Moving From Moral Distress to Moral Resilience Using Acceptance and Commitment Therapy

Ria Nishikawara; Teresa Maynes

doi:10.53379/cjcd.2023.350

Auteurs-es

Ria Nishikawara University of British Columbia
Teresa Maynes University of British Columbia https://orcid.org/0000-0001-8001-8814

DOI :

https://doi.org/10.53379/cjcd.2023.350

Mots-clés :

détresse morale, résilience morale, la thérapie d'acceptation et d'engagement, engagement professionnel, soins de santé

Résumé

La détresse morale (DM) est une expérience problématique pour les travailleurs de la santé, qui a des répercussions sur l'engagement professionnel, notamment l'épuisement professionnel, la rotation des emplois et la rotation de carrière. Les cas de MD sont en augmentation depuis le début de la pandémie de COVID-19, menaçant de plus grands problèmes pour le système de santé. Bien qu'une gamme d'interventions ait été explorée, aucun traitement fondé sur des preuves n'a été identifié. En raison de l'intégration de la prise de décision éthique dans le domaine des soins de santé, il est peu probable que la MD soit éradiquée ; cependant, il est suggéré que la MD peut être apprise et transformée en résilience morale. Des preuves indiquent que les travailleurs de la santé pourraient bénéficier de compétences basées sur la pleine conscience et la régulation des émotions, ainsi que de stratégies basées sur les valeurs et l'action, pour soutenir le développement de la résilience morale.

Références

Austin, C. L., Saylor, R., & Finley, P. J. (2017). Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychological Trauma: Theory, Research, Practice, and Policy, 9(4), 399-406. https://psycnet.apa.org/doiLanding?doi=10.1037/tra0000201

Campbell, S. M., Ulrich, C. M., & Grady, C. (2018). A broader understanding of moral distress. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 59-77). Springer.

Earvolino-Ramirez, M. (2006). Resilience: A concept analysis. Nursing Forum (Hillsdale), 42(2), 73-82. https://doi.org/10.1111/j.1744-6198.2007.00070.x

Flaxman, P. E., Bond, F. W., & Livheim, F. (2013). The mindful and effective employee: An acceptance and commitment therapy training manual for improving well-being and performance. New Harbinger Publications.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25. https://doi.org/10.1016/j.brat.2005.06.006

Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and Commitment Therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(22), 180-198. https://doi.org/10.1016/j.beth.2009.08.002

Helmers, A., Palmer, K. D., & Greenberg, R. A. (2020). Moral distress: Developing strategies from experience. Nursing Ethics, 27(4), 1147-1156. https://doi.org/10.1177/0969733020906593

Hoare, P. N., McIlveen, P., & Hamilton, N. (2012). Acceptance and Commitment Therapy (ACT) as a career counselling strategy. International Journal for Educational and Vocational Guidance, 12(2), 171-187. https://doi.org/10.1007/s10775-012-9224-9

Holtz, H., Heinze, K., & Rushton, C. (2017). Interprofessionals’ definitions of moral resilience. Journal of Clinical Nursing, 27(3-4), e488-e494. https://doi.org/10.1111/jocn.13989

Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.

Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONN’s clinical issues in perinatal and women’s health nursing, 4(4), 542–551.

Lachman, V. D. (2016). Moral resilience: Managing and preventing moral distress and moral residue. Medsurg Nursing, 25(2), 121-124.

Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S.C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3(3), 155-163. https://doi.org/10.1016/j.jcbs.2014.06.003

Luken, T., & de Folter, A. (2019). Acceptance and Commitment Therapy fuels innovation of career counseling. In N. Arthur, R. Neault, & M. McMahon (Eds.), Career theories and models at work: Ideas for practice (pp.195-205). Ceric.

