Critical Care Nurses' Perceptions about Palliative Care and Moral Distress: Implications for Practice

Background: As the need for palliative care in the intensive care unit becomes increasingly recognized, it is unknown how gaps and variations in palliative care education and utilization are associated with the moral distress of critical care nurses.

Purpose: To examine critical care nurses’ perceived knowledge of palliative care, examine their recent experiences of moral distress, and explore how these variables may be related.

Design: Quantitative, descriptive study design.

Methods: Survey questionnaires were distributed to 517 critical care nurses across seven intensive care units at an academic medical center in central Virginia. Validated instruments were used to measure participants’ perceptions, beliefs, and experiences with palliative care in their practice setting and their recent experiences of moral distress.

Results: A total of 168 surveys were returned (response rate = 32.5%), of which 167 were analyzed. Each palliative care domain was rated highly important by a majority of respondents, but fewer than 40% of respondents reported being highly competent in any domain, with the lowest proportions rating themselves highly competent in knowledge of advance directives, assessing patient-family support and resources, and self-care. Most respondents reported little to no recent preparation in palliative care, with 38% reporting no palliative care education in the past two years. Most respondents reported some degree of moral distress during the study period, and there were significant differences in moral distress level based on perceived utilization of palliative care services (F = 3.02, p = .03). Respondents who reported palliative care services being more frequently utilized appropriately tended to experience lower levels of moral distress during the study period. A small, significant inverse correlation was found between moral distress levels and self-care, resilience, recognizing/managing stress, grief, and moral distress, indicating that respondents who felt less competent in this domain experienced greater moral distress during the study period.

Conclusion: Palliative care knowledge gaps and moral distress remain highly prevalent in critical care nurses. Health system leaders and educators must improve and expand opportunities for nurses to become more competent in palliative care and how to cope with situations that may lead to moral distress, and empower nurses as leaders and advocates to reduce barriers to palliative care.