Welcome to the simulation titled Moral Distress and Resilience. This is a transcript of the simulation designed for screenreaders.
Care providers routinely face situations where their personal values come into conflict with their professional responsibilities causing moral distress. In this course you will learn resilience strategies that help you recognize when you are experiencing moral distress and techniques to engage your peers and leadership to address the root causes.
Supporting Peers
Engaging Leadership
Resilience
PIC 0: A title card with the words “Moral Distress” is displayed. The screen fades to Joseph Hilliard, P.H.D, M.S.N., who appears on a dark background.
JOSEPH: Hi, I’m Joe Hilliard. I spent my career caring for patients before becoming a bioethicist.
Our line of work, making life and death decisions, challenges our sense of what’s right. Now I help my fellow care providers navigate those situations.
PIC 1: A provider icon representing Dr. Hilliard fades in, along with the letters N.I.C.U.
JOSEPH: Part of what led me here was an experience I had early in my career, working in a neonatal intensive care unit.
There was a child, Chester, who was born with life-threatening congenital conditions.
We weren’t sure he would survive or what quality of life could be expected even if he did.
PIC 2: A thought bubble reading “Why are we doing this?” appears above the provider icon.
JOSEPH: The parents went for every surgery and treatment, and we respected that. But as time wore on, there was little reason to hope Chester would survive outside the hospital. Every day I asked myself, “Why are we doing this?”
PIC 3: A box appears around the provider icon, with the label “The family’s values constrained us as providers.”
JOSEPH: Seeing Chester suffer was agonizing, and I felt guilty I couldn't do better. I felt powerless to change anything. I had this sense of how I was supposed to care for patients, and I wasn't sure this was it.
PIC 4: Around the provider icon, the following words appear: “Agonizing, Guilty, Powerless”. A banner across the screen reads “I questioned my core beliefs.”
JOSEPH: I’d heard distressing situations like these would be a common part of the job. I knew colleagues in other departments handled D.N.R. disagreements among families,or dealt with care limitations because of insurance or financial constraints. Or witnessed policy decisions adversely impact patients.
PIC 5: We fade back to Dr. Hilliard. Three bullet points appear.
JOSEPH: But when I experienced one myself, it hit hard. I remember people saying I looked rough. Saying I should do things like exercise or meditate.
But I realized I didn’t just need self-care. I needed to develop resilience strategies to navigate, heal, and learn from distressing situations. And I needed to prepare for them, the way we prepare for a code, so I could perform at my best and be there for my team.
PIC 6: Two boxes appear on screen, reading “Self Care and Resilience Strategies”
JOSEPH: These experiences can have a unique impact, called moral distress. It’s a kind of stress that occurs when we’re prevented from doing what we know or feel is right.
PIC 7: A box appears, reading “Moral Distress: A unique kind of distress that occurs when we know the right thing to do but are prevented from carrying it out due to a constraint.” Citation: Jameton A. Nursing Practice: The Ethical Issues. Englewood Cliffs, New Jersey: Prentice Hall; 1984: 6.
JOSEPH: We expect some of this as part of a stressful job. But moral distress doesn't just go away once the event is over. There’s a Moral Residue that stays with us, lingering feelings of guilt, anger, and frustration that can weigh us down.
PIC 8: A box appears, reading “Moral Residue: Feelings that don’t go away after a morally distressing event.”
JOSEPH: So while I tried to forget the distress of watching Chester suffer, it wasn’t entirely gone. It hit me again any time a newborn faced uncertainty, and I noticed myself feeling more and more anxious, even if everything was going well.
Each new experience was more distressing. This is called the Crescendo Effect.
PIC 9: A box appears, reading “Crescendo Effect: When the distress of past events accumulates, making new events more and more distressing.
JOSEPH: We tend to think it gets easier over time to deal with difficult feelings. “It’s just part of the job.” But without resilience strategies to help us recover, process, learn, ignoring it can lead to burnout, engaging less with patients, enjoying our work less.
PIC 10: A box appears, reading “Burnout: When continued stress leads you to disengage.”
JOSEPH: I joined this profession because I care deeply about others. I didn’t want to give that up just to get by. It wasn’t too late to address my moral distress. To do that, I had to recognize that I was feeling distressed, by noticing my feelings and behaviors. Here are some examples. Think about any times you might have experienced these feelings or noticed these behaviors.
PIC 11: A banner across the screen reads “Notice your Feelings and Behaviors.” The word “Feelings” expands into a set of bullet points reading:
Then the word “Behaviors” expands into a set of bullet points reading: