Moral distress experienced by intensive care nurses

Abstract

Background. Moral distress is experienced when nurses experience conflict while making an ethical decision. This is magnified when the decisions are about withholding or withdrawing life-sustaining treatment. Objective. To explore and describe nurses' experiences of situations that involve end-of-life care and evoke moral distress in the intensive care units (ICUs) of two public tertiary-level hospitals in South Africa (SA), the personal consequences of these situations and the means employed to manage their distress. Methods. An exploratory, descriptive design was used. A short survey/interview guide was administered to registered and enrolled nurses (N=100) employed in the ICUs from two academic-affiliated, specialist public hospitals. Results. A total of 65 completed surveys were collected. Of these, 32 responses were judged not to be describing moral distress while 33 clearly described moral distress and were included and analysed by means of initial content analysis. The findings were presented in five major categories: (i) collegial incompetence or inexperience; (ii) resource constraints; (iii) end-of-life issues; (iv) lack of consultation, communication and negotiation; and (v) support. Conclusion. The study found that nurses experienced considerable moral distress. This is compounded in an environment where gender, professional and social status inhibit the nurses' assertiveness, 'voice' and influence in the healthcare system. Parallels can be drawn between the microcosm of the ICU and the macrocosm of the SA social and ethical character.

Moral distress experienced by non-Western nurses: An integrative review

“…37 A second unique cause was found among South African nurses who illustrated their moral distress due to requests by doctors to increase morphine doses to levels that could end a patient’s life or to be involved in treatment decisions to hasten the deaths of terminally ill patients. 40…”

A survey of moral distress and end of life care in mechanical circulatory support nurses

“… 13 As might be expected, many situations around end-of-life (EOL) care contribute to moral distress as well. 14 , 15 In one study focusing on end-of-life care issues experienced by intensive care unit (ICU) nurses and physicians, nurses reported higher moral distress than physicians and were more likely to encounter familial pressure to continue unwanted medical treatments. 16 Notably, while education is often proposed as one solution for reducing moral distress, findings are mixed as to whether targeted education and/or training in palliative or end-of-life care is associated with lower moral distress.…”

“…Past research suggests that those engaged in EOL care will experience higher levels of moral distress. 14 , 15 The relationship between taking action to turn off pumps in the home setting, by phone, or in the hospital and levels of moral distress. Given that the process of turning off the LVAD is the ultimate last step in EOL patient care, it is expected that VAD coordinators who engage in this action will have higher levels of moral distress.…”

“…Past research suggests that those engaged in EOL care will experience higher levels of moral distress. 14 , 15 …”

Moral Distress in Nursing and Its Causes

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