A critical incident study of ICU nurses during the COVID-19 pandemic

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being.

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Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses

American Journal of Critical Care ◽

10.4037/ajcc2018252 ◽

2018 ◽

Vol 27 (4) ◽

pp. 295-302 ◽

Cited By ~ 15

Author(s):

Krista Wolcott Altaker ◽

Jill Howie-Esquivel ◽

Janine K. Cataldo

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Ethical Climate ◽

Moral Distress ◽

Care Delivery ◽

National Database ◽

Palliative Care Teams ◽

Intensive Care Unit Nurses ◽

Distress Scale

Background Intensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance. Objectives To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. Methods Intensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale–Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed. Results Of 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor’s degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r = −0.145; P = .02) and ethical climate scores (r = −0.354; P < .001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores. Conclusions Poor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress. The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.

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Moral Distress of Staff Nurses in a Medical Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2005.14.6.523 ◽

2005 ◽

Vol 14 (6) ◽

pp. 523-530 ◽

Cited By ~ 257

Author(s):

Ellen H. Elpern ◽

Barbara Covert ◽

Ruth Kleinpell

Keyword(s):

Job Satisfaction ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Moral Distress ◽

Medical Intensive Care Unit ◽

Well Being ◽

Individual Characteristics ◽

Medical Intensive Care ◽

Distress Scale

• Background Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.• Objectives To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.• Methods A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.• Results Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.• Conclusions Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

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Relationship between perceived organizational justice and moral distress in intensive care unit nurses

Nursing Ethics ◽

10.1177/0969733017712082 ◽

2017 ◽

Vol 26 (2) ◽

pp. 460-470 ◽

Cited By ~ 7

Author(s):

Ghazaleh Haghighinezhad ◽

Foroozan Atashzadeh-Shoorideh ◽

Tahereh Ashktorab ◽

Jamileh Mohtashami ◽

Maasoumeh Barkhordari-Sharifabad

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Organizational Justice ◽

Moral Distress ◽

Interactional Justice ◽

Significant Negative Correlation ◽

Moral Decision Making ◽

Informed Consent Form ◽

Intensive Care Unit Nurses ◽

The Relationship

Background: The nature of the nursing profession pays more attention to ethics of healthcare than its therapeutic dimension. One of the prevalent moral issues in this profession is moral distress. Moral distress appears more in intensive care units due to the widespread need for moral decision-making regarding treatment and care in emergency situations. In this connection, organizational justice is of high importance and, as a significant motivational tool, leaves important impacts upon attitude and behavior of personnel. Aim/objective: This study aimed at investigation of the relationship between perceived organizational justice and moral distress in intensive care unit nurses. Research design: This is a descriptive-correlational research which examined the relationship between perceived organizational justice and moral distress in intensive care unit nurses. Participants and research context: A total of 284 intensive care unit nurses were selected via census sampling. The data were collected through questionnaires and then were analyzed via SPSS-20 using Pearson and Spearman correlation tests. Ethical considerations: This study was approved by the Committee of Ethics in Medical Research. Completion of informed consent form, guarantee of the confidentiality of information, explanation on purposes of the research, and voluntary participation in the study were moral considerations observed in this study. Findings: There was a statistically significant negative correlation between the total perceived organizational justice and the total moral distress (p = 0.024, r = −0.137) and also between “procedural and interactional justice and errors” and “not respecting the ethics principles.” Meanwhile, no relationship was found by the findings between distributive justice and dimensions of moral distress. Conclusion: According to the results of the study, there was a reverse significant relationship between moral distress and perceived organizational justice; therefore, the head nurses are expected to contribute to reduce moral distress and to increase perceived organizational justice in nurses.

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Relationship between ICU nurses’ moral distress with burnout and anticipated turnover

Nursing Ethics ◽

10.1177/0969733014534874 ◽

2014 ◽

Vol 22 (1) ◽

pp. 64-76 ◽

Cited By ~ 53

Author(s):

Foroozan Atashzadeh Shoorideh ◽

Tahereh Ashktorab ◽

Farideh Yaghmaei ◽

Hamid Alavi Majd

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Turnover Intention ◽

Work Experience ◽

Moral Distress ◽

Statistical Correlation ◽

Medical Sciences ◽

Anticipated Turnover ◽

Intensive Care Unit Nurses ◽

Distress Scale

Background: Moral distress is one of intensive care unit nurses’ major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses’ personal and professional practice, recognizing moral distress is very important. Research objective: The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses. Research design: This study is a descriptive-correlation research. Participants and research context: A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included “demographic questionnaire,” “ICU Nurses’ Moral Distress Scale,” “Copenhagen Burnout Inventory” and “Hinshaw and Atwood Turnover Scale.” Data analysis was done by using SPSS19. Ethical considerations: Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran. Findings: The findings showed intensive care unit nurses’ moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses’ age, their work experience and the fraction of nurses’ number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress. Discussion: Some of the findings of this research are consistent with other studies and some of them are inconsistent. Conclusion: Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses’ moral distress, burnout and their turnover intention are essential.

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Critical Care Nurses’ Experiences During the COVID-19 Pandemic: A US National Survey

American Journal of Critical Care ◽

10.4037/ajcc2022312 ◽

2021 ◽

pp. e1-e7

Author(s):

Jill L. Guttormson ◽

Kelly Calkins ◽

Natalie McAndrew ◽

Jacklynn Fitzgerald ◽

Holly Losurdo ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Moral Distress ◽

Community Support ◽

Well Being ◽

The United States ◽

Critical Care Nurses ◽

Emotional Symptoms

Background Given critical care nurses’ high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses’ mental health and continuation in the ICU workforce. Objective To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States. Methods Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic. Results Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses’ feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent. Conclusions Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses’ experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

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Exploring the meaning of critical incident stress experienced by intensive care unit nurses

Nursing Inquiry ◽

10.1111/nin.12365 ◽

2020 ◽

Vol 27 (4) ◽

Author(s):

Giuliana Harvey ◽

Dianne M. Tapp

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Incident ◽

Critical Incident Stress ◽

Intensive Care Unit Nurses

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Iranian intensive care unit nurses’ moral distress

Nursing Ethics ◽

10.1177/0969733012437988 ◽

2012 ◽

Vol 19 (4) ◽

pp. 464-478 ◽

Cited By ~ 57

Author(s):

Foroozan Atashzadeh Shorideh ◽

Tahereh Ashktorab ◽

Farideh Yaghmaei

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nursing Education ◽

Cultural Values ◽

Nurse Educators ◽

Moral Distress ◽

Nursing Leaders ◽

Clinical Nurses ◽

Communication Problems ◽

Intensive Care Unit Nurses

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses’ moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care.

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