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TRANSCRIPT
RESILIENCE
At its core, resilience is about cultivating a quality of Internal Stability, awareness and flexibility that supports a person facing difficult challenges to navigate in a way that reduces the long term detrimental effects.
MORAL DISTRESS
Moral Distress occurs when one knows the ethically correct action to take but due to
institutional constraints is powerless to take that action.
(Jameton, 1984)
MORAL DISTRESS
• Is aware of the moral problem
• Acknowledges moral responsibility
• Makes a moral judgment about the correct action but as a result of real or perceived constraints, participates in or allows the moral wrong-doing to occur
The pain or anguish affecting mind, body or relationships in response to a situation in which a person:
(Nathaniel. A., 2006)
EMPATHIC AROUSAL
• Connected to empathy & compassion
• A physiological process
• If not well-regulated, results in attempts to relieve personal distress
EMOTIONAL DYSREGULATION
• Personal distress and negative emotions are your body’s reaction designed to alleviate the aversive emotional state.
• People who can regulate their emotions and behavior are more likely to experience compassion rather
than distress.
(Eisenberg et al 1994)
MORAL RESIDUE
That which each of us carries from those times in our lives when in the face of moral distress we
have seriously compromised ourselves or allowed ourselves to be seriously compromised.
These times are very painful because they threaten or sometimes betray deeply held and
cherished beliefs and values.
(George Webster & Francois Baylis)
•Changes to standards •Standards are impractical •Lack of resources •Compliance issues
•Shortage of staff •Perceptions of staffing levels •Increase in care needs of residents
•Issues with management and staff •Conflict with staff •Lack of role clarity
•Lack of time •Unsafe practice (s) •Quality of care lacking
•Self identity •Emotional exhaustion •Ethical dilemmas / Lack of skills
FACTORS IN LONG-TERM CARE
1. Recognizing and dealing with competition between organizational and individual interests
2. Avoiding harm and providing exemplary care to clients 3. Preserving and respecting human dignity
(Source: Powers, B.A. (2003). Nursing Home Ethics. New York: Springer. p. 72)
“It’s really…you feel like your hands are tied ten times behind your back and you just…you’re not doing what you really feel is right.”
(Interview with Health Care Aid, in Elaine Wiersma (2011), Everyday Ethics in Long term Care Homes. Lakehead University, Thunder Bay, ON)
MORAL CONCERNS IN
LONG-TERM CARE
HEALTH CARE
RELATIONSHIPS
Each encounter with another person, is a “moral encounter” in that it gives expression to the things I value as a person or the harms I seek to avoid. My values touch each moment and each conversation.
VALUES
• Deeply held preferences or ideals to which we aspire.
• Overall life values – physical safety, integrity, social justice, sanctity of marriage, material wealth, friends, family….
• Work related – well paying, prestige/high status, intellectual stimulation, autonomy, power, altruistic, teamwork, competitive….
MY VALUES
• Trust/Fidelity
• Privacy
• Relationships
• Physical safety
• Integrity
• Individual choice/autonomy
• Family
INFLUENCE MY BELIEFS
Expectation that others will be honest and act within my values
Need for satisfying relationships
I must protect those in care (paternalism)
SELF IDENTITY
• Linked to our ability to respond empathically
• Thoughts of failure reflect damaged self-image
• Shame leads to self-preservation from further harm by avoiding and withdrawing
• Self-image linked to social identity (belong to a profession/role identity)
• Can also be affected vicariously through others
TYPICAL RESPONSE
• Initiate positive change
• Job dissatisfaction
• Disengage/Avoidance
• Judge/blame others
• Withdraw from patients
• Leave the profession
ATTEMPTS TO RESOLVE
• System Reform
• Mediation, Ethics Consultation
• Education – Communication Skills
• Conflict Resolution
• Education on Moral Reasoning and Responsibility
• Grief Counseling and EAP Programs
INTERACTIVE
• Environment – Triggers/prompts
• Biology – Senses (5) – Muscles (tension/relaxation) – Heart rate – Breathing (rate & depth) – Genetic makeup
• Psychology – Beliefs/values – Wants/urges – Fears Drawing courtesy of Louise B. Barnard. LCSW
BUILDING RESILIENCE
All people are more prone to emotional reactivity when they are under physical or environmental stress
MORAL SENSITIVITY
• Moral Radar
• Discern morally salient dimensions/aware of ethically justified options
• Recognize how one’s actions affects self/others
• Enhances capacity to respond in an emotionally balanced, ethically grounded and compassionate manner
Activation Of Emotions
Interpretation Assumptions
Personal characteristics High
Personal characteristics Low
Emotional Regulation
Emotional Dysregulation
Distress / Over arousal
Impulsive Self focused behavior
Secondary trauma/ Moral Distress
Empathy compassion
Resilience/
Integrity
Empathy Moral Sensitivity Memory Perspective taking
Rushton et. al. (2014)
RESILIENCE
• Develop coping skills so your emotions are an important but not controlling factor in your life
• Build moral sensitivity – learn ethical concepts and decision-making frameworks
• Increase positive emotional experiences, create more balance in our lives
• Be able to distinguish your needs from those whom you are helping
• Establish healthy living practices
RESILIENCY BUILDERS
• Optimism
• Creativity
• Humor
• Flexibility
• Self-Motivation
• Spirituality
• Perseverance
“Owning our story can be hard, but not nearly as difficult
as spending our lives running from it. Embracing our
vulnerabilities is risky, but not as dangerous as giving
up on love, belonging and joy – the experiences that
make us the most vulnerable. Only when we are brave
enough to explore the darkness will we discover the infinite
power of our light.”
MANITOBA PROVINCIAL HEALTH
ETHICS NETWORK (MB-PHEN)
Website – www.mb-phen.ca