Moral distress of critical care nurses

Abstract

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

Moral distress: levels, coping and preferred interventions in critical care and transitional care nurses

“…The Cronbach's a for the shortened MDS was reported at 0Á83, measured by using a product score for each item (Hamric, & Blackwell, 2007). Some version of the MDS has been used in at least five previous studies (Corley 1995, Corley et al 2005, Elpern et al 2005, Hamric & Blackwell 2007, Zuzelo 2007, Pauly et al 2009).…”

“…Moral distress has been studied extensively in the intensive care environment. These environments contain a frequency of highly complex patients and challenging situations that involve the use of advanced technology (Corley 1995, Elpern et al 2005, Cronqvist & Nystrom 2007, Hamric & Blackwell 2007, Mobley et al 2007, McClendon & Buckner 2007. The critical care environment often involves situations that call for a nurse to overcome institutional obstacles and interpersonal conflicts about values.…”

Moral problems and distress among nurse practitioners in primary care

“…Studies among acute care nurses have found that when moral problems are left unresolved or resolved in ways that compromise the moral integrity of the nurse, distress results (Kelly, 1998;Rushton, 1995). This distress is characterized by anger, guilt (Wilkinson, 1987(Wilkinson, /1988, powerlessness, and frustration (Fry, Harvey, Hurley, & Foley, 2002;Krishnasamy, 1999;Wilkinson, 1987Wilkinson, /1988Wilkinson, , 1989 and has been associated with nurses losing their capacity for caring, avoiding patient contact, and failing to give good physical care (Corley, 1995;Davies et al, 1996;Kelly;Redman, & Fry, 2000). Furthermore, some suggest that the greater the distress, the more likely are nurses to become burned out and leave the profession (Corley;Fowler, 1989;Fry et al 2002;Kelly).…”

Nurses' lived experiences of moral stress support in the intensive care context

“…The process of reflecting, briefly or over time, on this choice and the outcome, leads presumable to feelings of stress. In contrast to the concept of moral distress (see for example, Jametown 1984, Corley et al 1995, Kä lvemark et al 2004, moral stress emphasizes the moral component of a stressor rather than the psychological (emotional) component.…”