By Kay Gorka
I need moral distress. I have studied moral distress, off and on, for my 17 years as a chaplain, and I also encounter it myself. But those revelations and discoveries can lead me to moral resilience, and ultimately moral courage.
According to Johns Hopkins University’s Cynda Rushton, “moral distress is a predictable response to situations where nurses recognize that there is a moral problem, have a responsibility to do something about it, but cannot act in a way that preserves their integrity.”
Moral distress shows up for a variety of reasons personal, interpersonal, and/or environmental. Chaplains notice it most in end-of-life challenges, conflicts with the interdisciplinary team, workplace violence, ethical dilemmas, and – most recently – visitor restrictions.
I experience moral distress as a collision between belief, unbelief, and disbelief. It invites me to a conversation between what I do [both visible and invisible] and how I want to be. I do not like it, I try to avoid it, but it always has a way of letting me know I need to listen.
Moral distress surprised me during the pandemic. I had been making great progress on my self-care and spiritual growth, and I had been finding new ways to self-regulate emotions during trauma and stress. And in that good place, for the first time I had to tell someone that he couldn’t see his deceased mom.
This encounter still sticks with me now, in our third year of pandemic. I remember the man’s striped shirt. I remember the tone of his voice when he stood before me alone, after traveling a great distance to be with his mom, the cry from the depths when I told him that visitors were not allowed to see patients who have died. I remember my own inner voice reminding me that I am called to the work of connection.
The invisible aspect of what I did in this moment was fostering a healing environment in the hospital. Having patient visitation limits was for the health of the common good, our patients, our community, and our staff. Ultimately, all of us in healthcare are healers, and this is the work we do.
This was my moral distress case, because of the perception of the visitor limitations and my identity came into conflict. Moral distress takes us on a journey to who we really are, and invites curiosity into our culture, our organizations, and our integrity. As Socrates said, “an unexamined life is not worth living.” It is important to pay attention to the moral distress. It helps to recognize and clarify values and ethics, and it invites us into a more authentic ministry.
There is much literature on moral resilience, and even though we can know this is the best path forward, it still ebbs and flows in my own journey. I do not have this mastered, but I do know when I recognize moral distress, that I make space for a deeper conversation. Rushton says, “Moral resilience is defined as the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks.” I have discovered I am the most morally resilient when I chaplain my moral distress: reach out to others, actively listen to the moral distress, seek meaning and accompany the suffering, and if needed ask for consultation and act.
In our community, COVID cases remain high, visitor restrictions remain in place, and we continue to hold the tension between connection and health. A tension we could not have imagined three years ago, but one we dive into each day. The moral distress has been a great teacher, a creator of new ways of connecting.
I now have a trusted group of people I connect with when this comes up – a few peers who understand what I am encountering, ethicists, and my leader. I can check facts and perceptions with them and find a path forward. What I have learned is that moral distress is like trees. Little trees grow into big trees, and it is a lot easier to take care of the little trees. I work to be more proactive at asking questions about my reality and my perceptions, and moral distress has invited a more in-depth conversation.
I need moral distress – to invite me into the conversations that are challenging, to open the door to revelation and discovery. In those moments, I remember Edith Eva Eger’s book The Choice: “Healing is not recovery. Healing is discovery. Discovering hope in hopelessness, discovering an answer where there doesn’t seem to be one, discovering it is not what happens that matters, it is what you do with it.” The conversations that moral distress invites often create an entry point for deeper revelations, and belonging in community.
Kay Gorka, BCC, is director of spiritual care services at Providence SHMC in Spokane, WA.