Intervening on Moral Distress: Intensive Care Unit Nurses and the Moral Distress Map

Background: Moral distress is an event that occurs when a health care worker feels as though they cannot do the right thing for a patient due to situational constraints. Moral distress is correlated with burnout, compassion fatigue, intent to leave, and perceived worse quality of care.
Purpose: The primary aim of this project was to evaluate use of the moral distress map (MDM) among ICU nurses, with the secondary aim of discerning any change in moral distress resultant from the MDM’s use.
Design: Pre/post intervention project.
Methods: ICU nurses were introduced to the moral distress thermometer (Wocial & Weaver, 2013) as an instrument to measure current moral distress. They subsequently completed the MDM with colleagues, and repeated the moral distress thermometer. They were asked to complete a PI-designed questionnaire to evaluate how they used the map.
Results: Findings reveal that when ICU nurses (N = 47) use Dudzinski’s moral distress map with nurse colleagues at the point of care, their moral distress increases as measured by the moral distress thermometer (p < 0.001). There was no statistically significant evidence that the mean pre-post change in moral distress scores could be explained by whether the case(s) selected for discussion with the MDM was presently occurring, or had occurred in the past (p = 0.097), (p = 0.058), however, trends in the data were found to be clinically meaningful in that they supported theory about moral residue.
Discussion: This project is novel for three reasons. First, the results demonstrated that mean MD in ICU nurses (N = 47) increased significantly as measured by the MDT when nurses use the moral distress map to debrief one another about MD cases at the point of care (p < 0.001). Second, the project’s findings provided clinical evidence about the intensity of MD over time, substantiating theory about moral residue. Finally, the participant responses to the questionnaire provided general feedback about how to optimize the use of the MDM in this setting.
Conclusions: Among ICU nurses there is statistically significant evidence that when nurses use Dudzinski’s (2016) moral distress map to debrief one another at the bedside, they experience a statistically significant increase in moral distress. There is also clinical evidence affirming moral residue among these nurses.