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Moral Distress

Moral Distress

Contents

TOC o “1-3” h z u HYPERLINK l “_Toc378180546” Introduction PAGEREF _Toc378180546 h 1

HYPERLINK l “_Toc378180547” Impacts of moral distress PAGEREF _Toc378180547 h 2

HYPERLINK l “_Toc378180548” Ways of improving the level of moral distress at the work place/Hospital PAGEREF _Toc378180548 h 2

HYPERLINK l “_Toc378180549” Conclusions PAGEREF _Toc378180549 h 3

IntroductionThe state in which people experience the psychological disequilibrium, or any discomforts that affects their physical health, anxiety and those results which are anguished by making decisions which are moral but which do not go hand in hand with the stated moral behaviors are said to be moral distress. It can also be defined as an experience of people to know what is acceptable, that is, the right things which people should do in order to pursue courses of actions which are right.

There are related factors at work places such as in hospitals which does not cause moral distresses to the nurses. For example in cases where nurses do not allow things like terminating ventilators to ill people or anyone, by doing so, the nurse would have lacked the moral distress by putting terminating ventilators to ill people. Moral distress can only result from any nurse who is not acting on her own moral belief, as well as, suffering from inaction (Smith.2008).

According to Moyet, the care of ill patients typically requires integrations of technical skills, which are, very high with psychological as well as spiritual support to patients also to the families. The care mostly presents the nurses with critical challenges of making a proper morals or ethics decisions. Many concerns have been spoken out in nursing literature as well as general media, which talks about, the shortages of nurses in the healthcare system (Moyet, 2008)..

Impacts of moral distressMoral distress has some significant consequences which includes stress, other significant consequences are a consequence in job dissatisfaction, burnout, as well as departure from places of work, although no information are available about moral distress that affects the nursing care quality. Moral distress has got some impact on people hence in order to avoid distress, there should be stress reducing techniques which when are used positively it can have positive effects but if the nurses has very poor coping skills it can reflect in stress reducing the techniques that they are using.

Moyet reports that there are pictures which are mixed in regarding the impacts of moral distress, about the moral distress particularly on the provision of care and findings suggesting that moral distress does not have negative impacts on care and other people suggesting that the moral distress can only result in nurses. Moyet on the other hand came into conclusions that moral agony leads to many nurses resigning from their work places (Moyet, 2008).

Ways of improving the level of moral distress at the work place/HospitalFor the last four decades, many evidences have shown that the work of nursing has been a stressful work to the nurses. Stresses affect nurses’ health, the well-being of people, and the job satisfaction, the negatively impacts in many organizations in terms of absenteeism, psychological, emotional stress, and turnover. Stress mostly results when nurses are exposed to unclear moral situations, also when nurses are prevented from carrying out some tasks which they were supposed to have done or carried out.

Moral distress in the working places such as hospitals can be improved by observing the source of distress in work related places, and ways in which observing the symptoms of the distress within the team members. Hence nurses who work in various hospitals should be aware that the moral distress is something which is present. Another way of improving the level of the moral distress at the work place is by affirming the distress and commitments to take care of it. On the other hand, one should try to validate their feelings, as well as, perceptions with other people in the organization.

Moral distress at the work place can be improved by identifying the sources of distress. The sources of distress can either be a personal distress or may come from the entire environment. Nurses should make sure that they determine all the severity of their distress, and to contemplate their readiness to act on them, this is where the nurses recognize that there are issues, but they still take the risks of changing the stated action, on the other hand, they should analyze the risks and benefits of the moral distress.

Lastly, the level of moral distress can be improved by getting prepared to act. This is by preparing personally as well as professionally by taking action. After a person is done with the action stated, the nurses should be ready of taking the action by implementing the strategies of initiating the changes that are desired.

