Considering Care: A Descriptive Study of Moral Distress (S747)

Abstract

•Understand the concept of moral distress in health care professionals and be able to identify two potential contributing factors and two potential consequences of moral distress.•Identify two strategies or types of interventions that a palliative care team and others can use in a hospital or other healthcare settings to mitigate moral distress and improve staff morale. Moral distress involves stressful situations in which moral values are challenged. As patient acuity rises, staff will likely face more situations presenting ethical dilemmas that may result in moral distress. Our academic medical center serves a multicultural community that includes a large population of a minority, faith-based group, which influences decisions to utilize life-sustaining therapy (LST). Patients on the respiratory care unit (RCU) have a mean age of 82, have chronic ventilator-dependent respiratory failure, and often utilize additional LST (tube feeding, dialysis, vasopressors). Faith-based minority patients are disproportionately high on this unit. To understand the experience of moral distress and factors contributing to, and resulting from, that distress. The research explored current coping strategies and possible interventions to address identified issues. A descriptive, qualitative design was used, with convenience purposive sampling. IRB approval was obtained. All RCU nurses were invited to participate. Participants provided demographic information and took part in semi-structured focus groups. Transcriptions of audio recordings of the focus groups were analyzed to identify themes. Moral distress was evident in staff and manifested in many ways. Contributing factors included communication issues, difficulty working with families, differences in values related to culture, and aggressiveness of medical treatment. Consequences included themes of emotional and behavioral responses (depersonalization, desensitization, disempowerment). Demographic differences between day and night staff suggested different interventions needed. Staff offered recommendations, some of which have been implemented, and they demonstrate early positive impact on staff engagement and morale. These include ethics rounds, support sessions, and an ELNEC education day. Our findings indicate an urgent need to recognize and address moral distress in staff. Staff satisfaction has important implications for optimal relationship-based care as well as staff retention.