family and the health care providers, and unrealistic expectations from patients’ families.  Applying the philosophical theory of virtue ethics to moral distress would help nurses have a way of taking the right action depending on the prevailing circumstance. Aristotle’s theory of virtue ethics provides a holistic approach to the dilemmas that face nurses in the work place, and might offer innovative solutions to the distressing situations that surround end-of-life. Combining the theory of virtue ethics which is borrowed from the philosophy with the theory of end-of-life which is a nursing theory will offer concrete solutions to the moral distress that surround end-of-life decisions.

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