ConclusionsIn summary, the nurses who are taking care of the ill people have got intense plus frequent experiences of the moral distress. The idea of providing the aggressive care to all patients is not expected to be advantaged from the critical care as it is the main source caused by the moral distress. The critical care nurses should identify a significant and a wide-ranging implication to moral distress which extends well, in retention and beyond the job satisfaction. Moral distress sometimes tends to be a serious issue in the workplace as well as deserving an urgent plus extended attention (Masters, 2012).

References

Masters, K. (2012). Nursing theories: a framework for professional practice. London: Jones & Bartlett Learning.

Moyet, L. J. (2006). Nursing diagnosis: application to clinical practice (11th ed.). New Yolk: Lippincott Williams & Wilkins.

Smith, M. J., & Liehr, P. R. (2008). Middle Range Theory for Nursing (2nd ed.). New York: Springer Pub. Co..

Module Three Worksheet

Module Three Worksheet

Student’s Name

Institutional Affiliation

Course Tittle

Professor’s Name

Date

Question 1

The term plural executive denotes an executive branch whereby the functions have been distributed among a number of mostly elected officeholders instead of existing in a single individual, the Governor. Texas uses a plural executive which signifies the authority of the Governor are limited and shared between other government executives. There is no one government in Texas that is exclusively in charge of Texas Executive Branch. The Texas constitution of 1876 was made with an intention in mind to limit executive authority in the nation (Gathman, 2019). It was attained by creating the plural executive. Seven chosen officials share executive power to make sure no single person had a lot of executive supremacy. Those who make up the plural executive include the Governor, commissioner of the general land office, comptroller of public accounts, lieutenant governor, and attorney general.

Texas uses the plural executive to have common confidence and cooperation between the executive and the legislature. As specified in Article 4 of the Texas constitution, the plural executive influence Texas government since it guarantees that every affiliate of the plural executive has a self-governing base of power. It safeguards against the concentration of power. It diffuses the functions of the executive among many offices.      

Question 2

Upon comparing the similarities and differences in power between the Texas Speaker of the House and the Lieutenant Governor, the Lieutenant governor can make appointments to committees and also assign bills to the committee of his choice. On the other hand, the speaker maintains order, appoints members of all standing committees, and appoints how many on the standing committee before the Rule of seniority takes over. The speaker is also responsible for appointing the conference committee. The Lieutenant Governor serves as the chairman of legislature budget and legislature council. He also serves as a vice-chairman of the legislative audit committee and legislature education board. The speaker functions as the legislative budget board’s vice-chairman and is an affiliate of the legislature redistricting board. 

The Constitution of Texas limits or restricts government power. This standard is recognized as limited government. Most of the limits protect the citizens of Texas civil rights. The Governor’s limitations comprise of appointed power (Morrow, 2020). Those who are appointed as governors serve six-year duration, and new governors are never able to fire appointees of the preceding government.

Question 3

There are four federal district courts, trial courts, a state court of appeals in Texas, a state supreme court, and both limited and general jurisdiction. They all serve different purposes. There are 94 district courts, one Supreme Court, 13 circuit courts, and all over the nation. Courts in the federal structure-function in a different way in several methods than national courts. 

In order to serve as a judge in theses courts, one must be a United States citizen and a resident of Texas. An individual should also be between the ages of 25 and 75 years and licensed to practice law in the States. An individual ought to be a practicing judge for at least four years. One should also be the resident of his/her respective judicial district for at least two years. These courts’ duties in that they are responsible for the effective administration of the judicial branch and they authorized to promulgate rules of administration not changeable with the regulations of the State as might be essential for the uniform and efficient administration of justice in the various courts. These courts play a role in administrative decision-making.

Question 4

The three types of states courts include appeal courts, general trial courts, and a state supreme court. Lower courts normally rule on minor cases, including civil cases involving small amounts of money and misdemeanor criminal cases and Judges do hearings in these courts devoid of a jury. District courts are the primary trial courts in Texas. The trial courts are the most numerous, including over 500 county courts, 450 state district courts, over 900 municipal courts, and over 800 Justice of the Peace courts.

