Moral distress: Developing strategies from experience

Abstract

Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. Objectives We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. Research design An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. Participants Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. Research context This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. Ethical considerations The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. Findings Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. Discussion Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. Conclusion This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice.

Ethical climate and moral distress in paediatric oncology nursing

“…Fortunately, nurses consider formal ethics support as helpful in resolving moral distress. 34 We found that disagreements on end-of-life care as a root cause of moral distress were not quite as prominent in paediatric oncology units as those reported in critical care settings. 8,21 Although grief and loss are unavoidable in paediatric oncology nursing, 35 not all emotionally distressing situations generate moral distress.…”

“…Maybe the repetitive exposure to distressing situations over time is not solely disadvantageous. According to Helmers et al, 34 it can broaden the understanding of different ways of dealing with ethical dilemmas, leading to a wider perspective on ethical issues that in turn can be helpful in diminishing experiences of moral distress.…”

Nursing Education: Students’ Narratives of Moral Distress in Clinical Practice

“…The gap between what students have learned and the actions they take in practice may lead to "moral distress" [12]. Graduated nurses also experience moral distress [13][14][15]. In a systematic review by Sasso et al [4], the authors highlighted that further research is needed to improve our understanding of the phenomenon of moral distress.…”

“…Helmers et al [ 13 ] found that moral distress was a common experience in nursing practice, with both social and environmental stressors, such as lack of empathy or differences in opinion about care, prioritizing, or resource allocation. It seems that we cannot eliminate moral distress, thus we need to foster personal growth that enables nurses and students to better address and manage the situations of moral distress associated with practice [ 10 , 13 ]. Consequently, we need more knowledge about the types of difficult situations nurses encounter in their work.…”

Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study

“…To reduce the emotional distress associated with living and coping with an ethical conflict, strategies like daily debriefings and consultations with a psychologist about the complexity of relationships with older patients and their families could be implemented ( Choe et al., 2018 ; Dufrene & Young, 2014 ; Pileggi et al., 2014 ). According to Helmers et al. (2020) and Stolt et al.…”