RESILIENCE

&

MORAL DISTRESS

Presenter: Richard Lavoie

RESILIENCE

At its core, resilience is about cultivating a quality of Internal Stability, awareness and flexibility that supports a person facing difficult challenges to navigate in a way that reduces the long term detrimental effects.

MORAL DISTRESS

Moral Distress occurs when one knows the ethically correct action to take but due to

institutional constraints is powerless to take that action.

(Jameton, 1984)

MORAL DISTRESS

• Is aware of the moral problem

• Acknowledges moral responsibility

• Makes a moral judgment about the correct action but as a result of real or perceived constraints, participates in or allows the moral wrong-doing to occur

The pain or anguish affecting mind, body or relationships in response to a situation in which a person:

(Nathaniel. A., 2006)

Thoughts

Breathing

Sensations

Emotions

SIGNS

EMPATHIC AROUSAL

• Connected to empathy & compassion

• A physiological process

• If not well-regulated, results in attempts to relieve personal distress

EMOTIONAL DYSREGULATION

• Personal distress and negative emotions are your body’s reaction designed to alleviate the aversive emotional state.

• People who can regulate their emotions and behavior are more likely to experience compassion rather

than distress.

(Eisenberg et al 1994)

EXPERIENCING LIVED REALITY

MORAL RESIDUE

That which each of us carries from those times in our lives when in the face of moral distress we

have seriously compromised ourselves or allowed ourselves to be seriously compromised.

These times are very painful because they threaten or sometimes betray deeply held and

cherished beliefs and values.

(George Webster & Francois Baylis)

•Changes to standards •Standards are impractical •Lack of resources •Compliance issues

•Shortage of staff •Perceptions of staffing levels •Increase in care needs of residents

•Issues with management and staff •Conflict with staff •Lack of role clarity

•Lack of time •Unsafe practice (s) •Quality of care lacking

•Self identity •Emotional exhaustion •Ethical dilemmas / Lack of skills

FACTORS IN LONG-TERM CARE

1. Recognizing and dealing with competition between organizational and individual interests

2. Avoiding harm and providing exemplary care to clients 3. Preserving and respecting human dignity

(Source: Powers, B.A. (2003). Nursing Home Ethics. New York: Springer. p. 72)

“It’s really…you feel like your hands are tied ten times behind your back and you just…you’re not doing what you really feel is right.”

(Interview with Health Care Aid, in Elaine Wiersma (2011), Everyday Ethics in Long term Care Homes. Lakehead University, Thunder Bay, ON)

MORAL CONCERNS IN

LONG-TERM CARE

FUNDAMENTAL PART OF

HEALTHCARE

HEALTH CARE

RELATIONSHIPS

Each encounter with another person, is a “moral encounter” in that it gives expression to the things I value as a person or the harms I seek to avoid. My values touch each moment and each conversation.

Healthcare is rooted in commitment to ourselves & to others

VALUES

• Deeply held preferences or ideals to which we aspire.

• Overall life values – physical safety, integrity, social justice, sanctity of marriage, material wealth, friends, family….

• Work related – well paying, prestige/high status, intellectual stimulation, autonomy, power, altruistic, teamwork, competitive….

My inspiration to work in Health Care

MY VALUES

• Trust/Fidelity

• Privacy

• Relationships

• Physical safety

• Integrity

• Individual choice/autonomy

• Family

WHERE THEY CAME FROM

• Parents

• Family

• Friends

• Education/professional

• Lived experience

INFLUENCE MY BELIEFS

Expectation that others will be honest and act within my values

Need for satisfying relationships

I must protect those in care (paternalism)

Value Statements Shape

Moral Identity

SELF IDENTITY

• Linked to our ability to respond empathically

• Thoughts of failure reflect damaged self-image

• Shame leads to self-preservation from further harm by avoiding and withdrawing

• Self-image linked to social identity (belong to a profession/role identity)

• Can also be affected vicariously through others

• Moral integrity is who we expect ourselves to be

• When challenged we strive for equilibrium

TYPICAL RESPONSE

• Initiate positive change

• Job dissatisfaction

• Disengage/Avoidance

• Judge/blame others

• Withdraw from patients

• Leave the profession

ATTEMPTS TO RESOLVE

• System Reform

• Mediation, Ethics Consultation

• Education – Communication Skills

• Conflict Resolution

• Education on Moral Reasoning and Responsibility

• Grief Counseling and EAP Programs

INTERACTIVE

• Environment – Triggers/prompts

• Biology – Senses (5) – Muscles (tension/relaxation) – Heart rate – Breathing (rate & depth) – Genetic makeup

• Psychology – Beliefs/values – Wants/urges – Fears Drawing courtesy of Louise B. Barnard. LCSW

BUILDING RESILIENCE

All people are more prone to emotional reactivity when they are under physical or environmental stress

• Empathy

• Perspective taking

• Memory

• Moral sensitivity

PRE-CONDITIONS TO EMPATHIC

RESPONSE

MORAL SENSITIVITY

MORAL SENSITIVITY

• Moral Radar

• Discern morally salient dimensions/aware of ethically justified options

• Recognize how one’s actions affects self/others

• Enhances capacity to respond in an emotionally balanced, ethically grounded and compassionate manner

Activation Of Emotions

Interpretation Assumptions

Personal characteristics High

Personal characteristics Low

Emotional Regulation

Emotional Dysregulation

Distress / Over arousal

Impulsive Self focused behavior

Secondary trauma/ Moral Distress

Empathy compassion

Resilience/

Integrity

Empathy Moral Sensitivity Memory Perspective taking

Rushton et. al. (2014)

RESILIENCE

• Develop coping skills so your emotions are an important but not controlling factor in your life

• Build moral sensitivity – learn ethical concepts and decision-making frameworks

• Increase positive emotional experiences, create more balance in our lives

• Be able to distinguish your needs from those whom you are helping

• Establish healthy living practices

RESILIENCY BUILDERS

• Optimism

• Creativity

• Humor

• Flexibility

• Self-Motivation

• Spirituality

• Perseverance

“Owning our story can be hard, but not nearly as difficult

as spending our lives running from it. Embracing our

vulnerabilities is risky, but not as dangerous as giving

up on love, belonging and joy – the experiences that

make us the most vulnerable. Only when we are brave

enough to explore the darkness will we discover the infinite

power of our light.”

MIND & BODY

AND SPIRIT

MANITOBA PROVINCIAL HEALTH

ETHICS NETWORK (MB-PHEN)

Website – www.mb-phen.ca

QUESTIONS