Moral distress and moral resilience of nurse managers

Abstract

Background Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience. Aim The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil. Research design The research design is the qualitative study with discursive textual analysis. Participants and research context : 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions. Ethical considerations The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity. Findings Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation. Conclusion From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.

Moral distress among nurse leaders: A qualitative systematic review

“…All reviewed articles indicated that nurse leaders experience MD regardless of their leadership role and responsibility. [41][42][43][44][45][46] The consuming nature of MD is best reflected by the descriptive themes "impacts on wellbeing" and "impacts on the organization and quality of patient care." These impacts, at times, were detrimental for the nurse leader.…”

“…I think they make me more aware of my role, because my attitudes in the workplace interfere with other people's lives." (NM11) 44 Personal Support and Organizational Empowerment: Seeking guidance from peers and colleagues external to their organization and from friends and family was reported by some nurse leaders as a mitigating factor to their MD. 41 Psychological protection by the organization was an important component nurse leaders reported from within their organizations.…”

“…41 Psychological protection by the organization was an important component nurse leaders reported from within their organizations. 42,44 Ethics or moral distress consultation, employee assistance programs, and upholding accountability were reported as effective mitigators of MD by nurse leaders. 42 Nurse leaders expressed that organizations that empowered them allowed them to mitigate their MD.…”

“…42 Nurse leaders expressed that organizations that empowered them allowed them to mitigate their MD. 44 "…a manager needs to be well informed, analyze situations from more than one point of view and also have the support of the areas of people management and human resources, so that they feel more con;dent in the face of confrontations." (NM3) 44 Team Approach: Nurse leaders reported they were able to mitigate MD by effectively collaborating with their teams and organizational leadership.…”

“…44 "…a manager needs to be well informed, analyze situations from more than one point of view and also have the support of the areas of people management and human resources, so that they feel more con;dent in the face of confrontations." (NM3) 44 Team Approach: Nurse leaders reported they were able to mitigate MD by effectively collaborating with their teams and organizational leadership. 41,42,44,46 Fostering communication was an integral component of collaboration that nurse leaders utilized to mitigate MD.…”