When working as an intern in one of the district hospitals, I experienced an incident that triggered a feeling of dissatisfaction in me and some of the nurses with whom I worked. One man had been admitted as a nursing home patient and suffered from dementia. It also appeared to me that the old man suffered from co-morbidities as well. I noticed that whenever a nurse approached him for medication, he often kicked and punched. It was surprising that one day a nurse in my department had to be admitted after she was punched in the face when she attempted to talk to the patient. In fact, the man’s family members were refusing to give him medications as a way of sedating him stating the consequences of medication.
Moreover, communication became an issue with the doctors since they could only see the patient regularly. We felt threatened by the patient despite knowing that giving medication to the patient was the only way out. We cared for our safety not to end up in an emergency center after the patient’s blows and kicks. It is a moral distress because we knew the right thing to do, which was giving medication to the patient. However, the doctors who are the seniority could not the prescription since they lacked the extent to which the patient was suffering. On the other hand, the wife of the patient feared any side effects of medication. Considering the power of an attorney, sedation should be avoided. We were confident of the corrective action to take only to be constrained by lack of concern by the authorities. Our role is to provide effective care to any patient, but, in this case, we could not correctly respond to the incident. The main idea here is that we felt powerless in taking any action. Furthermore, we were eventually unable to relay our worries to the doctors who could have asked for corrective action.
Solving or addressing the situation would require changes to be made. The four A’s include ask, act, affirm, and assess . The following steps can solve this situation:
ASK: At this stage, it would be vital to review the meaning and signs of the situation and ask ourselves whether that is moral distress. In this case, I am distressed just like my colleagues in the hospital about the feeling of powerlessness hence the need to take further actions.
AFFIRM: At this stage, we can affirm the feelings that we have concerning this situation. That way, we should be able to understand the part of our moral integrity that is being weighted or threatened. Moreover, at this point, we can determine the action that we could or should take. In this case, it could be advisable to relay the information to the seniors.
ASSESS: At this point, we should have started collecting and combining facts about the situation with the patient and the authorities who were supposed to provide prescriptions. It is also vital to determine the source of our moral distress and what we all think is the rightful action to do and the reasons for such decisions.
ACT: At this stage, we ought to have planned and implemented actions in the situation. Acting required us to think of any pending pitfalls in order to strategize on solving them in the future. In this case, we could have approached the authorities despite the feeling of powerlessness in order to make them fully understand the situation. That will prevent any similar incidents in the future.
The model is quite effective in solving this situation of moral distress. This model assists in determining whether it is true that one is feeling powerless in a certain situation. It happens at the initial stage named “ask”. The second one is to affirm what is applicable to this situation. That means that we can all confirm that we are distressed by the situation since we cannot do what we know is ethically correct. That is because the senior doctors are not aware of the whole problem and fail to provide prescriptions. The assess stage is also helpful in solving this situation because it assists in determining the root cause of the moral problem. Moreover, it helps to provide the correction, which is to talk to the seniors. The last stage is also helpful since it can assist us in thinking about actions to take in case such a situation happens again.
The article was composed by one of the top elite writers Rico Shenk.
