Moral Resilience: Transforming Moral Suffering in Healthcare

Abstract

This book is an important and welcome voice in the ongoing conversation about moral suffering and burnout in the health care community. Cynda Hylton Rushton, in collaboration with known experts, synthesizes current knowledge and an extensive literature review on these topics. The goal was to provide a shared understanding and language, resulting in a set of innovative strategies and tools that both individual clinicians and health care organizations can use to build moral resilience and a healthier workforce.In the first chapters, Rushton describes the reduced moral responsiveness, disillusionment, and shame that result from unresolved moral distress. She describes short- and long-term consequences (physical, spiritual, emotional, and behavioral), and defines the moral “residue” that builds over time, resulting in uncertainty, guilt, frustration, and anxiety. Rushton explains the moral uncertainty resulting from power imbalances and abusive relationships all too common in the health care setting. This moral uncertainty can lead to unrealistic expectations of ourselves and others, further contributing to the development of moral distress.The focus of the book then shifts to developing moral resilience. Rushton believes that maintaining integrity is a critical element for moral resilience. Clinicians must have a congruence of values, beliefs, and actions to stay morally whole— the foundation of ethical care. This foundation includes an alignment of clinicians’ personal and professional moral compasses. According to Rushton, moral distress results when personal integrity is threatened, and our conscience provides the gauge of how our intentions, character, and behaviors align with our moral values and commitments, thereby helping to maintain our integrity.Rushton describes specific strategies for cultivating moral resilience, such as the importance of improving self-awareness and self-regulation, including the skills of reaction and insight, ethical competence, self-stewardship, and transformational learning, as well as an understanding of our personal fundamental values and the motives and intent behind our work. Most importantly, she stresses the importance of standing up for what matters to preserve and maintain integrity and, consequently, to avoid moral suffering. She also emphasizes the importance of developing mindfulness to be self-aware and self-controlled— the practice of self-stewardship is described by Rushton as “the obligation to honor and safeguard our health and well-being in order to serve others.”Moral Resilience concludes with recommended strategies for building moral resilience at the organizational level. The individuals, leadership, and systems have a mutual obligation to work together to build moral resilience and a healthier workforce. Organizations should not develop these strategies alone, but must work with individuals and leaders within the system to design solutions to prevent moral distress and to develop moral resilience.