Moral Distress in the ICUCATCritically

Appraised Topic

Caitlin McCabe SN, Leah Miller SN & Kelcie Chyla SNCarroll University, Waukesha, WI

Collaborating ICU Practice Council Member: Cindy Zielke ICU Charge RNWaukesha Memorial Hospital, Waukesha, WI

PICO QUESTION: What are the facilitators and manifestations of moral distress among ICU nurses and what coping strategies are most effective?

CLINICAL BOTTOM LINE: The facilitators and manifestations of moral distress among ICU nurses include: Most effective coping strategies are:

Van Eijk, M., Van Marum, R., Cavaliere, T., Daly, B., Dowling, D., & Montgomery, K. (2010). Moral distress in neonatal intensive care unit rns. Advances in Neonatal Care, 10(3), 145-156.

X Descriptive

Convenience sample of

Ninety-four registered

nurses from level III NICUs in two flagship hospitals of a

large healthcare

system in the northeastern United States

(Cavaliere, Daly, Dowling,

& Montgomery, 2010, p. 147).

This study found that situations leading to moral distress include “futile, aggressive care without perceived benefit, patients harm from pain and suffering, unnecessary treatments, inadequate staffing, and working with colleagues who are deemed incompetent for the level of care required” (Cavaliere et al, 2010, p. 153). Coping strategies recommended in this study include: “developing moral sensitivity, acquiring knowledge about the concept and its consequences, acting to change the work environment to safeguard personal values and integrity” (Cavaliere et al, 2010, p. 153). Strategies recommended for the institutions to utilize include: “unit based, interdisciplinary councils in which patient goals and diverse opinions are discussed openly and respectfully, availability of social workers, chaplains, grief counselors, and/or employee assistance personnel to interact with staff during and after stressful situations, unrestricted access to ethics committees that include nursing representatives, and educational sessions and training to manage and decrease moral distress” (Cavaliere, 2010, p. 154).

Elpern, E., Covert, B., Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American Journal Of Critical Care, 14(6), 523-530.

X Descriptive

Twenty-eight registered

nurses from the Medical

Intensive Care Unit at Rush University

Medical Center, Chicago, Illinois

This study found that increased levels of moral distress happened in situations when “nurses felt they were providing aggressive care to patients who would

not benefit” (Elpern, Covert, & Kleinpell, 2005, p. 528). Manifestations of moral distress included: “job dissatisfaction, burnout, and loss of nurses from the

workplace and profession” (Elpern et al, 2005, p. 529). Unexpected manifestations of moral distress included increased desire to create advance

directives and decreased desire to donate blood and organs (Elpern et al, 2005, p. 529).

McClendon, H., Buckner, E.B., (2007). Distressing situations in the intensive care unit: A descriptive study of nurses’ responses. Dimensions of Critical Care Nursing, 26(5), 199-206.

X Descriptive

Nine registered nurses from “the intensive and coronary care units at a regional urban hospital in southeastern United States” (McClendon & Buckner, 2007, p. 202).

- This study found that situations leading to moral distress “involved critically ill patients whose families wished to continue aggressive treatment when it probably would not benefit the patient in the end” (McClendon & Buckner, 2007, p. 203). Recommended coping strategies in this study include “talking with families about patient condition, relaxation, deep breathing, counting to 10, and distancing oneself from the situation” (McClendon & Buckner, 2007, p. 203). Additional coping strategies include support groups, having a social worker or counselor, shorter shifts, better staffing, improving patient and family education, physicians being more realistic with patient and family about patient outcome. (McClendon & Buckner, 2007, p. 204). Manifestations of moral distress on nurses’ personal life found in this study include feeling “short-tempered, grouchy, irritable, or ill with their family” (McClendon & Buckern, 2007, p. 203). Manifestations of moral distress on nurses’ professional life include burnout, loss of focus, insufficient time for tasks, less time to care for families, less patience, and feeling ineffective (McClendon & Buckern, 2007, p. 203).

Reference Level of Evidence

Design Sample Findings

Comments of the Evidence: Strengths- XXXXXXXXApplicability: XXXXXXXX

Evidence Search: PubMed Central, EBSCO, CINAHL

Key words: ICU, Moral Distress, Registered Nurses, Ethnical Dilemmas