Addressing Moral Distress in Critical Care Nurses: A Pilot Study

Abstract

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.

Moral Distress and Related Factors in Nurses Working in Intensive Care Units

“…The results of this study showed that the nurses in intensive care units participating in this study had a low average score of moral distress. In line with the present study, Fumis in Brazil [26], Allen in the United States [27] and Karagozoglu in Turkey [28] all showed some degree [29], Etebari in Ardabil [30], Sadeghi in Shahroud [31], and Ashktorab in Tehran [32] showed the moral distress in nurses. While Wenwen et al in China [33] confirmed less moral distress in nurses in intensive care units.…”

Exploring moral distress among critical care nurses at a private hospital in Kwa-Zulu Natal, South Africa

“…[7,16,17] Most studies conclude that moral distress in healthcare professionals can escalate to burnout, increased medico-legal errors and increased turnover, all of which impact negatively on the quality of healthcare provided to patients and their significant others. [5,18] In contrast, a study by Henrich et al [19] revealed that the presence of moral distress positively impacted healthcare workers by increasing their vigilance and compassion for critically ill patients. Bearing in mind the negative consequences of moral distress on healthcare professionals working in CCUs, hospital managements may institute strategies such as counselling and debriefing sessions to assist CCNs cope with moral distress.…”

Exploring the experiences of nurses’ moral distress in long-term care of older adults: a phenomenological study

“…In circumstances where patients are treated in the ICU for an extended period (e.g., due to terminal condition, advanced age, or multi-organ dysfunction), moral distress can be a common experience among healthcare professionals. Many factors have been identified to be positively correlated with high moral distress among ICU staff such as job dissatisfaction, high patient-healthcare ratio, and perceived stress from patient demands [38].…”