Palliative Care and Moral Distress: An Institutional Survey of Critical Care Nurses

Wolf, Alexander T.; White, Kerr L.; Epstein, Elizabeth G.; Enfield, Kyle B.

doi:10.4037/ccn2019645

Cited by 72 publications

(72 citation statements)

References 46 publications

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“…The feelings experienced by our sample during moral distressing events were similar to those described in other studies. 8,[17][18][19][20][21]47 The majority of our sample felt fear in front of physicians, which was also reported by Pendry. 48 Factors that worsened or influenced the experience of moral distress in our sample were similar to those reported by other studies, including young patient age, 49 a friendly relationship with the patient, 49,50 a long recovery in the same ward and the worsening clinical condition of a patient.…”

Section: Discussionsupporting

confidence: 79%

“…57 Consultation with colleagues was viewed as the best strategy for coping with moral distress, based on the results of our study and others. [17][18][19][20][21] The majority of our sample experienced fear when physicians were present, which was also reported by Pendry. 48 Our study demonstrated that morally distressing events can lead to changes among the nursing staff.…”

Section: Discussionsupporting

confidence: 77%

“…12 Several studies have focused on moral distress among nursing staff, [13][14][15][16] and the triggers and consequences of moral distress associated with end-of-life care have been widely studied. [17][18][19][20][21] However, moral distress is an often neglected issue by palliative education programmes, and research has largely focused on the phenomenon as an occupational problem for nursing staff. 1 To our knowledge, no qualitative study has been conducted in Italy exploring the morally distressing events that occur among nursing hospital staff in onco-haematological settings.…”

Section: Introductionmentioning

confidence: 99%

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Nurses' moral distress in end-of-life care: A qualitative study

et al. 2020

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Background: Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff. Research question: The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events. Research design: A hermeneutic-phenomenological qualitative study was performed. Participants and research context: Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim. Ethical considerations: Ethical approval was obtained from the Institutional Review Hospital Board. Findings: Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured. Discussion: In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients’ last requests. According to our findings, the concept of ‘good’ end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events. Conclusion: Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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Nurses' moral distress in end-of-life care: A qualitative study

et al. 2020

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“…This is consistent with the literature that identifies that the delivery of primary and specialty palliative care in the ICU setting is an important strategy to address ethical conflict and moral distress. [38][39][40] Increasing the primary palliative care skills of ICU nurses, physicians and other members of the interprofessional team may be an important way to integrate palliative care in the ICU. In addition, increasing the palliative knowledge and expertise of ICU nurses could empower them to deliver the type of care that is aligned with their nursing philosophy of care.…”

Section: Discussionmentioning

confidence: 99%

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

McAndrew

Hardin

2020

Nurs Ethics

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Background: Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit. 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.

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“…New evidence has emerged that some critical care nurses, especially those with less experience, may develop moral distress as a result of providing palliative care in the ICU setting. 67 Careful self-examination as well as participation in palliative care education may alleviate moral distress for critical care nurses. Lastly, critical care nurses should understand the difference between palliative care and hospice care and know when patients could benefit from a referral to hospice care for end-of-life care.…”

Section: Clinical Implications For Critical Care Nursesmentioning

confidence: 99%

Integrating Palliative Care Into Heart Failure Management

Bierle

Vuckovic

Ryan

2021

Critical Care Nurse

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Background The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. Clinical Relevance The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient’s quality of life. Purpose To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. Content Covered This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.

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Palliative Care and Moral Distress: An Institutional Survey of Critical Care Nurses

Cited by 72 publications

References 46 publications

Nurses' moral distress in end-of-life care: A qualitative study

Nurses' moral distress in end-of-life care: A qualitative study

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

Integrating Palliative Care Into Heart Failure Management

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