Surgical Intensive Care Unit Nurses’ Coping With Moral Distress and Moral Residue

Abstract

Background Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Objective The purpose of this study was to explore surgical intensive care unit (SICU) nurses’ experiences of moral distress, moral residue, coping, and perceived quality of patient care. Method A descriptive qualitative approach used in-depth, semistructured individual interviews of SICU nurses in a metropolitan, academic medical center until theoretical saturation occurred. Results Five themes were identified from 21 interviews. Root causes of moral distress were identified including end-of-life care, conflicts with management, staffing, inadequate resources, communication problems, power differentials between physicians and nurses, and working with incompetent providers. Interviews highlighted the torment experienced by participants, which demonstrated that unacknowledged moral distress impacted their quality of patient care and well-being. Accounts provided insight into patient care that was perceived to be wrong. Well-being was affected as 2 participants sought inpatient psychiatric treatment for moral distress, whereas others were looking for new nursing careers, and many were in school to leave the SICU. Discussion This study is unique because it corroborated Epstein and Hamric’s Crescendo Effect framework by providing in-depth analyses of moral distress, moral residue, and the crescendo effect and how these concepts developed within SICU nurses when left unaddressed. Interviews revealed that unacknowledged moral distress created moral residue, which subsequently impacted the quality of patient care and the nurses’ well-being.