Moral Distress and Correctional Nursing
Just returned from a fantastic National Commission on Correctional Health Care (NCCHC) conference. This year the Nurse Manager Round Table tackled moral distress and burnout for correctional nurses. It was an energizing discussion as about 40 nurse leaders from jails and prisons around the country grappled with the issue and suggested some remedies.
Moral distress in nursing is described as a psychological imbalance or disequilibrium that occurs when nurses finding themselves in situations where they feel unable to do the right thing. This conflict can cause physical, emotional and spiritual suffering. The residual build up of continuing moral distress can lead to burnout and burden.
Correctional nurses have unique situations that lead to moral distress. Examples include conflict with custody over inmate access to care, a higher volume of healthcare needs than resources available to meet them, and continuing need for guarded evaluation of potential manipulative patient behaviors. Other potential sources of moral distress include nurse-physician conflict, disrespectful interactions, workplace violence, and clinical ethical dilemmas.
Nurse Managers at the round tables had many ideas to combat moral distress:
- Acknowledge that moral distress exists in our practice.
- Educate staff on the causes and symptoms of moral distress.
- Provide venues for verbalizing distress and seeking solutions such as an open-door management practice, support groups facilitated by an outsider, and constructive solution seeking during staff meetings.
- Seeking ways to reduce moral distress through communication among the disciplines and across disciplines with custody.
- Establishing policies about civility and actions to take when in a morally distressing situation.
These suggestions are aligned with those recommended by the American Association of Critical Care Nurses in 2006.
Have you found correctional nursing to be morally distressing? How do you deal with it? Share your experiences in the comments section.
Photo Credit: © olly – Fotolia.com
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Lorry,
I would add that one important comment from our round table discussion is to acknowledge that moral distress does occur in correctional nursing. Acknowledging moral distress and establishing a structure for nurses to verbalize their experiences, then working to address, resolve and support those experiences is important. I believe we also discuss the impact of unresolved or addresses experiences of moral distress can have an impact on recruitment and retention. It is important to identfy the attributes and consequences of moral distress.
Mary Muse
Good points, Mary! Thanks for being a part of the panel and providing much expertise in this topic.
Hey Lorry,
I just found this blog, its pretty interesting. Im a Paramedic also attending RN school in the coming spring (pretty excited). I have picked up many patients from correctional facilities, I worked in Fresno for a while, they have a huge facility out there that we were constantly going to. I couldnt imagine being a nurse out there. For the most part it seems like 80% of the cases are guys trying to get out of jail for a day. I cant imagine the amount of lieing, and well.. disrespect a nurse runs into out there.
Ive seen a lot of fake heart attacks, strokes, seizures, you name it Ive seen it. And I give you guys mad props for the work you do, not many people could handle that. Anyways Im going to grab your rss feed. Cya Lorry
Glad you found us! Visit and comment often. Sure you don’t want to join us in our crazy world when you graduate???
A huge issue for me is the mentally ill incarcerated. It is hard to see people locked down without treatment, Then sit in meetings where it is discussed whether someone should go to long term hospital treatment in the community. And whetehr or not if it will be cost effective, The short sightedness of the truye costs of untreated SMI boggles the mind. Those same people will in the same breath tell me that the mentally ill have a civil rights issue and may deny treatment, yet allow that not providing them treatment gaurantees detioration, public safety issues, court fees and PD fees, and LE costs, ED and incarceration costs with jail time. What a gerbil wheel of ineffective government.
The frustration can really build up, too. I like the gerbil wheel visual. Some days, lots of days, if seems like that. I have to recenter myself frequently to the good work we do in our field…..even if it IS only baby steps at times.
I found the issue with peanuts and inmates very knowledgeable. I have a friend whom is allergic to peanuts and is facing jail time she was ordered by the judge to talk with the jail nurse. The nurse refused to answer any concerns or any questions. Her attorney has also tried to reach this nurse with no luck. It will hopefully work out to house arrest cause I could only imagine how this nurse would react to a allergic reaction. Unfortunately this nurse is giving hard honest nurses whom care about there patience reguardless of there criminal record a bad name. By the way my friend has a statement from her Dr that does document her allergy that she has shown the judge….