Consequences of clinical situations that cause critical care nurses to experience moral distress

2012 ◽  
Vol 19 (4) ◽  
pp. 479-487 ◽  
Author(s):  
Debra L Wiegand ◽  
Marjorie Funk
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
Thematic Analysis ◽  
Moral Distress ◽  
Medical Center ◽  
Critical Care Nurses ◽  
Negative Consequences ◽  
Convenience Sample ◽  
Methodological Rigor ◽  
Descriptive Approach

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families.

Moral distress of critical care nurses

1995 ◽  
Vol 4 (4) ◽  
pp. 280-285 ◽  
Author(s):  
MC Corley
Keyword(s):  
Factor Analysis ◽  
Critical Care ◽  
Intensive Care ◽  
Private Hospital ◽  
Moral Distress ◽  
Medical Center ◽  
Critical Care Nurses ◽  
Moral Integrity ◽  
Healthcare Organizations ◽  
Aggressive Care

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.

Resilience as an Incomplete Strategy for Coping With Moral Distress in Critical Care Nurses

2020 ◽  
Vol 40 (6) ◽  
pp. 62-66
Author(s):  
Lucia D. Wocial
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Clinical Relevance ◽  
Moral Distress ◽  
Critical Care Nurses ◽  
Negative Consequences ◽  
Important Quality

Topic Moral distress is receiving increasing attention in health care. The theoretical value of resilience as a strategy for coping with moral distress is prominent in the literature. Clinical Relevance The potential negative consequences of moral distress for nurses are indisputable, driving a push to identify interventions to help nurses deal with the experience. The evidence that resilience is an important quality and skill for maintaining wellness is equally clear. Purpose To review moral distress and resilience and examine the evidence for the new focus on resilience. Content Covered The complexity of both moral distress and resilience suggests that resilience by itself is an incomplete strategy for coping with and addressing moral distress.

Moral distress and intention to leave intensive care units: A correlational study

2020 ◽  
pp. 147775092097709
Author(s):  
Abbas Naboureh ◽  
Masoomeh Imanipour ◽  
Tahmine Salehi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Pearson Correlation ◽  
Intention To Leave ◽  
Critical Care Nurses ◽  
Self Report ◽  
Correlational Study ◽  
Negative Consequences ◽  
High Exposure

Moral distress is a fundamental problem in the nursing profession that affects nurses. Critical care nurses are more susceptible to this problem due to the nature of their work. Moral distress may, in turn, lead to several undesirable consequences. This study aimed to determine the relationship between moral distress and intention to leave the ward among critical care nurses. This descriptive-correlational study was conducted by census method on all eligible nurses who worked in Coronary Care Unit (CCU) and Intensive Care Unit (ICU) of AhVaz hospitals, Iran. Data was collected by Corley’s moral distress questionnaire and a researcher-made questionnaire to investigate the intention to leave the ward. Questionnaires were completed through self-report and data were analyzed using a t-test and Pearson correlation coefficient. The results showed that there was a direct association between moral distress and intension to leave the ward in critical care nurses (P < 0.05). Also, the intensity of moral distress (P = 0.03) and the intention to leave the ward (P = 0.007) were significantly higher in ICU nurses. Given the high exposure of critical care nurses with moral distress and its association with leaving the ward, it seems that devising strategies to reduce or control moral distress and its negative consequences are necessary, particularly in ICU nurses.

CNE Article: Moral Distress and Psychological Empowerment in Critical Care Nurses Caring for Adults at end of Life

2013 ◽  
Vol 22 (2) ◽  
pp. 143-151 ◽  
Author(s):  
Annette M. Browning
Keyword(s):  
Critical Care ◽  
Regression Analysis ◽  
End Of Life ◽  
End Of Life Care ◽  
Moral Distress ◽  
Psychological Empowerment ◽  
Significant Negative Correlation ◽  
Critical Care Nurses ◽  
Life Care ◽  
Distress Scale

BackgroundCritical care nurses providing care for adults at the end of life may encounter moral distress when they cannot do what they believe is ethically correct. Psychological empowerment can decrease moral distress among critical care nurses.ObjectivesTo describe the relationships between moral distress, psychological empowerment, and demographics in critical care nurses caring for patients at the end of life.MethodA total of 277 critical care nurses were surveyed via the Moral Distress Scale and the Psychological Empowerment Instrument. Responses were scored on a Likert scale of 1 to 7.ResultsMoral distress intensity was high (mean 5.34, SD 1.32) and positively correlated with age (r = 0.179, P = .01). Moral distress frequency was moderate (mean 2.51, SD 0.87) and negatively correlated with nurses’ collaboration in end-of-life patient care conferences (r = −0.191, P = .007). Psychological empowerment scores (mean 5.31, SD 1.00) were high and positively correlated with age (r = 0.139, P = .03), years of experience (r = 0.165, P = .01), collaboration in end-of-life-care conferences (r = 0.163, P = .01), and end-of-life-care education (r = 0.221, P = .001) and were negatively correlated with moral distress frequency (r = −0.194, P = .01). Multiple regression analysis revealed that empowerment was a significant predictor of moral distress frequency (â = .222, P &lt; .01).ConclusionThe significant negative correlation between psychological empowerment and frequency of moral distress in these nurses indicated that nurses with higher perceived empowerment experience moral distress less often. This finding is of particular interest as interventions to decrease moral distress are sought. (American Journal of Critical Care. 2013;22:143–152)

scholarly journals Exploring the Presence of Moral Distress in Critical Care Nurses

