Using the AACN Framework to Alleviate Moral Distress

2010 ◽  
Author(s):  
Carole McCue
Keyword(s):  
Critical Care ◽  
Chief Executive Officer ◽  
Moral Distress ◽  
American Association ◽  
Chief Executive ◽  
Organizational Outcomes ◽  
Critical Care Nurses ◽  
Leadership Role ◽  
Nurse Executive

In this article the author describes a situation in which the Nurse Executive’s values were in direct opposition to those of the Chief Executive Officer (CEO). She describes how it took considerable courage on the part of the Nurse Executive to resolve this situation by demonstrating concern and respect for a chemically impaired staff member, rather than by focusing on the situation from a strictly “right versus wrong” perspective. After describing the situation the author emphasizes the importance of the leadership role of the Nurse Executive and shares the perspective of the agency’s Chief Executive Officer. The author also explains how the American Association of Critical-Care Nurses’ Framework (4 A’s to Rise Above Moral Distress) was used as a resource to guide the Nurse Executive in moving the situation to a productive conclusion. Organizational outcomes of the situation are shared.

Epidemiology, pathophysiology and clinical presentation of gram-negative sepsis

1993 ◽  
Vol 2 (3) ◽  
pp. 224-235 ◽  
Author(s):  
MF Hazinski ◽  
TJ Iberti ◽  
NR MacIntyre ◽  
MM Parker ◽  
D Tribett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Healthcare Provider ◽  
American Association ◽  
Clinical Signs ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Gram Negative ◽  
Current Terminology

OBJECTIVE: To review the epidemiology and pathophysiology of gram-negative sepsis and the new consensus terminology describing the clinical signs of sepsis. DATA SOURCES: Review of the medical literature and compiled data from animal and clinical trials. PARTICIPANTS: Members of the Society of Critical Care Medicine, American College of Chest Physicians and American Association of Critical-Care Nurses with expertise on the subject of sepsis and its complications. RESULTS: Preconference and general sessions were offered at the National Teaching Institutes of the American Association of Critical-Care Nurses, with the goal of clarifying the epidemiology, risk factors and pathophysiology of gram-negative sepsis. In addition, current terminology and new (1992) consensus terminology describing the clinical signs of sepsis were presented. Special emphasis was placed on the role of the healthcare provider in the prevention and recognition of sepsis and the role of the septic mediators in the septic cascade. CONCLUSIONS: If the incidence of sepsis is to be reduced, the healthcare provider must be aware of the risk factors for sepsis and methods of reducing nosocomial infections. A thorough understanding of the role of mediators and consensus terminology used to describe sepsis, severe sepsis, septic shock and multiple organ dysfunction syndrome is necessary to recognize early or progressive signs of sepsis and to initiate state-of-the-art therapy.

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.

Compassion Fatigue and the Healthy Work Environment

2017 ◽  
Vol 28 (4) ◽  
pp. 351-358 ◽  
Author(s):  
Lesly Kelly ◽  
Michael Todd
Keyword(s):  
Critical Care ◽  
Work Environment ◽  
Compassion Fatigue ◽  
American Association ◽  
Medical Center ◽  
Academic Medical Center ◽  
Compassion Satisfaction ◽  
Critical Care Nurses ◽  
Healthy Work Environment ◽  
Healthy Work

Background:Burnout is a concern for critical care nurses in high-intensity environments. Studies have highlighted the importance of a healthy work environment in promoting optimal nurse and patient outcomes, but research examining the relationship between a healthy work environment and burnout is limited.Objective:To examine how healthy work environment components relate to compassion fatigue (eg, burnout, secondary trauma) and compassion satisfaction.Methods:Nurses (n = 105) in 3 intensive care units at an academic medical center completed a survey including the Professional Quality of Life and the American Association of Critical-Care Nurses’ Healthy Work Environment standards.Results:Regression models using each Healthy Work Environment component to predict each outcome, adjusting for background variables, showed that the 5 Healthy Work Environment components predicted burnout and that meaningful recognition and authentic leadership predicted compassion satisfaction.Conclusions:Findings on associations between healthy work environment standards and burnout suggest the potential importance of implementing the American Association of Critical-Care Nurses’ Healthy Work Environment standards as a mechanism for decreasing burnout.

Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses

2003 ◽  
Vol 12 (3) ◽  
pp. 246-257 ◽  
Author(s):  
Susan L. MacLean ◽  
Cathie E. Guzzetta ◽  
Cheri White ◽  
Dorrie Fontaine ◽  
Dezra J. Eichhorn ◽  
...  
Keyword(s):  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
American Association ◽  
Family Members ◽  
Invasive Procedure ◽  
Critical Care Nurses ◽  
Invasive Procedures ◽  
Emergency Nurses ◽  
Family Presence ◽  
Do So

• Background Increasingly, patients’ families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence. • Objective To identify the policies, preferences, and practices of critical care and emergency nurses for having patients’ families present during resuscitation and invasive procedures. • Methods A 30-item survey was mailed to a random sample of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. • Results Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures). Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedure) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures). • Conclusions Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

2006 ◽  
Vol 15 (2) ◽  
pp. 130-148 ◽  
Author(s):  
Deborah Becker ◽  
Roberta Kaplow ◽  
Patricia M. Muenzen ◽  
Carol Hartigan
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Clinical Judgment ◽  
American Association ◽  
Critical Care Nurses ◽  
Advanced Practice ◽  
Clinical Nurse ◽  
Care Nurse ◽  
Clinical Nurse Specialists

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification

2003 ◽  
Vol 12 (2) ◽  
pp. 154-164 ◽  
Author(s):  
◽  
Keyword(s):  
Critical Care ◽  
American Association ◽  
The United States ◽  
White Paper ◽  
Critical Care Nurses ◽  
Specialized Knowledge ◽  
Care Nurse ◽  
Call To Action ◽  
Knowledge And Skills ◽  
The Public

Today’s critically ill patients require heightened vigilance and extraordinarily intricate care. As skilled and responsible health professionals, the 403 000 critical care nurses in the United States must acquire the specialized knowledge and skills needed to provide this care and demonstrate their competence to the public, their employers, and their profession. Recognizing that nurses can validate specialty competence through certification, this white paper from the American Association of Critical-Care Nurses and the AACN Certification Corporation puts forth a call to action for all who can influence and will benefit from certified nurses’ contribution to patient care.

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.

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