Knowing the right thing to do is one thing. Actually being able to do it, quite another.
In fact, many nurses experience that dilemma every day, according to University of Lethbridge researcher Dr. Shannon Spenceley. She is exploring ways to lessen this source of moral stress among nurses in the workplace.
The study, which is funded by the national Alzheimer Society Research Program, is the first in Canada to focus on moral distress in continuing care settings, such as long-term care or supportive living facilities.
A nursing professor in the Faculty of Health Sciences, Spenceley is the principal investigator on a study that is examining moral distress among nurses who care for those with Alzheimer's disease (AD) and other forms of dementia.
The Alzheimer Society of Canada reports that more than 747,000 Canadians are living with AD or other types of dementia – and that figure is expected to more than double in 25 years (by 2038).
In Alberta, there are more than 46,000 people with Alzheimer's or related dementias, and over the next 25 years, that figure is expected to reach more than 100,000. Seventeen per cent of new cases are 'early onset', where people are diagnosed before age 65, and 72 per cent of those are women.
A fatal and progressive disease that destroys brain cells, AD affects one's ability to remember things, make decisions and perform routine activities. Most people living in residential care facilities have some form of dementia, including AD.
Nursing caregivers can find themselves in difficult, and ethically complex, situations when trying to provide the best care for residents with dementia.
"It may be that a nurse who is caring for a confused and agitated resident can either use a prescription drug to reduce the agitation or simply sit with a resident until the resident calms down," says Spenceley. "The nurse knows that while the former option may cause undesirable side effects, the latter one will require extra time. In a situation where staffing is short and there are many competing demands, the nurse may feel that the choice he/she feels is right is simply not possible. Such situations create feelings of moral distress, which has been linked over time to nurse burnout, and to nurses leaving a job or even the profession."
To better understand the triggers and effects of moral distress, and to help residential-care managers address staff recruitment and retention challenges, Spenceley's team will interview and survey nursing caregivers in several facilities across southern Alberta.
"Ultimately, we want to develop strategies to mitigate moral distress," says Spenceley. "By understanding such issues, and working to create solutions, it creates the opportunity to address some of the recruitment and retention issues faced in this sector of care. Finally, anything that can be done to create a healthier and happier workforce caring for this complex population is a step in the right direction in terms of providing high-quality residential care."
The two-year project also involves U of L health sciences co-investigators Dr. Bradley Hagen and Dr. Olu Awosoga, as well as Dr. Barry Hall of the University of Calgary Faculty of Social Work (Lethbridge Campus) and Dr. Roland Ikuta, the medical director of Seniors Health, Alberta Health Services (AHS) South Zone. Colin Zeiber, executive director of Seniors Health for Alberta Health Services (AHS) South Zone, is the AHS community partner liaison for the project.