Evaluating an Intervention to Reduce Moral Distress in the Intensive Care Unit

Background: Experiencing situations that contribute to feelings of moral distress in is higher for healthcare
providers in the intensive care unit (ICU). Moral distress is associated with burnout, intention to leave a position, and disempowerment.
Aim: The purpose of the study was to evaluate the effectiveness of moral distress consultations on reducing moral distress and improving empowerment for healthcare providers in the ICU.
Population: A convenience sample of twenty-four thoracic cardiovascular ICU staff members attended the three moral distress consultations conducted August-November 2017. The moral distress consultation participants were nurses, respiratory therapist, and unit manager with an average of 3.5 years in their current position.
Study Design: The pretest-posttest comparison study design utilized the Moral Distress Thermometer and
Global Empowerment Scale to evaluate the effectiveness of the moral distress consultations. The moral distress and global empowerment data were analyzed using the Wilcoxon rank signed paired t-test and Pearson correlation test.
Results: The moral distress consultations significantly reduced moral distress; however, global empowerment did not increase significantly. The mean pre-moral distress score was 3.54 (1.95) and the median post-moral distress score is 2.79 (1.67), p=.007; the global empowerment means prior to and after the moral distress consultations were medium 6.89 (1.34) and 6.79 (1.37), p=0.36. The themes identified during the consultations that contributed to feelings of moral distress were, healthcare providers giving “false hope” to patient and families regarding patient prognosis, continuing to provide care not in the best interest of the patient, resistance to consult palliative care, insufficient team communication, and patient code status and advance medical directives.
Conclusion: Moral distress consultations provide a safe environment for healthcare providers to
communicate, and identify and develop strategies to mitigate moral distress in the ICU.