Correctional Nurse Self-Care: Are You Carrying the Heavy Burden of Moral Distress?

Kiko con cajaRecently I traded in my clunky 2009 laptop for a new streamlined model. It wasn’t until my first journey with this new laptop that I realized just how heavy my old version was. Now I have a good idea why my shoulders ached after a long day of traversing airports for gate changes while running to make the connection with computer bag in tow.

Moral distress can be like that – a heavy weight on your shoulders that has been slowly building as you work in the criminal justice system. You may not even notice the developing distress until something snaps. Correctional nurses need to monitor moral distress and seek morally satisfying solutions to the ethical dilemmas encountered in day-to-day practice.

What’s in a Name?

The first step in solving moral distress is to identify it. Moral distress has been defined as knowing the right action to take, but being constrained from taking it. In its simplest form, then, moral distress in correctional nursing may be knowing that a patient should be able to make a health decision autonomously but seeing that they are being forced to make that decision against their will.

However, researchers in moral distress among nurses add to this definition in important ways. Nurses are often confronted with an ethical dilemma where the course of action best for the patient is in conflict with what would be best for others; whether it is the organization, other providers, other patients, or society. So, the interior world of the nurse that identifies who they are as a professional is in conflict with the exterior world of the work environment and work team. This is what leads to the distress that can be strongly felt by a nurse.

Moral distress is when:

  1. A nurse is involved in or aware of a situation that calls for a moral action.
  2. Is obstructed from taking that moral action.
  3. Experiences negative feelings because that action was not taken.

I hear of many examples of moral distress among correctional nurses in my various interactions. Intentional bias, poorly staffed medical units, or obstruction from officers or leadership can lead to treatment delays, unrelieved pain, or gaps in care management. Conscientious nurses absorb the stress of longstanding unethical treatment.

The Grimy Build Up of Moral Distress

Absorbing moral stress over time leads to a grubby film that builds up in our nursing souls and affects our emotional, psychological and physical well-being. This has been defined as ‘moral residue’ and is particularly intense when injury to a nurse’s moral integrity is repeated over time. In a correctional setting, a nurse may see the ‘take down’ of mentally ill inmate multiple times over months of practice and have a ‘here we go again’ response to the moral wound caused by seeing this action and feeling unable to do anything about it.

Identifying Moral Distress

Although nurses cannot always name the feeling, most of us know what it is like to be in moral distress. We feel powerless, anxious, and unhappy. Moral residue can lead to typical stress-related symptoms such as nausea, insomnia, and headaches. It can cause us to seek other employment or even leave the profession. When these feelings are present, it is important to seek the source of discontent. It may be the weight of long-standing moral distress.

Seeking a Good Response

Nurses can also feel belittled or unimportant in morally distressing situations. It is easy to experience isolation if we do not feel supported in talking about the morally injuring situations around us. Yet, talking to a supportive colleague is an important action to help identify and clarify moral distress.

Critical care nurses also often find themselves in a morally distressing situation. The American Association of Critical Care Nurses (AACN) developed a 4 step process to help nurses address and reduce moral distress.

ASK Ask yourself if what you are feeling is moral distress. Are others exhibiting signs of moral distress, as well?
AFFIRM Affirm your feelings and consider what aspect of your moral integrity is being threatened.
ASSESS Objectively analyze the situation and what the ‘right’ action would be. Consider what is currently being done, who the players are, and your readiness for action.
ACT Create a plan of action considering any pitfalls and strategies to overcome them.

Have you had to deal with moral distress in your correctional nursing practice? Share your experience with our readers using the comments section of this post.

Photo Credit: © KostaKostov –

2 thoughts on “Correctional Nurse Self-Care: Are You Carrying the Heavy Burden of Moral Distress?

  1. Pingback: Correctional Nurse Self-Care: Preventing Compassion Fatigue | Essentials of Correctional Nursing

  2. Pingback: Commentary on the Heavy Burden of Moral Distress in Correctional Nursing | Essentials of Correctional Nursing

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