Moral Distress of Staff Nurses in a Medical Intensive Care Unit

Abstract

• Background Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.• Objectives To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.• Methods A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.• Results Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.• Conclusions Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care

“…These results are in contrast with the results of others who found that the most common situation associated with moral distress was futile care (Elpern et al 2005, Rice et al 2008. These studies were conducted in an intensive care unit and in medical and surgical acute care units.…”

“…However, when they did have these responses, its intensity was at a moderatehigh level. Others have also found low levels of moral distress frequency with high levels of intensity (Kalvemark et al 2004, Meltzer & Huckabay 2004, Elpern et al 2005, Rice et al 2008 in different nurse populations in other parts of the world. These consistent results might imply that such situations do not occur often, and that their occurrence is more associated with the essence of the work of nursing rather than with a specific type of healthcare system.…”

Moral distress: levels, coping and preferred interventions in critical care and transitional care nurses

“…The Cronbach's a for the shortened MDS was reported at 0Á83, measured by using a product score for each item (Hamric, & Blackwell, 2007). Some version of the MDS has been used in at least five previous studies (Corley 1995, Corley et al 2005, Elpern et al 2005, Hamric & Blackwell 2007, Zuzelo 2007, Pauly et al 2009).…”

“…The determination of medical futility can only be made within the context of the individual clinical situation. In a study by Elpern et al (2005), the highest levels of moral distress were found in situations where aggressive care was given to terminal patients. Withdrawing, halting or continuing interventions that prolong life or delay the inevitable death can be difficult for all members of the healthcare team to experience.…”

“…Moral distress has been studied extensively in the intensive care environment. These environments contain a frequency of highly complex patients and challenging situations that involve the use of advanced technology (Corley 1995, Elpern et al 2005, Cronqvist & Nystrom 2007, Hamric & Blackwell 2007, Mobley et al 2007, McClendon & Buckner 2007. The critical care environment often involves situations that call for a nurse to overcome institutional obstacles and interpersonal conflicts about values.…”