When Moral Distress is Present, Moral Resilience is Necessary

May 7, 2019

By Dr. Nefertiti Poyner

This week is Teacher Appreciation Week. As a teacher by training, and now as a provider of professional development to teachers across the country, I know first-hand the challenges and the joys of teaching. In honor of Teacher Appreciation Week, I took some time to reflect on what my work at the Devereux Center for Resilient Children (DCRC) has taught me about my early days in the classroom.

When I began my teaching career almost 25 years ago, I knew one thing for sure: I wanted to be the best teacher I could be. I promised myself I would learn, challenge myself, ask for help, and never give up on a child or a family. My level of commitment came from a simple place … experience. As a child, my mother was my biggest cheerleader. In the classroom, I repeatedly met educators who would hold me accountable to be the best I could be. This often coming at a time when I did not know what my best actually was.

When I entered the classroom for the first time, I did so as a pre-kindergarten (Pre-K) teacher. Pre-K programs are designed to provide high-quality educational experiences to enhance school readiness for eligible four-year-old children. My first classroom was on the second floor of a church building. It was a large room, with hardwood floors and stain glassed windows that actually opened – which we all became thankful for on warm days, as the church did not have air conditioning or central air. The physical location of the building was interesting. On one side of the building, the area could be described as an upper-middle-class section of the city. On the other side, socioeconomic status ranged from the middle class to lower middle class with many pockets of poverty, and even extreme poverty present. Many of my students were from the immediate neighborhood. Socioeconomic diversity was also present in my classroom. For me, this is just an example of where the moral dilemmas began and where my moral resilience began to grow.

Let’s define a few words before we move on:

Moral – concerning or relating to what is right and wrong in human behavior, considered right and good by most people; agreeing with a standard of right behavior. (Merriam-Webster Dictionary, 2015)

Resilience – The ability to become strong, healthy or successful again after something bad happens; an ability to recover from or adjust easily to misfortune of change. (Merriam-Webster Dictionary, 2015)

Moral Resilience – The ability and willingness to speak and take right and good action in the face of an adversity that is moral/ethical in nature. (Lachman, 2016)

Andrew Jameton (1984) first coined the term, moral distress; to capture the inability of nurses to act on what they believe is the right thing to do because of institutional constraints. Moral distress often involves feelings of frustration and anger (Elpern, Covert, & Kleinpell, 2005; Wilkinson, 1988), which are easy to recognize. Under the surface, and more difficult to identify, are the feelings that threaten one’s moral integrity – feeling belittled, unimportant or unintelligent. Unfortunately, these feelings are often born alone as professionals are often hesitant to speak openly about their innermost feelings. As a result, morally distressed individuals may also feel isolated, an additional threat to their integrity. Though the terms moral distress and moral resilience are most often used in the nursing profession, I maintain a position that it also applies to teachers, as well as other caregiving professions.

According to Vicki D. Lachman (2016), resilient people employ transformational coping strategies and an ability to both analyze and strategize a situation. Educators are faced with this situation daily. I think about my experiences as a teacher when I planned a rich, developmentally appropriate project that I would do with my class. Minutes into introducing the activity, I readily identify a group of tired, hungry students not ready to learn. My lesson plan says, “Activity Time,” but my children’s bodies read, “food” and “rest.” I will be penalized and held accountable if I do not carry this activity as planned, and at the time it is planned. Enter moral distress.

When moral distress in present, moral resilience is necessary. Lachman (2016) describes the application of moral resilience as being able to see the reality of the culture of the work environment, understanding that sometimes we have to take action that does not support our moral beliefs. During such times, it will be important to utilize situation-focused problem solving to reframe the events in terms of a challenge over which we have some level of control. Above all, when faced with moral distress, moral resilience presents an individual with an opportunity to acknowledge the experience, understand that there may be different, even competing moral systems – while at the same time maintaining a healthy sense of self-worth, self-compassion, commitment and control.

Moral resilience also involves cultivating self-regulation and self-awareness to recognize when integrity is threatened. With this foundation, we are better able to name the ethical problem, inquire into the facts and determine the action that supports integrity. What is at stake? What can be done? Can there be a compromise? Using tools of ethical reasoning and reflection to identify ways to support all involved stakeholders can help to build moral resilience. I am proud of the work carried out each day at the Devereux Center for Resilient Children (DCRC). We recognize resilience as a process and reflection as a necessary component. We have developed reflective tools for individuals and leaders to reflect on their current strengths related to resilience as well as identify areas for growth. You can learn more at www.centerforresilientchildren.org.

When I began my education to become a teacher, I did not think about the many days where my morals would be tested, my integrity questioned or my sense of self-esteem jeopardized. The only thing I was certain of is that I wanted to do well in my role. Now, many years and many experiences later, I recognize that nurses and educators will face moral distress … it is almost inevitable. In fact, as I mentioned earlier, those in the caregiving profession will undoubtedly face moral distress. When moral distress in present, moral resilience is necessary. Moral resilience will not make the problem or challenges that impact our ethics or beliefs go away. What moral resilience can do is help us to practice self-stewardship (also known as self-care) by helping us to remember that we are not alone, the pain will not last, and simple acts such as spending time with friends, being flexible and laughing can help us bounce back from any situation we face.

Citations:

  • Elpern, E. H., Covert, B., & Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care, 14(6), 523-530.
  • Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONNS Clinical Issues in Perinatal & Womens Health Nursing, 4(4), 542-551.
  • Lachman, V.D. (2016). Moral resilience: Managing moral distress and moral residue. MEDSURG Nursing, 25(2), 121-124.
  • Wilkinson, J. M. (1988). Moral distress in nursing practice: Experience and effect. Nursing Forum, 23(1), 16-29.

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