The CAIPER Blog

May 13, 2020

By Gerri Lamb

I began writing this blog some weeks back. At the time, we all were just beginning to grasp the magnitude of what we would experience with COVID-19. The stories coming from the front lines of health care were powerful and concerning. Health care workers were stepping forward in the face of huge risks: If I go to work today, will I put my family at risk? If I don’t, will I fail my patients, my team?   

Fast forward to today – a lifetime in a few short weeks. Every single day there are countless more stories. The outpouring of appreciation and support for nurses, doctors and for every member of the health care team is amazing. Watching newscasts of people in New York City going out into the streets or on to their balconies to applaud hospital workers or people in Kansas or Iowa driving in car caravans with signs showering love on nursing home staff is incredibly uplifting.   

Looking closer – and I know we all are - the pain and exhaustion in the faces and voices of our colleagues are as inescapable as the tears. Two nights ago, I watched a physician barely get through an interview. She struggled not to break down in tears. I cried with her. Listening closer – it is impossible to miss the distress.  

As we celebrate our health care workforce, in hospitals, nursing homes, prisons – everywhere where our nation’s citizens are at terrible risk – we need to call out that our colleagues, our health care workforce are so vulnerable –certainly for infection, but also for overwhelming emotional and moral distress.  

My team and I learned about moral distress well before COVID-19 when we were working on a project with teams in community health centers. During our conversations about what it was like for team members to care for extremely vulnerable populations, they told us that along with their deep sense of satisfaction, they felt pain and frustration when they were not able to do what they felt they should be doing for their patients and families. What they expressed is the essence of moral distress. Simply stated, moral distress is “knowing the right thing to do and not being able to do it.” Andrew Jameton, a social scientist, identified and named it over 30 years ago. Since that time, it has been the focus of a lot of research: it is real, painful and can become debilitating.  

Moral distress shows up in the “should” emotions like guilt, sadness, shame, and anger. Its physiological manifestation, referred to as moral injury, appears as lack of sleep or appetite and symptoms of anxiety. Moral distress, at its core, is about values and professional integrity. The triggers for moral distress abound in COVID-19 – the lack of protective equipment, the inability to bring family members together during crises, wanting to do the right thing for patients and families while possibly putting your own family at risk.   

During our project which resulted in the digital magazine issue, Conversations about Moral Distress and Moral Injury we learned several ways to recognize when they are happening and to take action to support team members. Here’s a few that do not take much time and can help.  

Most people do not call out that they are struggling with a moral conflict. In recent webinars that I have been doing on moral distress, a number of people have shared they weren’t aware of the idea of moral distress and being able to put a name to it was important to them. 

To support your colleagues – and possibly yourself – become attuned to the words and feelings that signal moral distress.  Listen for comments like “I feel like I’m not doing the right thing” or “I can’t get this situation out of mind.”  The physical symptoms that accompany moral distress are ones we commonly associate with stress. It likely will be tough to sort them out with all the stress everyone is experiencing right now so keep a look-out for the “should” emotions in combination with signs of sleeplessness, loss of appetite, and the like. 

If you think team members may be experiencing moral distress, ask them to talk about what they are feeling. Don’t assume they are ok just because they’re not emoting. Much of the research on moral distress suggests that talking with people who are part of a trusted community makes a difference. Dr. Cynda Rushton, a nurse and prolific author on moral resilience, advises that recognizing signs and symptoms early and taking action can strengthen resilience and reduce distress.  

Select a trusted colleague and agree to look out for each other. Dr. Bill Nash, a psychiatrist and expert on moral distress, recommends pairing up to check in regularly. He suggests that you can plan what to do if you see signs of distress in your buddy. Ask each other: “What would you want me to do? What would you want me to say?”  

I find solace in reading and thinking about “What next?” and “What will we have learned that will make us stronger as a healthcare community, nation, and world?” There is so much good that we can embrace and take forward with us. 

In the meantime, please take care of yourself and each other.   

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