Doing the Best I Can Do: Moral Distress in Adolescent Mental Health Nursing

Abstract

The purpose of this research was to explore the process used by mental health nurses working with adolescents to ameliorate the experience of moral distress. Using grounded theory methodology, a substantive theory was developed to explain the process. All the incidents that led to the experience of moral distress were related to safety and resulted in the nurses asking themselves the question, "Is this the best I can do?" Engaging in dialogue was the primary means nurses used to work through the experience of moral distress. Engaging in dialogue was an ongoing process, and nurses sought out dialogue with a variety of people as they tried to make sense of their experience. Participants identified qualities of dialogue that were helpful or unhelpful as they sought to resolve their moral distress. Participants who had a positive experience of dialogue were able to answer the "Is this the best I can do" question satisfactorily and continue working with adolescents with a renewed focus on the therapeutic relationship. Participants who had a negative experience of dialogue are unable to answer the question and either left the unit or agency or talked about leaving.

Patient participation: causing moral stress in psychiatric nursing?

“…This exacerbated the feeling of being squeezed between expectations – their own and the doctors’/the ‘system’. Such inter‐ and intraprofessional judgement or clinical decision‐making conflicts cause frustration and moral stress . This seemed to affect the nurses the hardest as they were closer to the patients then the doctors and had a strong feeling of responsibility towards them.…”

“…Healthcare workers, who strive to achieve the ideal of patient participation but lack the tools and/or the knowledge to achieve it, may experience moral stress . Moral stress or moral distress is recognised as a significant factor in nurse turnover rates in health care if they find themselves unable to do what they see as morally right. As the two concepts, moral stress creates a greater emphasis on the ethical component(s) that cause(s) the stress than does moral distress , and the former concept is used in this text.…”

“…As the two concepts, moral stress creates a greater emphasis on the ethical component(s) that cause(s) the stress than does moral distress , and the former concept is used in this text. When nurses experience moral stress, it is a fair assumption that this has implication for the quality of patient care .…”

Putting ‘quality’ in qualitative research: a guide to grounded theory for mental health nurses

“…Data are continuously compared to ideas, and ideas are compared to other ideas. For example, in a grounded theory of adolescent mental health nurses in moral distress, Musto and Schreiber described, ‘We started with line‐by‐line coding and then collapsed in vivo codes into higher‐level categories at increasing levels of abstraction’ (Musto & Schreiber , p. 139). It is through this comparison that the researcher can discover what is consistent and what varies among data, both of which are valuable contributions towards identifying a core variable and defining its properties.…”

“…Wilson & Baker () effectively explain how Maori mental health nurses bridge the Maori world and the mainstream health services world by ‘going beyond’ and ‘practicing differently’. Musto & Schreiber () explain the process and possible resolutions to nurses answering the question ‘Is this the best I can do?’ after experiencing moral distress. In each of these cases, the theory provides extensive amounts of information on, for example, context, causes, consequences, conditions, covariances, contingencies, and input from those integrally involved in the experience or process of interest.…”