Critical care nurses’ perception of moral distress in intensive care during the COVID-19 pandemic – A pilot study

Factors contributing to moral distress among intensive care nurses: A scoping review

“…According to Henrich et al (2016), nurses were concerned when aggressive care continued, even when the decision to switch to comfort care was made, when the decision was made on a weekend or at night; physicians commonly wanted to wait until after the weekend or until the next morning to implement the plan, for their own convenience rather than patients' best interests. This finding was confirmed by Prompahakul et al (2021), who found that ICU nurses were disturbed when they saw patients suffering as a result of overly aggressive and unnecessary treatments that they believed were not in the best interest of the patient Futile care has been described in several studies as a factor that triggers moral distress among ICU nurses (Andersson et al, 2022;Asayesh et al, 2018;Hiler et al, 2018;Karagozoglu et al, 2017;Prompahakul et al, 2021;Shoorideh et al, 2012). Futile care can be defined on the basis of survival or subsequent quality of life, and includes aggressive treatments or end-of-life interventions in patients with very low life expectancy or chance of recovery (Asayesh et al, 2018).…”

“…Almost all of the articles in this review indicated that the powerlessness of ICU nurses in the face of organizational obstacles and constraints is one of the main causes of their moral distress while working with patients (Altaker et al, 2018;Andersson et al, 2022;Browning, 2013;Choe et al, 2015;Epstein et al, 2019;McAndrew et al, 2018;Morley et al, 2022;Prompahakul et al, 2021;Sannino et al, 2019;Shoorideh et al, 2012).…”

“…The decision-making hierarchy often encourages physicians to ignore and disregard nurses' opinions regarding patient care, contributing to the nurses' moral distress (Morley et al, 2022;Shoorideh et al, 2012). Futile actions (Andersson et al, 2022;Asayesh et al, 2018;Choe et al, 2015;Hiler et al, 2018;Karagozoglu et al, 2017;Prompahakul et al, 2021;Shoorideh et al, 2012) Providing false hope and information (Andersson et al, 2022;Browning, 2013;Choe et al, 2015;Forozeiya et al, 2019;Morley et al, 2022;Prompahakul et al, 2021) Planning end of life care (Forozeiya et al, 2019;Henrich et al, 2016) 3-Ineffective Team Function…”

“…Poor communication and collaboration (Choe et al, 2015;Henrich et al, 2016;Karagozoglu et al, 2017;Karanikola et al, 2014;McAndrew et al, 2018;Prompahakul et al, 2021;Shoorideh et al, 2012) Incompetent healthcare providers (Andersson et al, 2022;Browning, 2013;Henrich et al, 2016;Karagozoglu et al, 2017;McAndrew et al, 2018;Prompahakul et al, 2021;Sannino et al, 2019) Contradictory orders related to patient care among physicians (Henrich et al, 2016;Shoorideh et al, 2012) Inappropriate behaviour of colleagues (McAndrew et al, 2018;Morley et al, 2022;Prompahakul et al, 2021) 4-Personal Characteristics (Altaker et al, 2018;Asayesh et al, 2018;Browning, 2013;Forozeiya et al, 2019;Hiler et al, 2018;Sannino et al, 2015Sannino et al, , 2019Shoorideh & Ashktorab, 2015) From the results of this review, it was found that there was a strong hierarchical relationship between healthcare providers in the facilities where the studies were conducted. ICU nurses who are morally challenged felt powerless and helpless to stop treatment that they believed was ethically wrong, or where the care delivered did not meet required standards (McAndrew et al, 2018;Morley et al, 2022;Prompahakul et al, 2021).…”

“…According to Shoorideh et al (2012), ICU nurses suffer moral distress due to unnecessary testing, unnecessary and expensive medications for patients nearing the end of life, unnecessary counselling, and cardiopulmonary resuscitation (Shoorideh et al, 2012). In critical care, the failure to set limits on futile treatments may exacerbate the experience of moral suffering in nurses (McAndrew et al, 2018) Deceptive information and false hope for patients and relatives were cited in several studies as a distressing act that caused moral distress for ICU nurses (Andersson et al, 2022;Browning, 2013;Forozeiya et al, 2019;Morley et al, 2022;Prompahakul et al, 2021). Nurses' distress over withholding information from patients' families was compounded by a stark discrepancy between what they saw physicians say directly to families and what they then said in private (Forozeiya et al, 2019), affirming a point highlighted by Choe et al, (2015).…”