Moral distress in emergency and critical care nurses: A metaethnography

Abstract

Background: Moral distress has detrimental effects on nurses which impacts the entire healthcare cycle. Described as a crescendo effect, resolved situations of moral distress leave residue on the nurse with three potential outcomes: moral numbing, conscious objection to the situation, and burnout. Objective: This metaethnography strives to achieve a fuller understanding of moral distress by interpreting the body of qualitative work of moral distress in emergency and critical care nurses. Method: This study used the Noblit and Hare’s approach of interpretative synthesis. Ten studies met the criteria and were used in this synthesis. Ethical considerations: Ethical issues were minimal since no human subjects were involved. Ethical requirements were respected in all study phases. Results: The synthesis of qualitative research on moral distress resulted in one central theme, “the battle within,” and five subthemes. Conclusions: The unique nature of this nursing specialty resulted in a lasting inner conflict for nurses that is consistent with the previously described crescendo effect. The effects are complex and long lasting and may potentially affect the nurses’ future patient care.

Moral distress in critical care nursing practice: A concept analysis

“…Two attributes emerged in the literature: (1) emotional and psychological distress and (2) lack of power. Emotional and psychological distress was described as having the ability to torment and haunt nurses 7,19,22,23 . Arnold 22 uses the metaphor “valley of pain” to describe the symptomatic lows brought on by MD.…”

New approach to assessing and addressing moral distress in intensive care unit personnel: a case study

“…First, the proposed MCA methodology addresses a widespread problem: inadequate interprofessional communication and teamwork that tend to exacerbate moral distress. [19][20][21][22] In the current example, four different professions were represented in the discussions using a dialogical approach to making sense of a problem situation and acting on it. Second, participants were invited to distinguish moral distress from ethical dilemmas and situations of emotional distress, a distinction that is made clear from the beginning of the process.…”

Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care

“…55 Futile treatments at the end of life have been the subject of research in the last decades and are one of the root causes of ethical tensions and moral distress for healthcare providers, especially nurses. 56 – 58 Their constant proximity to patients and their responsibility to relieve suffering makes it understandable for moral distress to occur after a lengthy exposure to patient suffering, 38 coupled with an inability to effectively influence the course of treatments. Nurses are often excluded from discussions concerning medical treatments with patients and their families, 59 leaving them to enact treatment plans they do not necessarily agree with.…”