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.

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.

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

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.

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.

Addressing Moral Distress in Critical Care Nurses: A Systemized Literature Review of Intervention Studies

2019 ◽  
Vol 13 (2) ◽  
pp. 71-89 ◽  
Author(s):  
Sonya L. Dacar ◽  
Christine L. Covell ◽  
Elizabeth Papathanassoglou
Keyword(s):  
Critical Care ◽  
Literature Review ◽  
Intervention Studies ◽  
Randomized Clinical Trials ◽  
Moral Distress ◽  
Risk Of Bias ◽  
Critical Care Nurses ◽  
Biomedical Sciences ◽  
Healthcare Organizations ◽  
Eligibility Criteria

BackgroundThe literature on moral distress highlights the need for hospitals and healthcare organizations to improve the work environment in critical care. However, only few studies delve into the types of intervention programs and administrative processes that can be put into effect to help nurses effectively deal with moral distress.AimThe aim of this study was to systematically synthesize evidence from published studies of interventions that address moral distress in critical care nurses. The attributes, measures, and outcomes of published interventions were described.MethodsSystemized literature review based on searches in four biomedical sciences databases (CINAHL, MEDLINE, COCHRANE, and SCOPUS). The Cochrane Collaboration's tool was employed for risk of bias. Eligibility criteria included published full-text articles exploring any type of intervention for critical care nurses' moral distress.ResultsBased on the selection criteria, seven studies were included in the review (two quasi-experimental, two randomized clinical trials, three mixed method). The majority of studies exhibited high risk of bias. Only two studies had moderate risk of bias. The most common type of interventions were workshops.ConclusionWe identified a small number of overall low-quality intervention studies, which provided weak evidence on the effectiveness of workshops for moral distress. Based on the indications for potentially large effect size of workshops, more well-designed studies are needed in order to elucidate the characteristics, content, and duration of effective workshops for moral distress. The results of this review can inform future efforts to develop and test intervention strategies for moral distress among intensive care unit (ICU) nurses.

Giving nurses a voice during ethical conflict in the Intensive Care Unit

2020 ◽  
Vol 27 (8) ◽  
pp. 1631-1644
Author(s):  
Natalie S McAndrew ◽  
Joshua B Hardin
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Ethics Education ◽  
Moral Distress ◽  
Academic Medical Center ◽  
The United States ◽  
Critical Care Nurses ◽  
Organizational Resources ◽  
Ethical Conflict

Background: Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses’ perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. Research question/objectives/methods: The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. Participants and research context: Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. Ethical considerations: This study was approved by the Institutional Review Board at the organization where the study took place. Findings: Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. Discussion: Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. Conclusion: These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care.

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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