In Texas, there are certain types of the court that the legislator can create. The legislative courts’ examples include the Court of Federal Claims, the United States Tax Court, the Court of Appeals for the Armed Forces, the Court of Appeals for Veterans Claims, and federal district courts. The state courts hear all the cases not mainly selected for federal courts. The same way as the federal courts interpret federal laws. State courts interpret state laws. Every State gets to establish and interpret its laws.

Question 5

There are some aspects of the Texas Legislature that assist the legislature in providing services. In Texas, just like the Congress and a number of other states, the lawmaking procedure consists of four major stages: introduction, committee action, floor action, and enrollment. The Texas legislature comprises two different chambers, a 150 member House of Representatives and 31 house of the senate (Morrow, 2020). The state representatives and senators are chosen from single-member localities to work on two-year terms and four-years, respectively. The legislature of the State of Texas is their lawmaking body. Its main function is to pass laws, provide for the well-being, health, environment, education, and financial and overall well-being of Texas citizens. The effect of low pay, redistricting, ad person cost of running for office make the position undesirable and hinders it

Reference

Gathman, A. E. (2019). Divided Plural Executives: Examining the Where, the Why, and the Do They Even Matter (Doctoral dissertation).

Morrow, J. (2020). There Is Only One Texas Constitution.

Module Reflections. Reading this module has enabled me to grow more into being a professional nurse

Module Reflections

Name of student

Institution

MODULE REFLECTIONS

Reading this module has enabled me to grow more into being a professional nurse. It has imparted skills in me that will enable me to practice from a professional point of view. I have appreciated the basis of theory in nursing and its contribution to the development of the profession. After reading the module, I am confident when applying nursing theory in the aspect of the profession, such as teaching in the clinical area, research and, as well, patient care. One other aspect I have found very interesting is learning out the tenets of evidence-based practice. This is a very vital area of modern nursing. Learning about this has given me the required confidence in the clinical area. Learning about the professional basis of practice has been very helpful for me. I am now able to confidently stand before a group of nurses and address them professionally, and present myself with the professional principles required in order to set a role model. This wouldn’t have been possible without the concepts of professional practice that I have learned in this module.

Professional ethics is a very vital aspect of the profession. I connect to the recommendations made by Marrs and Lowry (2006) concerning integration of good personal values to patient’s care. They advise empathizing with the patient instead of only sympathizing with them. I have been able to advance in this area of practice through my interactions with this module. Additionally, I have appreciated the principles of holistic care giving. This has set my basis for me to initiate research in the area of holistic care giving, which has been a very passionate area for me. I am also purposing to apply these skills on holistic care to the clinical area, so that I can better the care I give to patients in the clinical area. Lastly, research is very necessary for nursing. This module, especially the seminars, has enabled me to develop my research skills to a very advanced level.

The combination of knowledge from the recommended articles and the seminars in the module is coming out very well in shaping one to a model of professionalism in the practice of nursing. I have enjoyed reading the modules so much, this has aroused me into reading them frequently and has enabled me make good progress. I am almost through with them all, and I plan to review all of them again before the deadline. They have helped me to find my place in nursing, and I believe by the time I review them for the second time I will emerge a very professional nurse.

Reference

Marrs, J., & Lowry, L. W. (2006). Nursing theory and practice: connecting the dots. Nursing Science Quarterly, 19(1), 44-50.

REFLECTION TO POST 1: THE CONCEPTS: STRESS/BURN OUT By B.P.

Dear B.P,

Good post there concerning a concept and its relevance to the practice of nursing, and nursing research. I interacted with this word when I was doing my first research article, and I was required to explain the conceptual framework. At first I was at ease but the explanations given by Chinn and Kramer (2011) helped me a lot in getting the gist concerning conceptual framework in nursing research. I concur with your observation, based on your analysis of these two studies, that the concept should be well selected, and its relevance to nursing research be outlined. In the future, our nursing profession will gain the place it deserves in the society, courtesy of professional interpretation and application of concepts.

