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

2021 ◽  
pp. 104990912110493
Author(s):  
Gina M. Piscitello ◽  
Vivien Joy Lamadrid ◽  
Zoë Post ◽  
Ramandeep Kaur ◽  
Barbara Gulczynski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Moral Distress ◽  
Medical Intensive Care Unit ◽  
Intervention Group ◽  
Control Group ◽  
Do Not Resuscitate ◽  
Post Intervention ◽  
Medical Intensive Care

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.

Moral Distress of Staff Nurses in a Medical Intensive Care Unit

2005 ◽  
Vol 14 (6) ◽  
pp. 523-530 ◽  
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.

The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit

2009 ◽  
Vol 24 (2) ◽  
pp. 311-315 ◽  
Author(s):  
Rubin I. Cohen ◽  
Gita N. Lisker ◽  
Ann Eichorn ◽  
Alan S. Multz ◽  
Alan Silver
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Do Not Resuscitate ◽  
Medical Intensive Care ◽  
The Impact ◽  
Triage Decisions

Nurse-Led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit

2011 ◽  
Vol 31 (6) ◽  
pp. 27-35 ◽  
Author(s):  
Rabia Khalaila ◽  
Eugene Libersky ◽  
Dina Catz ◽  
Elina Pomerantsev ◽  
Abed Bayya ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Medical Intensive Care Unit ◽  
Control Group ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Blood Glucose Levels ◽  
Protocol Group ◽  
Medical Intensive Care

BackgroundRecent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.ObjectiveTo evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.MethodsA nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.ResultsNinety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P&lt;.001) were within the target glucose range (110–149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose &lt;70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P&lt;.001).ConclusionsImplementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.

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