2016 ◽  
Author(s):  
Justina Gonzalez
Keyword(s):  
Critical Care ◽  
Ethical Climate ◽  
Moral Distress ◽  
Small Sample ◽  
Critical Care Nurses ◽  
Small Community ◽  
Convenience Sample ◽  
Difficult Situation ◽  
Frequent Event ◽  
Distress Scale

<p>With healthcare moving toward greater outpatient and preventative approaches, hospitalizations are increasingly intended for those who are critically ill. Frequently this requires the need for highly specialized nursing as well as resource utilization. Technological advances have aided in providing this type of intensive care but they have also compelled practitioners to make treatment decisions that did not previously exist. The conflict of maintaining one’s life without ascertaining whether there will be quality of life is just one example of a difficult situation that can lead to moral distress. The purpose of this study was to explore the effects of moral distress on critical care nurses. The project employed a survey design. After obtaining IRB approval, a convenience sample of 28 nurses was obtained from a small community hospital’s ICU and CCU. Each participant completed the Moral Distress Scale-Revised (MDS-R) measure and some demographic questions. Results confirmed that moral distress was present among the participants at low to moderate levels: 18 nurses (64%) scored low with seven nurses (25%) scoring in the moderate range. The most morally distressing experiences were related to end of life care. The most morally distressing and frequent event was that of “follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient”. There was no correlation between nurses’ age, level of experience and moral distress. Limitations included a small sample size and lack of diversity in age and experience. It is possible that the researcher’s affiliation with the unit could have affected participants’ responses regarding leaving their current position. The findings suggest that more research should be done on exploring the ethical climate and other factors that effect moral distress.</p>

scholarly journals Critical care nurses’ moral distress in end-of-life decision making

2014 ◽  
Vol 4 (6) ◽  
Author(s):  
Saira Weinzimmer ◽  
Susan M. Miller ◽  
Janice L. Zimmerman ◽  
Jay Hooker ◽  
Stacey Isidro ◽  
...  
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
End Of Life ◽  
Moral Distress ◽  
Critical Care Nurses ◽  
End Of Life Decision ◽  
Life Decision

scholarly journals Using evidence-based debriefing to combat moral distress in critical care nurses: A pilot project

2019 ◽  
Vol 9 (12) ◽  
pp. 1 ◽  
Author(s):  
Nicole M. Fontenot ◽  
Krista A. White
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pilot Project ◽  
Critical Care Nurses ◽  
Evidence Based ◽  
Self Awareness ◽  
Post Intervention ◽  
The Impact

Objective: Moral distress (MD) is a problem for nurses that may cause despair or disempowerment. MD can have consequences like dissatisfaction or resignation from the nursing profession. Techniques such as evidence-based debriefing may help nurses with MD. Creating opportunities for critical care nurses to debrief about their MD might equip them with the tools needed to overcome it. Measuring MD by using the Moral Distress Thermometer (MDT) could provide insight into how debriefings help nurses. The purpose of this pilot project was to examine the impact of evidence-based debriefing sessions on critical care nurses’ sense of MD.Methods: This pilot project used a quasi-experimental, one-group, before-during-after design. Critical care nurses (N = 21) were recruited from one unit at a large academic medical center. Four debriefing sessions were held every 2 weeks. Participants completed the MDT 2 weeks before the first session, at the end of each session they attended, and 1 month after the debriefing sessions.Results: In the pilot project, participants felt that debriefing was helpful by increasing their self-awareness, giving them time to commune with colleagues, and encouraging them to improve self-care habits; however, MDT scores did not change significantly when comparing pre with post intervention scores (t(12) = 0.78, p = .450).Conclusions: The use of debriefing may help nurses gain self-awareness of MD and it may offer nurses strategies to build moral resilience.

Gender and the experience of moral distress in critical care nurses

2014 ◽  
Vol 22 (1) ◽  
pp. 32-42 ◽  
Author(s):  
Christopher B O’Connell
Keyword(s):  
Gender Differences ◽  
Critical Care ◽  
Gender Difference ◽  
Intent To Leave ◽  
Moral Distress ◽  
Psychological Symptoms ◽  
Research Question ◽  
Critical Care Nurses ◽  
Underrepresented Groups ◽  
Distress Scale

Background: Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether. Research question: Do significant gender differences exist in the moral distress scores of critical care nurses? Research design: This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores. Participants and research context: Participants ( n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale–Revised online over a 5-day period in July 2013. Ethical considerations: Institutional review board review approved the study, and accessing and completing the survey implied informed consent. Findings: The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low. Discussion: The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress. Conclusion: Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups.

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