Concerning your discussion on stress and burnout as brought out by your two selected authors, let me first point out that you have brought it out very well, and I agree you have interacted thoroughly with the modules. Concerning the article by Ifagwazi (2006), I will admit here that we share opinion concerning this article. Her research is very systematic towards application of conceptual frameworks. I particularly liked it because I work in a hospice, and psychological burnout is a common phenomenon among workers in such a setting. Severally, I have witnessed verbalizations of my colleagues concerning psychological burnout. In addition, the way in which Ifeagwazi (2006) links concepts to hypothesis is impressive.

Further, I share your sentiments concerning the organization and the focus of Ifeagwazi’s work. It is paramount that research in nursing adds value to the already existing literature. It should also contribute to bettering the tenets of professional, and ethical practice. After reading Ifeagwazi’s article, I recommended it to my colleagues at the workplace because I felt her study was very relevant to the setting I work. In my future research work, I purpose to dedicate some study to stress and burnout among staff. I feel am learning a lot through these interactions, which I need to share with the generations to come.

References

Chinn, P. A. & Kramer, M. K. (2011). Integrated theory and knowledge development in nursing (8th ed). St. Louis, MO: Elsevier Mosby.

Ifeagwazi, C. M. (2006). The influence of marital status on self-report of symptoms of psychological burnout among nurses. Omega, 54(4), 359-373.

 

REFLECTION TO SECOND POST: CONCEPTUAL ANALYSIS OF QUALITY OF LIFE:

Dear J.D

I have loved your article about quality of life so much. This is particularly on the aspect of the connection between the quality of life and health. I agree that the two are related, and one contributes to the other. I was concerned with this article particularly because I work in a hospice care setting, where the two concepts apply very well. In my place of work, I deal with chronically ill patient. Improving the quality of life for these clients means a lot to them. In essence, the whole concept of care in my setting involves giving priority to health with the aim to improving the patient’s quality of life. I have enjoyed reading your reflection on Plummer and Mohlzahn (2009) on their article that is based on quality of life. You argue that quality nursing care, which focuses on the whole person, contributes to improving a person’s quality of life, through enabling them to live a healthy life. You also point out that the quality nursing care should focus on the individual as a whole, and not the condition of the individual. I would like to introduce the term holistic to explain my understanding of this concept of care.

In “Holistic nursing: A handbook of practice”, Montgomery and Keegan (2008) write that the nurse must focus on the client as a complex system of units, and not just focusing on the condition or the illness of the client. Some of our colleagues in the practice of nursing have left the principles of care, because they are not practicing holistic care. I am a witness that; only the practice of nursing that is holistic will improve a client’s quality of life, thus contributing fully to their healthy living. While approaching nursing, it is important to approach it with a view to improving a patient’s condition of living, rather than focusing on treating the illness alone.

References

Montgomery, B. D., & Keegan, L. (2008). Holistic nursing: A handbook for practice (2nd ed). Sudbury, MA: Jones & Bartlett Learning.

Plummer, M and Molzahn, A (2009) Quality of life in contemporary nursing theory: a concept analysis. Nursing Science Quarterly Vol 22

REFLECTION TO POST THREE: KNOWLEDGE AD CLINICAL PRACTICE

Dear K.B.

I loved your article so much that I had to review it again and again. I am an advocate of knowledge in nursing. I hold the same belief you are expressing here thorough the articles you are discussing. We cannot practice nursing without knowledge, and we cannot practice without adding to what we know. The basis of the profession is the body of knowledge for that profession. Nursing should be taken to the place it belongs I society. For it to get there, nurses must develop a culture of adding value to their practice through research. I particularly identify with the views of Doering (1992), which nursing has to gain power through developing a very comprehensive body of knowledge that distinguishes it from other professions. Even though we have made some steps towards this realization, we have not yet achieved the ultimate goal. Desiring knowledge by a good number of nurses will help us to get there.

