Influence of Moral Distress on the Professional Practice Environment During Prognostic Conflict in Critical Care

McAndrew, Natalie S.; Leske, Jane S.; Garcia, Annette E.

doi:10.1097/jtn.0b013e31823a4a12

Cited by 71 publications

(115 citation statements)

References 50 publications

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“…Our findings echo those of Hamric and Blackhall, 52 suggesting that the intensity of moral distress in critical care has remained high over time. Recent studies and anecdotal experience with ethics consultations support this conclusion 83,84 and underscore the need for individual-and system-focused interventions to mitigate the effects of moral distress in high-risk areas. [83][84][85] Hope is associated with resilience and is possibly a factor in mitigating stress.…”

Section: Discussionmentioning

confidence: 94%

“…Recent studies and anecdotal experience with ethics consultations support this conclusion 83,84 and underscore the need for individual-and system-focused interventions to mitigate the effects of moral distress in high-risk areas. [83][84][85] Hope is associated with resilience and is possibly a factor in mitigating stress. [45][46][47] In our sample, nurses with the least experience reported higher levels of hope and lower levels of moral distress, generalized stress, and burnout (emotional exhaustion and depersonalization) than did nurses with more experience.…”

Section: Discussionmentioning

confidence: 94%

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Burnout and Resilience Among Nurses Practicing in High-Intensity Settings

Rushton

Batcheller

Schroeder

et al. 2015

American Journal of Critical Care

490

374

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Define and better understand burnout and moral distress. 2. Identify the impact that burnout and resilience have among nurses. 3. Discuss the results of the study.To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue. " No CE test fee for AACN members.Background The high level of stress experienced by nurses leads to moral distress, burnout, and a host of detrimental effects. Objectives To support creation of healthy work environments and to design a 2-phase project to enhance nurses' resilience while improving retention and reducing turnover. Methods In phase 1, a cross-sectional survey was used to characterize the experiences of a high-stress nursing cohort. A total of 114 nurses in 6 high-intensity units completed 6 survey tools to assess the nurses' characteristics as the context for burnout and to explore factors involved in burnout, moral distress, and resilience. Statistical analysis was used to determine associations between scale measures and to identify independent variables related to burnout. Results Moral distress was a significant predictor of all 3 aspects of burnout, and the association between burnout and resilience was strong. Greater resilience protected nurses from emotional exhaustion and contributed to personal accomplishment. Spiritual well-being reduced emotional exhaustion and depersonalization; physical well-being was associated with personal accomplishment. Meaning in patient care and hope were independent predictors of burnout. Higher levels of resilience were associated with increased hope and reduced stress. Resilience scores were relatively flat over years of experience. Conclusions These findings provide the basis for an experimental intervention in phase 2, which is designed to help participants cultivate strategies and practices for renewal, including mindfulness practices and personal resilience plans. (American Journal of Critical Care. 2015; 24:412-421)

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Burnout and Resilience Among Nurses Practicing in High-Intensity Settings

Rushton

Batcheller

Schroeder

et al. 2015

American Journal of Critical Care

490

374

View full text Add to dashboard Cite

show abstract

“…[62][63][64][65] These consequences can lead to inadequate staffing, which in turn, is linked to unfavorable patient outcomes such as hospital-acquired infections. 66 Lingering effects of providers' moral distress can lead to moral desensitization, 50 harmful workplace climates, 23 and suffering of patients and their families. 26 The health system itself is financially affected when moral distress drives nurses and other providers to decrease their work engagement and productivity.…”

Section: 50mentioning

confidence: 99%

“…12,[17][18][19][20][21][22][23][24][25][26] Ethical conflicts are particularly relevant during end-of-life care. 17,22,25,27,28 In a Pew Research Center (2013) survey, 29 31% of American respondents said that they believe that health care providers should always do everything possible to preserve life-up from 15% in 1990.…”

Section: Introductionmentioning

confidence: 99%

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Pavlish¹,

Hellyer²,

Brown-Saltzman³

et al. 2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the impact of ethical conflict in the intensive care unit (ICU) for patients, families, and health care workers. 2. Describe risk factors and early warning signs of potential ethical conflicts with ICU patients. 3. Explain key results of ethical risk factor screening for critical care nurses. Results Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium-and low-risk situations. Certain risk factors featured prominently in high-risk situations. Conclusions A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.

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“…MoD is often associated with what providers perceive as futile or inappropriate treatment (Mobley et al, 2007: Piers et al, 2011Wilson et al, 2013) and poor physician nurse collaboration (Hamric and Blackhall, 2007: Kalvemark et al, 2004: McAndrew et al 2011: Papathanassoglou et al, 2012.…”

mentioning

confidence: 99%

Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

et al. 2016

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Innovation: Establish formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers' moral distress and decreases length of stay for patients with lifethreatening illnesses.Evaluation: Pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls.Setting: Pediatric Intensive Care Unit in a quaternary care Children's Hospital. Participants: Physicians and nurses on staff in the unit.Patients: There were 60 patients in the interventional and 66 patients in the historical control group.Intervention: Over a year, weekly meetings (PEACE rounds) to establish goals of care for patients with longer than 10 days length of stay in the ICU. Results:Moral distress scores measured intermittently with the MDT fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall MDS-R scores were lower for respondents in all categories (non-significant), and on three specific items (significant). Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS (4.94 control vs 3.37 PEACE, p=0.015), a statistically significant increase in both code status changes DNR (11% control, 28% PEACE, p=0.013), and in-hospital death (9% control, 25% PEACE, p=0.015), with no change in patient 30 or 365 day mortality. Conclusion:The addition of a clinical ethicist and senior intensivist to weekly interprofessional team meetings facilitates difficult conversations regarding realistic goals of care. The PEACE

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Influence of Moral Distress on the Professional Practice Environment During Prognostic Conflict in Critical Care

Cited by 71 publications

References 50 publications

Burnout and Resilience Among Nurses Practicing in High-Intensity Settings

Burnout and Resilience Among Nurses Practicing in High-Intensity Settings

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

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