The Effect of Triggered Palliative Medicine Consults on Nurse Moral Distress in the Medical Intensive Care Unit

Abstract

Purpose: Moral distress in the intensive care unit contributes to negative emotional experiences in nurses and adversely affects patient care. This prospective cohort study evaluates an intervention designed to improve nurse moral distress in the medical intensive care unit and assesses patient outcomes which may improve moral distress. Methods: Nurse moral distress was measured before and after an intervention of triggered palliative consults and scheduled family meetings in the intensive care unit during the COVID-19 pandemic. Patient outcomes in the intervention medical intensive care unit were compared to a control group. Results: Forty-eight nurses (n = 48/78, 62%) completed the pre-intervention survey and 33 (n = 33/78, 42%) completed the post-intervention survey. Nurse moral distress using the MMD-HP scale pre- and post-intervention (122.5 vs. 134.0, P = 0.1210) was not statistically different. Intervention group patients (n = 57/64, 89%) had earlier transition to do not resuscitate status (hazard ratio 2.1, 95% CI 1.1-4.0, P = 0.0294), higher rate of documented alternate decision makers (100% vs. 61%, P < 0.0001), and higher rate discharged to a facility (28% vs. 14%) or hospice (19% vs. 7%) (P = 0.0090). Intervention group patients with a do not resuscitate (DNR) order had lower median length of stay in the intensive care unit (4 days vs. 13 days, P = 0.0004) and hospital (10 days vs. 21 days, P = 0.0005), and lower median total hospital costs per patient ($39,067 vs. $116,476, P = 0.0029) when compared control group patients with a DNR order. Conclusion: Triggered palliative consults with scheduled family meetings were not associated with change in nurse moral distress. More research is needed to uncover methods to improve nurse moral distress in the intensive care unit.

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic

“… Compassion Fatigue : Akkuş et al ( 2021 ); Carmassi et al ( 2021 ); Foli et al ( 2021 ); Missouridou et al ( 2021 ); Moreno-Mulet et al ( 2021 ); Rossi et al ( 2021 ); Rathnayake et al ( 2021 ); Ruiz-Fernández et al ( 2020 ). Moral Injury : Donkers et al ( 2021 ); Lake et al ( 2022 ); Malliarou et al ( 2021 ); Moreno-Mulet et al ( 2021 ); Nemati et al ( 2021 ); Petrișor et al ( 2021 ); Piscitello et al ( 2021 ); Rushton et al ( 2022 ); Sheppard et al ( 2022 ); Silverman et al ( 2021 ) STS : Ariapooran et al ( 2022 ); Erkin et al ( 2021 ); Foli et al ( 2021 ); Lee et al ( 2021 ); Malliarou et al ( 2021 ); Missouridou et al ( 2021 ); Rossi et al ( 2021 ). Second Victim : Foli et al ( 2021 ); Moreno-Mulet et al ( 2021 ).…”

“… Moral Injury : Donkers et al ( 2021 ); Lake et al ( 2022 ); Malliarou et al ( 2021 ); Moreno-Mulet et al ( 2021 ); Nemati et al ( 2021 ); Petrișor et al ( 2021 ); Piscitello et al ( 2021 ); Rushton et al ( 2022 ); Sheppard et al ( 2022 ); Silverman et al ( 2021 ) …”

Navigating the Storm

“… 31 Similarly, an intervention that included triggered palliative care consults and scheduled family meetings resulted in an earlier transition to do not attempt resuscitation as code status, higher rates of documented medical decision-makers, and higher rates of facility or hospice discharges. 32 Patients with do not attempt resuscitation as code status had a lower median length of stay in both the ICU setting and the hospital overall, along with decreased median hospital costs. In summary, studies conducted during the COVID pandemic indicate palliative care teams had a positive impact for critically ill patients, and palliative care teams can continue to provide these benefits when used in a timely manner.…”

“…Patients who received early palliative care consultations had increased documentation of medical decision-makers, more clearly defined goals of care, changes in code status, and transitions to comfort care compared with patients who did not have early involvement of palliative care clinicians 31 . Similarly, an intervention that included triggered palliative care consults and scheduled family meetings resulted in an earlier transition to do not attempt resuscitation as code status, higher rates of documented medical decision-makers, and higher rates of facility or hospice discharges 32 . Patients with do not attempt resuscitation as code status had a lower median length of stay in both the ICU setting and the hospital overall, along with decreased median hospital costs.…”

Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU)

“…6 Delivering what is considered medically nonbeneficial care or providing care that is not in line with a patient's wishes occurs frequently in the intensive care environment, which are frequent causes of moral distress. 7,8 In a survey of ICU health care professionals, a majority felt increased palliative care in the ICU would improve end-oflife discussions, and a trigger consultation program was a feasible way to integrate palliative care into the ICU environment. 9 A recent study on the effects of a palliative care trigger consult program on nurse moral distress over a 6-week period found no significant improvement, but further research is necessary due to the timing of the study (during the COVID-19 pandemic).…”