Q Maintaining my moral integrity is important to me, yet I have been faced with situations that challenge my ethical compass. How do I develop the internal strength to remain true to my values? How can my organization support efforts by my coworkers and me to speak up when we feel there are ethical concerns? What can I do as an individual and what can my organization do to enhance the environment to ensure ethical practice?

A Karen Stutzer, rn, phd, and Mary Bylone, rn, msm, cnml, reply:

It is well documented and acknowledged that the critical care environment contains daily challenges to individual nurses in regard to their moral integrity.1–3  Andrew Jameton initially described moral distress as when “one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of...

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