Moral discussion

March-April 2016 • Vol. 25/No. 2 121

Vicki D. Lachman, PhD, APRN, MBE, FAAN, is President, V.L.
Associates, a consulting and coaching firm, Avalon, NJ, and Sarasota,
FL. She is Chair, American Nurses Association Ethics and Human
Rights Advisory Board, and serves on a hospital ethics committee.

Moral Resilience: Managing and
Preventing Moral Distress and

Moral Residue

P racticing nurses need confidence in confronting
morally complex situations to reduce the poten-
tial for moral injury, and thus prevent moral dis-

tress and burnout (Rushton, Batcheller, & Schroeder,
2015). To gain this self-confidence, nurses need to iden-
tify appropriate levels of moral responsibility in situa-
tions of moral ambiguity or complexity. Understanding
the concept of moral resilience will be helpful in creat-
ing prevention and intervention strategies. An illustra-
tive case, table of definitions, and attributes of moral
resilience are described, with discussion of how leaders
can support resilience by building an ethical workplace.

A Case of Moral Injury and Moral Distress
This case example exemplifies the profound impact

of futile intervention on the mind of a nurse who was
able to write the narrative for a research project 30 years
later (Ferrell, 2006). This case will be used in this article
to illustrate the definitions (see Table 1) and examine
how moral resilience strategies could have helped.

I was working on a medical-surgical floor with a
pat ient with end-stage liver cancer. The oncolo-
gist decided to do a bone marrow biopsy. There
was no benefit to the patient; he just wanted to
see what was happening with her. He was not
going to change any treatment. My sense was
he just wanted to satisfy his curiosity. I was a
relatively new nurse and I questioned him some
but then let it go. (p. 927)

In this case, the nurse’s action was insufficient to pre-
vent an unnecessary, futile procedure. As a result, the
nurse experienced lingering feelings over the personal
loss of moral integrity (i.e., moral residue).

What Is Resilience?
The Merriam-Webster Dictionary (2015a) defined

resilience as “the ability to become strong, healthy, or
successful again after something bad happens; an ability
to recover from or adjust easily to misfortune or

change” (para. 1-2). By the nature of their work, all nurs-
es have had the opportunity to see human resilience in
clinical specialties – oncology, neurology, cardiology –
and trauma survivors, as well as post-combat experi-
ences of traumatic brain injury and post-traumatic stress
disorder. Nurses need resilience to thrive in these inti-
mate and complex clinical situations. What are the
characteristics of those who are resilient?

A concept analysis of resilience by Earvolino-Ramirez
(2007) resulted in helpful descriptive parameters. Her
research defined six attributes that repetiti