Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Abstract

Context: Providing nonbeneficial care at the end of life and delays in initiating comfort care have been associated with provider and nurse moral distress. Objective: Evaluate provider and nurse moral distress when using a comfort care order set and attitudes about timing of initiating comfort care for hospitalized patients. Methods: Cross-sectional survey of providers (physicians, nurse practitioners, and physician assistants) and nurses at 2 large academic hospitals in 2015. Providers and nurses were surveyed about their experiences providing comfort care in an inpatient setting. Results: Two hundred five nurse and 124 provider surveys were analyzed. A greater proportion of nurses compared to providers reported experiencing moral distress “some, most, or all of the time” when using the comfort care order set (40.5% and 19.4%, respectively, P = .002). Over 60% of nurses and providers reported comfort care was generally started too late in a patient’s course, with physician trainees (81.4%), as well as providers (80.9%) and nurses (84.0%) < 5 years from graduating professional school most likely to report that comfort care is generally started too late. Conclusions: The majority of providers and nurses reported that comfort care was started too late in a patient’s course. Nurses experienced higher levels of moral distress than providers when caring for patients using a comfort care order set. Further research is needed to determine what is driving this moral distress in order to tailor interventions for nurses and providers.

Effects and Satisfaction of Comfort Nursing plus Psychological Nursing in the Clinical Nursing of Neurology Patients: A Comparative Study

“…With the development of medical technology and the improvement of living standards, people's demand for neurological care is increasing [ 1 , 2 ]. Conventional nursing fails to meet the nursing needs of patients and may further result in nurse-patient disputes [ 2 , 3 ].…”

“…With the development of medical technology and the improvement of living standards, people's demand for neurological care is increasing [ 1 , 2 ]. Conventional nursing fails to meet the nursing needs of patients and may further result in nurse-patient disputes [ 2 , 3 ]. In addition, patients in the Department of Neurology are vulnerable to negative emotions, and the absence of effective psychological care is associated with compromised quality of life and self-care abilities.…”

Moral Distress and Perceived Community Views Are Associated With Mental Health Symptoms in Frontline Health Workers During the COVID-19 Pandemic

“…Nurses and allied health workers relative to medical staff, and ICU staff and other frontline areas relative to ED workers were frequently identified as having reduced odds of reporting moral distress. These results are somewhat surprising given professional autonomy is a frequent predictor of moral distress [32,33] and is generally greater for medical staff than nurses [34,35]. It is possible that greater decisional authority was available for nursing and allied health staff in the context of COVID-19 in Australia, though this is outside the scope of the current survey and warrants further investigation.…”

“…Of the indicators listed, 'wearing PPE limiting the ability to care for patients' and 'being required to quarantine lets down co-workers' were the most frequently associated with adverse mental health outcomes. Limitations on ability to provide adequate care is likely reflective of harms associated with lack of professional autonomy, wherein HCWs are at greater risk of psychosocial distress when denied the ability to advocate for their patients [34] and operate in accordance with their expertise [44]. Fears of 'letting down' co-workers potentially relate to both the stigma associated with contracting COVID-19, and a desire to shelter co-workers from the known risks associated with excessive workloads [45].…”

Strategies for Coping With Moral Distress Adopted by Nurses in Tertiary Care: A Scoping Review

“…The articles included in the "recommendations" category, on the other hand, are those whose focus was the MD experience, and the coping strategies were only recommendations/suggestions, that is, there were no detailed interventions throughout the article. Among the coded recommendations/ suggestions, it was noticed that 14 articles addressed the importance of spaces for discussion and exchange of experiences among the team [16][17][20][21][22][23][25][26][27][28][29]31,34 ; nine addressed the team's collaboration in this coping 16,17,19,[22][23][24][25]33,34 , the need for education and development of ethical skills 17,[20][21][22][23][24][27][28][29] and institutional and leadership support 16,[26][27][28][29][30][31][32]34 ; eight mentioned the implementation of moral strengthening programs and support for the ethical climate 17,[23][24][26][27...…”