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How Nurses Can Cope With Moral Distress

Moral distress occurs when nurses think they know the correct action to take in a situation, but various obstacles prevent them from doing so. Internal and external obstacles are causing moral distress during the COVID-19 pandemic. The key is to build moral resilience.   

What Is Moral Distress?

Moral distress ranges from feeling stress to complete burnout or even clinical symptoms of post-traumatic stress disorder (PTSD). Dr. Brendel states that “Moral distress comes in when it feels like the kinds of decisions we have to make about care or the kind of care we’re delivering really challenges our fundamental beliefs and commitments as medical professionals.” This conflict can threaten core values and beliefs. It can lead to symptoms such as gastrointestinal problems, sleep difficulties, headaches, panic attacks, flashbacks or nightmares.

What Obstacles Cause Moral Distress?

Moral distress can result from a lack of workplace support, which can manifest as a staff or supply shortage, institutional or legal constraints, or responsibility without authority.

Some perceived causes of moral distress include overly aggressive or ineffective treatment; inadequate pain control; insufficient resources; ineffective communication; incomplete disclosure or lack of informed consent; a lack of respect for the patient or indifference to the choices of the patient/family; and trivialization or objectification of patients.

How Is COVID-19 Contributing to Moral Distress?

Ethical issues related to COVID-19 can contribute to moral distress both at work and at home. Consider these two ethical situations. Nurses are obligated to:

Do no harm

An ethical principle of nursing is nonmaleficence or “do no harm.” Yet the code of ethics for nurses dictates that they must also care for themselves. Many nurses are balancing their own safety and COVID-19 risk, which can extend to loved ones. As a result, some nurses have had to self-isolate in their own homes or leave their homes to protect family members.

Be role models

Nurses have a responsibility as community role models with medical knowledge. Consider just a few situations that can create ethical conflict.

  • What do you do when the clerk at the grocery store is wearing their mask under their nose?
  • Will you attend your cousin’s bridal shower when you know not everyone will wear masks or follow social distancing?
  • How do you handle parents at soccer practice who try to talk to you without wearing masks?

Although these scenarios may not be the “who gets the ventilator” type of ethical discussions you may have had in nursing school, these everyday issues can be just as stressful.

How Do You Recognize Moral Distress?

Learn to recognize moral distress and give it a name using the 4As to Rise Above Moral Distress framework.

  1. Ask yourself, “Am I feeling distress or showing symptoms?”
  2. Affirm it. “Yes, I am suffering, and I will share my feelings with a trusted colleague.”
  3. Assess your willingness to change. “What can I do personally? How can I help my team?”
  4. “I plan to make changes to help myself.”

How Do You Combat Moral Distress?

Develop a plan to build moral resilience. Consider these three simple steps.

  1. Practice self-awareness. Mindfulness can focus your attention in situations that are causing moral distress and help you feel calmer and more in control. Start with just five minutes each day. Try apps such as Calm or Headspace.
  2. Create a safe space. Create a safe space at work to discuss concerns before they lead to moral distress. Explore workplace resources such as ethics education, an ethics committee or team experts. Often chaplains or social workers receive formal training.
  3. Increase self-care. Coping with stress, achieving more balance and building resilience improve with good self-care. Take an inventory of your nutrition, sleep, activity and relaxation methods. Build a moral community at work to hold each other accountable for self-care.

Moral distress can impact all nurses, particularly those working in high-intensity settings like COVID-19 units, pediatrics, critical care and oncology. Learning how to recognize moral distress and finding ways to cope with it can help nurses maintain an even keel in any situation.  

Learn more about TAMIU’s Master of Science in Nursing – Nursing Administration online program.


American Medical Association: 4 Ways COVID-19 Is Causing Moral Distress Among Physicians

American Nurses Association Crisis Standard of Care: COVID-19 Pandemic

American Nurses Association: Code of Ethics for Nurses With Interpretive Statements

American Nurses Association: Exploring Moral Resilience Toward a Culture of Ethical Practice

Calm 4A’s to Rise Above Moral Distress


Healthy Nurse, Healthy Nation: Moral Distress: What It Is and What to Do About It

Modern Healthcare: Doctors, Nurses leave Homes to Protect Families From Virus

Oncology Nursing Society: Cope With Moral Distress by Focusing on the Possibilities

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