Freirean Conscientization With Critical Care Nurses to Reduce Moral Distress and Increase Perceived Empowerment

Abstract

Moral distress in nursing has been linked to a relative lack of power in the workplace. We designed and piloted a Freirean-based conscientization intervention to raise awareness and address disempowerment with 13 critical care nurses in the US Midwest who recently experienced moral distress. A transformative, mixed-methods, pre/post design was used with convergence of qualitative and quantitative data. Results showed improved moral distress and mixed results in perceived personal and group empowerment. Further study is warranted to test conscientization-based interventions that give nurses opportunity collectively to develop empowered responses to situations that lead to moral distress.

Moral distress interventions: An integrative literature review

“…Two (9%) were qualitative, 94,98 and seven (32%) were mixed methods, with a quasi-experimental pre- and post-test design and thematic analysis. 83,86,87,91,93,96,99 The remainder (41%) were quasi-experimental with pre- and post-test design elements. 85,88–90,92,95,100,103,104 Three studies were conducted in Iran, 84,97,101 one in Sweden, 102 one in Canada, 96 and the remainder in the United States.…”

“…85,88–90,92,95,100,103,104 Three studies were conducted in Iran, 84,97,101 one in Sweden, 102 one in Canada, 96 and the remainder in the United States. 83,85–89,91–95,98–100,103,104 All but three studies (86%) 99–101 were conducted at a single institution. Sixteen studies (76%) were focused on nurses only.…”

“…85,[88][89][90]92,95,100,103,104 Three studies were conducted in Iran, 84,97,101 one in Sweden, 102 one in Canada, 96 and the remainder in the United States. 83,[85][86][87][88][89][91][92][93][94][95][98][99][100]103,104 All but three studies (86%) [99][100][101] were conducted at a single…”

“…The MDT is a validated tool developed by Wocial and Weaver 118 and allows for point prevalence of moral distress via an 11-point scale. The remaining studies (24%) used other measures potentially linked to moral distress such as self-efficacy (Self-Efficacy Scale (SE)), 95 resilience (Connor-Davidson Resilience Scale (CD-RISC-25)), 92 empowerment (Psychological Empowerment Scale (PES)), 86 work effectiveness (Condition of Work Effectiveness Questionnaire-II (CWEQ-II)). 86 Six of the 16 studies (38%) measuring moral distress using the MDS, MDS-R, or MDT showed significant difference post intervention (see Table 2).…”

“…The remaining studies (24%) used other measures potentially linked to moral distress such as self-efficacy (Self-Efficacy Scale (SE)), 95 resilience (Connor-Davidson Resilience Scale (CD-RISC-25)), 92 empowerment (Psychological Empowerment Scale (PES)), 86 work effectiveness (Condition of Work Effectiveness Questionnaire-II (CWEQ-II)). 86 Six of the 16 studies (38%) measuring moral distress using the MDS, MDS-R, or MDT showed significant difference post intervention (see Table 2). A trend in moral distress levels was reported by seven studies, 83,88,89,92,98,103,104 but none were statistically significant.…”