According to the American Association of Critical-Care Nurses (AACN), “Moral distress is “knowing the right thing to do but being in a situation in which it is nearly impossible to do it.”
Nurses are fighting under moral distress on the front lines caring for patients dealing with COVID-19. State, local, and federal health officials are continuously monitoring and responding to an on-going outbreak of Coronavirus Disease. Cases have been identified globally, including within the United States.
COVID-19 spreads person-to-person among close contacts via respiratory droplets produced from coughs or sneezes. It is also possible to spread COVID-19 via touching infected surfaces and then touching your nose, mouth, or eyes.
The COVID-19 incubation period lasts 2-14 days, symptoms associated with COVID-19 include mild to severe respiratory illness with symptoms of fever, cough, and shortness of breath. Spreading the virus in the absence of symptoms is possible, however, those are most contagious.
A U.S. Legal News report by Gabriella Borter (April 8, 2020) relates that U.S. nurses who can’t get tested fear that they are spreading the COVID-19 virus. This report goes on to say that a New York City intensive care nurse treated patients for three days after she started displaying symptoms of COVID-19 – but couldn’t get a test from her hospital.
In Georgia, a nurse was denied a test after treating an infected patient who died.
Many medical centers are testing only the workers with the most severe symptoms, according to the frontline workers and hospital officials. As a result, nurses and doctors risk infecting patients, colleagues and their families without knowing if they are carrying the virus.
Nationwide, the number of infections has surpassed 400,000 with nearly 13,000 deaths.
“It’s scary to come home and not know if you’re bringing it (COVID-19) home to your family,” said Sydnie Boylan, a nurse at Hollywood Presbyterian Medical Center in Los Angeles.
Boylan went to work in late March with a headache and sore throat, but no fever, after she had been exposed to a coronavirus patient while not wearing sufficient protective gear. Those symptoms did not qualify for testing at her hospital. Boylan’s hospital guidelines prioritize testing patients but not staff since they only have limited supplies.
Boylan said she has been tested at a drive-through site and is waiting for the results.
The AACN’s position relates “that moral distress is a complex, challenging problem with damaging repercussions that are often ignored in healthcare work environments. This problem is exacerbated in times of crisis. AACN asserts that every institution must implement readily accessible resources to identify and mitigate the harmful effects of moral distress.”
Ernest J. Grant, Ph.D., RN, FAAN President, American Nurses Association in an article written in American Nurse Journal (April 2020) – Healthcare and COVID-19 states “I can’t predict the future. But I know this: The health of our nation and the world frequently rests in the hands of nurses. Nurses will always be there for our patients and communities through public health crises and other significant events. I also we’ll always have to contend with external forces, like hurricanes, season influenza, or COVID-19.”
As I view my fellow nurses enduring moral distress in combating COVID-19 I’m reminded of an article by Leah Curtin, RN, ScD(h) FAAN Executive Editor Outreach American Nurse Journal (April 2020)- Seven Values That Ensure a Good Life.
The article outlines the basic principles of ethics – love, truthfulness, fairness, freedom, unity, tolerance, responsibility.
Love: A spontaneous willingness to reach out to others in need
Truthfulness: Honest of intent and purpose, even where perception differs.
Fairness: Concept of equality and equity – “Do unto others as you would have them do unto you.”
Freedom: A fundamental recognition of the human need for freedom of conscience.
Unity: A focus on our “oneness”
Tolerance: I would feel diminished if it were extinct – accepting variety.
Responsibility: Self-respect in the present
Each one of these values describes every nurse I’ve worked with and all the nurses currently working to preserve life and ease suffering for patients affected by COVID-19.
Communication is a powerful tool – just as powerful as personal protective equipment (PPE). Nurses live in a web of moral duties that includes their duty to protect themselves, their patients, their families, and their communities.
Nurses do the right thing in this impossible COVID-19 situation. Supplying nurses with adequate PPE and supporting them with the basic principles of ethics is what we can all do to show our appreciation in this extremely stressful time in our nation’s history. As Ernest Grant says: “…the health of our nation and the world frequently rests in the hands of our nurses.”
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