00175 Moral Suffering

Domain 10: vital principles
class 3: congruence between values/beliefs/actions
Diagnostic Code: 00175
Nanda Tag: moral suffering
Diagnostic focus: moral suffering
approved 2006 • Evidence level 2.1

NANDA Nursing Diagnosis Definition

The Nanda nursing diagnosis « moral suffering ” is defined as: response to the inability to carry out the chosen ethical or moral decisions and/or moral actions.

Definite characteristics

  • Informs of anguish for acting according to the moral choice itself

Related factors

  • Conflict between those who make the decision
  • Difficulty in making final decisions
  • Difficulty making decisions about treatment
  • Information available contradictory, to make the decision
  • Limitation of time for decision making
  • incongruous values ??with cultural norms

Risk population

  • People who experience loss of personal autonomy
  • Physically distant people from who makes decisions

Suggestions of use

  • Distinguish between moral suffering and decisions conflict. If the patient must choose between two equally good (or bad) actions and cannot be decided by one of them, decisions conflict should be used.
  • If the person believes that he knows what he should do, but for some reason he cannot carry out what he has decided, moral suffering should be used.
  • The pain that accompanies moral suffering can lead to the deterioration of religiosity and spiritual suffering. Moral suffering is defined in a more specific and precise way than the risk of deterioration of religiosity and the risk of spiritual suffering. Often moral suffering is accompanied by impotence.

Suggested alternative diagnostics

  • Decision conflict
  • Impotence
  • Religiosity, risk of deterioration of
  • Spiritual suffering, risk of

NOC Results

  • Personal autonomy: personal actions of a competent individual to control the decisions he makes in his life
  • Comfort status: psycho -spiritual: psycho -spiritual tranquility related to self -concept, emotional well -being, the source of inspiration, and the meaning and purpose of life
  • Dying with dignity: personal actions aimed at maintaining control during the near end of life
  • Anxiety level: severity of manifest apprehension, tension or discomfort, whose origin is not identifiable
  • Fear level: severity of the apprehension, tension or discomfort manifested, which result from an identifiable source
  • Spiritual health: connection with themselves, with others, with a superior power, with life, nature and the universe, which transcends the self and gives power

Evaluation objectives and criteria

  • • Moral suffering is reduced, as demonstrated
  • • Demonstrates personal autonomy, as manifested by the following indicators (specify from 1 to 5: never, sometimes, sometimes, often or usually):
    • Manifest independence in decision -making processes
    • Express your personal preferences
    • Make decisions without the pressure of (specify): parents, spouse, children, other family, friends, health care provider
  • Other examples

    • • Express satisfaction with your spiritual life
    • • Demonstrates coping capacity
    • • It manifests an acceptable level of happiness
    • • Verbally express the resolution of symptoms such as guilt, frustration and insecurity
    • • Verbally express that he understands that he has not incurred an immoral act due to his inability to carry out his moral decision

    NIC Interventions

    Note : Although Johnson, Moorhead, Bulechek, Maas, Swanson (2012), related support for decision -making with this nursing diagnosis, the author considers that it is not necessary since, According to the definition of the diagnosis, the patient has already made a decision).

    • Emotional support: provision of comfort, approval and encouragement during moments of stress
    • Support in decision making: Provision of information and support to a patient who is making a decision regarding his health
    • Spiritual support: patient assistance to feel in balance and communion with a higher power
    • Defense of patient rights: protection of a patient’s rights to health care, especially if they are a minor, disabled or incompetent, unable to make decisions
    • Facilitation of spiritual growth: facilitation of growth in the patient’s ability to identify, relate and resort to the source of meaning, purpose, comfort, strength and hope in their life
    • Improvement of self -esteem: assistance to a patient to increase the way of judging his own worth
    • Anxiety reduction: minimization of apprehension, fear, feeling or discomfort, related to an anticipated danger of unknown origin

    Nursing Activities

    • In nursing interventions for this diagnosis, it must be assumed that the patient feels comfortable with the moral decision he made and that anguish is the result of his inability to carry out that decision. Activities should focus on (a) help the patient
    • To face the immediate feelings of suffering; (b) Identify problematic feelings (for example, anxiety, helplessness) more specific to establish nursing diagnoses and interventions in order to relieve them. It is necessary to observe that impotence is usually related to moral suffering, and (c) recommend the patient to eliminate obstacles that prevent him from making the decision taken or reach an agreement that satisfies him. However, in many situations (if not in most), the nursing professional will not be able to help the patient, that is, regardless of the intervention, it may not be able (or will not be allowed) to carry out the moral decision what has taken.
    • In that case, interventions will aim to give power to the patient to make future decisions.

    Valuations

    • • Observe the presence of expressions of anguish or unhappiness
    • • Talk to the patient to identify their feelings more specific (for example, impotence, guilt, anger, frustration, anxiety, insecurity)
    • • Assess the physical manifestations and anxiety behavior
    • • Find out who is legally authorized to make decisions on behalf of the patient
    • • Assess the patient’s confidence in his own criteria

    Patient and family education

    • • Provide factual information about the situation that has occurred; clarify any misunderstanding
    • • Inform about previous guidelines
    • • Teach guided relaxation and imagery
    • • Provide a copy of the rights of patients, the patient-surface relationship, or of a similar document

    Collaboration activities

    • • Channel to the Ethics Committee of the Institution
    • • Channel to the patient with the chaplain or another spiritual advisor of his choice
    • • Communicate with the administrators and members of the health team to fulfill the wishes of the patient and family members

    Others

    • • Show empathy and acceptance; establish a relationship of trust; Make support comments
    • • Use physical contact, if appropriate
    • • Offer opportunities to carry out spiritual activities
    • • Make active listening; motivate the patient to express their concerns and feelings
    • • Determine if the clarification of values ??would be useful for the patient
    • • Encourage him to identify his own strength and reassess the negative perceptions of himself
    • • Analyze the reasons why you feel guilty
    • • Respect the privacy of conversations between the patient, the closest people and health professionals
    • • Do not impose treatment
    • • Help the patient recognize and express their feelings (of guilt, sadness, helplessness)
    • • Encourage the patient to speak or cry as a way to relieve tension
    • • Help the patient identify vital values ??
    • • Help the patient identify the support available

    At home

    • • The above interventions are suitable for home care