Moral distress is increasingly recognized as a problem affecting healthcare professionals. If not addressed, it may create job dissatisfaction, withdrawal from the moral dimensions of patient care, or even leaving the profession. Using the 21-Moral Distress Scale-Revised to assess moral distress, 323 surveys were received from 5 healthcare disciplines. The overall results showed that all disciplines experienced moderate to high actual moral distress, related to similar and/or different patient care situations.

Background: Moral distress can affect critical care nurses caring for complex patients. It can result in job dissatisfaction, loss of capacity for caring, and nurse turnover, resulting in a negative impact on quality care.Aim: This study purpose was to determine how moral distress impacts critical care nurses (adult and pediatric) and to implement improvement strategies to reduce moral distress, improve job satisfaction, and retention.Theoretical framework: Nathaniel's Theory of Moral Reckoning was the grounded theory used to show the application of the improvement interventions.Methods: Phase 1 was a cross-sectional design using the 26-item Hospital Ethical Climate Survey (HECS) and the 21-item Moral Distress Scale-Revised (MDS-R). Phase 2 consisted of a mixedmethod design employing focus group interviews, interventions, and pre-and posttest.Results: Pediatric nurses reported lower mean moral distress composite scores 21.71 (15.47) as compared to the adult nurses 88.75 (64.7). For adult nurses, a strong correlation existed between ethical climate and moral distress (r s = -0.62, n = 10, p = 0.05), with high levels of ethical climate associated with lower levels of moral distress. The cohort group identified personal and professional impact of moral distress with some differences between the pediatric and adult nurses related to the source of moral distress responses to suffering. The 3-month post survey showed a total moral distress score for one adult critical care nurse decreased from 158 to 74. The remaining three nurses' scores were unchanged. All four nurses were not considering leaving their position now. All participants either agreed or strongly agreed the education and action plan reduced their moral distress. Conclusion:A blended-learning training to include American Association of Critical Care Nurses' (AACN) 4As, communication and ethical reasoning skills, and personal action plans helped manage moral distress, aided retention, and improved satisfaction of critical care nurses.

It is a federal requirement for health care organizations to provide and obtain information from admitted patients about their rights to self-determination and executing an advance directive. But how compliant are acute care organizations with this law? This article explores the extent to which hospitalized patients in one Southeastern United States organization had advance directive documentation; its correlation with socioeconomic factors, and the success of educating patients and providing care that is consistent with patient's wishes.