Lutz, K. T., Amundson, N. E., & Nishikawara, R. K. (2023). Addressing compassion fatigue using career engagement and the Hope-Centered Model for Career Development. Canadian Journal of Career Development, 22(1), 38-47. https://doi.org/10.53379/cjcd.2023.351

Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is “moral distress”? A narrative synthesis of the literature. Nursing Ethics, 26(3), 646-662. https://doi.org/10.1177/0969733017724354

Morley, G., Bradbury-Jones, C., & Ives, J., (2021). Reasons to redefine moral distress: A feminist empirical bioethics analysis. Bioethics, 35(1), 61-71. https://doi.org/10.1111/bioe.12783

Musto, L., & Rodney, P. (2018) What we know about moral distress. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 9-20). Springer.

Neault, R. A., & Pickerell, D. A. (2019). Career Engagement: A conceptual model for aligning challenge and capacity. In N. Arthur, R. Neault, & M. McMahon (Eds.), Career theories and models at work: Ideas for practice (pp. 271-281). Ceric.

Pavlish, C L., Robinson, E. M., Brown-Saltzman, K., & Henriksen, J. (2018). Moral distress research agenda. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 103-125). Springer.

Prudenzi, A., Graham, C. D., Flaxman, P. E., Wilding, S., Day, F., & O’Connor, D. B. (2022). A workplace acceptance and commitment therapy (ACT) intervention for improving healthcare staff psychological distress: A randomized controlled trial. PloS One, 17(4), e0266357-e0266357. https://doi.org/10.1371/journal.pone.0266357

Rushton, C. H. (2016). Moral resilience: A capacity for navigating moral distress in critical care. AACN Advanced Critical Care, 27(1), 111-119. https://doi.org/10.4037/aacnacc2016275

Rushton, C. H. (2017). Cultivating moral resilience: Shifting the narrative from powerlessness to possibility. American Journal of Nursing, 117(2, Suppl 1), S11-S15. https://journals.lww.com/ajnonline/Fulltext/2017/02001/Cultivating_Moral_Resilience.3.aspx

Rushton, C. H., Thomas, T. A., Antonsdottir, I. M., Nelson, K. E., Boyce, D., Vioral, A., Swavely, D., Ley, C. D., & Hanson, G. C. (2022). Moral injury and moral resilience in health care workers during COVID-19 pandemic. Journal of Palliative Medicine, 25(5), 712-719. https://doi.org/10.1089/jpm.2021.0076

Sheppard, K. N., Runk, B. G., Maduro, R. S., Fancher, M., Mayo, A. N., Wilmoth, D. D., Morgan, M. K., & Zimbro, K. S. (2021). Nursing moral distress and intent to leave employment during the COVID-10 pandemic. Journal of Nursing Care Quality, 37(1), 28-34. https://doi.org/10.1097/ncq.0000000000000596

Shoorideh, F. A., Ashktorab, T., Yaghmaei, F., & Majd, H. A. (2015). Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nursing Ethics, 22(1), 64-76. https://doi.org/10.1177/0969733014534874

Spilg, E. G., Rushton, C. H., Phillips, J. L., Kendzerska, T., Saad, M., Gifford, W., Gautam, M., Bhatla, R., Edwards, J. D., Quilty, L., Leveille, C., & Robillard, R. (2022). The new frontline: Exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatry, 22(1), 19-19. https://psycnet.apa.org/doi/10.1186/s12888-021-03637-w

Smith-MacDonald, L., Lusk, J., Lee-Baggley, D., Bright, K., Laidlaw, A., Voth, M., Spencer, S., Cruikshank, E., Pike, A., Jones, C., & Bremault-Phillips, S. (2021). Companions in the Abyss: A feasibility and acceptability study of an online therapy group for healthcare providers working during the COVID-19 pandemic. Frontiers in Psychiatry, 12, 801680-801680. https://doi.org/10.3389/fpsyt.2021.801680

Ulrich, C. M., & Grady, C. (2018). Introduction. In C. M. Ulrich & C. Grady (Eds.), Moral Distress in the Health Professions (pp. 1-7). Springer.

Vaklavic, E. A., Stffileno, B. A., & Carlson, E. (2018). Moral distress: Using mindfulness-based stress reduction interventions to decrease nurse perceptions of distress. Clinical Journal of Oncology Nursing, 22(3), 326-332. http://cjon.ons.org/cjon/22/3/moral-distress-using-mindfulness-based-stress-reduction-interventions-decrease-nurse