By Peter Young


How can nurses show resilience in the face of moral distress? On August 11 and 12 of 2016, 45 nurse leaders, clinicians, researchers, ethicists, and key stakeholders convened at the Johns Hopkins School of Nursing to discuss that very question in a State of the Science Symposium entitled, “Transforming Moral Distress to Moral Resiliency in Nursing.”


Co-led by our Dr. Cynda Rushton and a collaboration between Johns Hopkins Berman Institute of Bioethics, the Johns Hopkins School of Nursing, the American Journal of Nursing (AJN), and the Journal of Christian Nursing, the symposium gave participants the opportunity to deliberate about ways to mitigate the effects moral distress.


Pam Grace, Mary Walton and Kenya Haney


Over the two days, participants discussed two broad questions: how to cultivate moral resilience within individuals and how to foster ethical practice at a systems level. Within those categories, participants identified essential steps needed to move forward as well as key priorities for education, practice, and policy.


The group came to consensus about the essential steps for building systems that support ethical practice. These include urging the National Academic of Medicine to conduct an analysis of the causes and impact of moral distress, conducting an analysis of the impact of moral distress on patient outcomes, and raising public “awareness of the impact of unresolved moral distress on patient care and quality outcomes.”


Kathy Schoonover-Shoffner and Lisa Lehman


As for the priorities needed to cultivate moral resilience at the individual level, deliberations concluded that committing resources to support individuals is crucial and that nurses need “education and mentoring to develop such relational skills as motivation, introspection, empathy, communication, mindfulness, and emotional intelligence in order to exercise moral agency in response to moral distress.”


Additionally, the group discussed and agreed upon the program of research needed to promote moral resilience at both the individual and systems levels. Some of the systems research questions in their consensus include, “what are the economic costs to a healthcare organization of measurable moral distress?” and “what constitutes a culture of ethical practice in health care?” For research into individuals, participants prioritized “what measures are needed to assess the effectiveness of moral resilience interventions?” and “what strategies can we implement to develop individual moral resilience?” among other recommendations. The entire executive summary showing the full consensus can be viewed here.


Patricia (Paddy) Rodney and Cynda Rushton


With new direction and agreement on how to move forward, the State of the Science Symposium has breathed fresh air into the profession of nursing. This promise of inquiry into moral resilience should identify ways to support and empower nurses, helping both nurses themselves and hopefully offsetting poor patient outcomes.


Banner Image: Symposium participants




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Nursing Ethics
Peter Young

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