Stories of Moral Distress

From a nurse working in a PACU -

This happened a number of years ago. A young man had an accident, and he had to have his legs set. From the accident, he had also lost a lot of skin from the area, and the grafts were not taking. He needed a plastic surgery procedure to try to graft some skin from other parts of his body, a very benign procedure. The plastic surgeon did the procedure and then they moved the patient, stable, to the PACU, the post anesthesia recovery area. Then something went terribly wrong. There was discussion that maybe the oximetry that measures oxygenation wasn't working and didn't trigger an alarm. The unit was extremely busy that day with lots of people coming from surgery, and this young man had been considered the easiest, most stable patient. And there was a shortage of nurses on the unit. The nurse got pulled away. She came back and he was blue, and he never regained consciousness.

He had all of these different physicians, anesthesiologist, orthopedic surgeon, plastic surgeon, and all of them basically said, "This isn't my fault," and Risk Management basically said not to say anything. And so they were not disclosing the error because everyone was busy fighting about what the error was. The patient gets back to the unit, he isn't responsive, which makes absolutely no sense to his family, and they keep asking the nurses what's going on, and the doctors aren't giving them the straight story. And the moral distress on the part of the nursing staff, who felt like the lack of truth-telling is a potent form of moral distress, they felt that everyone needed to be forthcoming, but it wasn't happening.

The situation escalated to the point where one of the nurses took the patient's chart and walked into the room and put the chart on this young man's bed. She looked at the patient's mother and said, "You need to read this," and she walked out and quit.

From a nurse in a pediatric critical care unit -

We had a very difficult case that involved a young person who had a situation that resulted in not having enough oxygen to her brain. It left her in a persistent vegetative state. After many attempts to try to change that outcome, it was clear that this was irreversible. At that time, her family had requested that we not continue the life-sustaining treatments that we were providing, a breathing machine and she had tube feedings. Basically, we were sustaining her biological functions.

The physician who was in charge of her care denied their request to discontinue those therapies. As a result of that, she basically lived in our unit for almost two years. She was, in many instances, moved around from unit to unit, from bed space to bed space, to accommodate other patients who had the potential to actually benefit from what we were doing. It felt like such a violation of her, as a human being. First of all, we were providing care that was sustaining her biological functions, but wasn't restoring her to any awareness of her existence. Her parents didn't believe that this was the best way for her to be cared for. They stopped visiting. It caused them incredible distress and grief, to the point where she basically died in our company, without her parents.