I also found interesting the part about bridging knowledge to clinical practice. This is another area of practice where nurses make a mistake. As you have observed, I agree that the propositions of Guiliano (2003) must be so much put into consideration in the practice of nursing. He proposes the integration of the measurements that will better nurse care. I find it that nurses have made a mistake in that; there are those nurses who have so much specialized in studying, while others have so much specialized I clinical practice. I feel that there is need for be a balance so that the nursing professionals can practice in the clinical area, and get a chance to utilize their knowledge on patient care. Similarly, the practicing nurses need to spend some time with books and research, so that they can better their practice of evidence-based nursing.

References

Doering, L. (1992). Power and knowledge in nursing: A feminist’s poststructuralist view. Advances in Nursing Science, 14(4).

Guiliano, K. K. (2003). Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice? Nursing Philosophy, 4(1), 44-52.

REFLECTION ON FOURTH POST: PATIENT-CENTERED CARE.

Dear D.H,

I have loved your article so much because it touches on the very foundation of nursing care. Nursing cannot achieve its objective about care if the patient will not be allowed to judge and decide the care they want. Your observations, even according to the two articles agree with the propositions of Stewart (2001), that the patient should be given all the space and freedom to guide their care. Also, I identify with your observation that patient-centered care ought to be multidisciplinary. The members of the multidisciplinary care team need to direct their focus to the progress of the patient. Your observation concerning the article by Hasse (2013) reflects what the module on theories and concepts has been emphasizing, that we must empower the patient in order to produce good results. According to Steward (1992), patient-centeredness has been challenged by many aspects like hospital-centeredness, where the institution focuses on making money from the patients. In other settings, the management has focused on staff, and they have not invested in measuring outcomes from the patient’s perspective. Some have been distracted by the need to employ technology. Sometimes the application of technology limits patient centered care. Even though there is the need to incorporate technology to clinical practice, it should be emphasized that patient-provider contact should be a priority.

References

Hasse, G. L. (2013). Patient-Centered Care in Adult Trauma Intensive Care Unit. Journal of Trauma Nursing, 20(3), 163-165. 

Stewart, M. (1992). Towards a global definition of patient-centered care. British Medical Journal, 322(7284), 444-445.

REFLECTION TO POST FIVE: END OF LIFE DECISIN MAKING.

Dear S. P

Thank you for this article. I love the way you articulate issues here. I particularly love it because it is directly touching my current field of practice. In hospice care, we deal so much with end of life care. The issue of decision-making is key in end of life-care, just as you have mentioned. Your articulation of the role of nurses in supporting the patients at this particular time comes out very well. This appears one of the hardest aspects of nursing practice. The nurse has to support the dying patient, the family and the self. Since we are human, we are also affected by a patient’s death when it occurs. Many people, however, and the profession as well expect that the nurse takes the role of a supporter. Since it is part of nursing care, we have to effect it with the precaution that it requires. According to Thacker (2008), nurses stand at the best position to support patients and families during the end of life care.

I would want to add two things that concern end of life care, and in regard to your post. Firstly, your observation concerning the limitation of the role of the nurse in the setting is very vital. Even though both Thacker (2008) and Thelen (2008) agree that nurses are at the best position to support patients at the end of life care, they also express sentiments that the nurse’s role is limited by the fact that decisions are made by the physician. This is an area I feel needs to be reviewed in order to support patients fully at the end of life care. Secondly, culture needs to be considered in end of life care. Phillip and Charles (2003) argue that cultural differences dominate the aspect of decision-making at the end of life. Some cultures empower the patient to make a decision. Other cultures will demand that a decision be made by the family. Still, others trust the physician with decision-making. Culture thus, is a very important component of end-of-life care.

References

Phillip, L. D., & Charles, L. S. (2003). Cultural differences at the end of life. Critical Care Medicine, 31(5), 354-357.

Thacker, S. K. (2008). Nurses’ advocacy in end-of-life nursing care. Nursing Ethics, 15(4), 174-185.

Thelen, M. (2005). End-of-life decision making in intensive care. Critical Care Nurse, 25(6), 28-37.