Week 12: Healthy Work Environments and Moral Distress

Question 1

Quality Practice Environments

Answer 1

“A quality practice environment supports the delivery of safe, compassionate, competent and ethical care while maximizing the health of clients and nurses

Question 2

Characteristics of a Quality Practice Environment

Answer 2

Communication and collaboration
Responsibility and accountability
Safe and realistic workload
Leadership
Technology and tools
Professional development
Workplace culture

Question 3

Workplace health and safety rights

Answer 3

Right to know about hazards
Right bring forward WHS concerns
Right to refuse unsafe work
Freedom from discriminatory action

Question 4

Workplace health and safety responsibilities

Answer 4

Employee
Follow all health and safety rules
Cooperate with health and safety committee

Employer
Provide safety equipment
Training

Question 5

Addressing disruptive behaviour

Answer 5

• Policies and Procedures
  
  • Zero-tolerance/respectful workplace policies
  • Procedures re: disciplinary action
• Education – awareness of issue, conflict resolution
• Attention to communication skills
• Confront the behaviors and report

Question 6

Preventing violence in the workplace

Answer 6

• Assessing risk
• Developing violence prevention policy
• Providing information to employees
• Investigate incidents

Question 7

Mitigating conflict situations

Answer 7

• Support each other
• Advocate for safe and healthy workplaces
• Address specific incidents with the individual
• Make a complaint through the proper channels
• Confront – use facts and experiences
• Rehearse responses

Question 8

Nonverbal cues/ nonverbal innuendo

Answer 8

Eye rolling
Making faces in response to questions

Question 9

Withholding information

Answer 9

Deliberately withholding information

Question 10

Scapegoating

Answer 10

Blaming negative outcomes on one identified nurse without regard to their actual responsibility for those outcomes

Question 11

Verbal remarks/ verbal affront

Answer 11

Snide, rude, demeaning comments
Shouting
Using a condescending or patronizing tone of voice

Question 12

Sabotage

Answer 12

Deliberately setting up another nurse for failure

Question 13

Passive aggressive behaviour

Answer 13

Backstabbing
Complaining to others about a person but not speaking to that person directly

Question 14

Actions/ inactions

Answer 14

Refusing assistance
Allocating unrealistic workloads
Hoarding or hiding supplies

Question 15

Infighting

Answer 15

Excluding members of staff from communication

Question 16

Broken confidences

Answer 16

Gossiping
Sharing information that is meant to be private

Question 17

Unreasonable burden

Answer 17

“may exist when a nurse’s ability to provide care and meet professional standards of practice is compromised by unreasonable expectations, lack of resources or ongoing threats to personal and family well-being”

Question 18

Moral distress AKA ethical distress

Answer 18

• Occurs when you know the ethically correct action to take but are constrained from taking it (AACN, ND)
• When constraints interfere with acting in the way one knows to be ethically right (CNA 2003)
  
  • Physical, emotional and psychological symptoms
  • Causes can vary

Question 19

The factors or barriers that prevent nurses from doing what they believe to be morally right include:

Answer 19

1. Clinical Situations
2. Factors internal to the caregiver
3. External/environmental factors

Question 20

Factors internal to caregiver preventing nurse from doing what is right

Answer 20

Nurse’s personal value (eg. MAID)
Lack of training
Relational issues (assignment is rude, racist, abusive or disrespectful)

Question 21

External factors preventing nurse from doing what is right

Answer 21

Power imbalances (lacking skill, knowledge, or resources to make values heard)
Policy, law or standards (be supportive or complicating)
Structural inequity (preventable differences in opportunities and outcomes due to social determinants of health)
Limited resources (working with too few staff, high nurse to patient ratio, not enough equipment)

Question 22

External factors preventing nurse from doing what is right

Answer 22

Power imbalances
Policy, law or standards
Structural inequity
Limited resources

Question 23

Consequences of moral distress

Answer 23

Physical symptoms, emotional turmoil, behavioural consequences
Job dissatisfaction
Disengage/ avoidance
Judge/ blame others
Desire to leave their job/ profession

Question 24

Four components of addressing moral distress

Answer 24

1. Determine what you are experiencing
2. Gauge the severity of your distress
3. Identify the causes and constraints
4. Take action to help you move forward

Question 25

Ways to reduce or prevent moral distress

Answer 25

System reform Mediation, consultation Education Conflict resolution, interdisciplinary collaboration, debriefing Grief counseling and EAP programs

Question 26

Whistleblowing

Answer 26

Disclosure of unethical or unsafe practice that creates substantial danger to the life, health or safety of persons, or to the environment Code of ethics requires nurses to address the issue with the person if possible Required to report concerns to the appropriate authority if unsuccessful Disclosures are NOT anonymous Whistleblowing carries significant personal risks despite protections in law

Question 27

Whistleblower protections

Answer 27

Public Interest Disclosure Act facilitates the disclosure of wrongdoing Protects whistleblowers from reprisal This means that it is illegal to punish or discipline anyone who reports a wrongdoing in good faith.

Question 28

Nurse burnout involves...

Answer 28

the emotional and physical exhaustion that comes with the stressful responsibilities required for nursing. In comparison, compassion fatigue results when prolonged emotional strain culminates in detachment and difficulties in providing empathetic care.

Question 29

Compassion fatigue comes from...

Answer 29

working with victims of trauma, although this is not necessarily the case for nurse burnout. Compassion fatigue can also appear more quickly than nurse burnout and can even cause anger or existential despair.

Question 30

Debrief

Answer 30

1. Determine what you are experiencing. How would you know if this is moral distress, burnout, or compassion fatigue? 2. Gauge the severity of your distress. How would you determine how significantly you are affected by the situation? How would you use this self-assessment to prioritize the actions you will take? 3. Identify the causes and constraints. What was the ethically right thing to do? What constraints stopped that from happening? 4. Take action to help you move forward. What resources or strategies might help to address your distress? – Code of Ethics encourages advocacy under Promoting Health and Well Being