Addressing Moral Distress in Critical Care Nurses: A Systemized Literature Review of Intervention Studies
DOI:
https://doi.org/10.1891/1748-6254.13.2.71Keywords:
moral distress, critical illness, nurse retention, intensive care units, critical care units, ethics, intervention, workshopAbstract
Background: The literature on moral distress highlights the need for hospitals and healthcare organizations to improve the work environment in critical care. However, only few studies delve into the types of intervention programs and administrative processes that can be put into effect to help nurses effectively deal with moral distress.
Aim: The aim of this study was to systematically synthesize evidence from published studies of interventions that address moral distress in critical care nurses. The attributes, measures, and outcomes of published interventions were described.
Methods: Systemized literature review based on searches in four biomedical sciences databases (CINAHL, MEDLINE, COCHRANE, and SCOPUS). The Cochrane Collaboration's tool was employed for risk of bias. Eligibility criteria included published full-text articles exploring any type of intervention for critical care nurses' moral distress.
Results: Based on the selection criteria, seven studies were included in the review (two quasi-experimental, two randomized clinical trials, three mixed method). The majority of studies exhibited high risk of bias. Only two studies had moderate risk of bias. The most common type of interventions were workshops.
Conclusion: We identified a small number of overall low-quality intervention studies, which provided weak evidence on the effectiveness of workshops for moral distress. Based on the indications for potentially large effect size of workshops, more well-designed studies are needed in order to elucidate the characteristics, content, and duration of effective workshops for moral distress. The results of this review can inform future efforts to develop and test intervention strategies for moral distress among intensive care unit (ICU) nurses.
References
Abbasi, S., Ghafari, S., Shahriari, M., & Shahgholian, N. (2019). Effect of moral empowerment program on moral distress in intensive care unit nurses. Nursing Ethics, 26(5), 1–11. doi:10.1177/0969733018766576
Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Siber, J. (2002). Hospital nursing staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987–1993. doi:10.1001/jama.288.16.1987
Allen, R., & Butler, E. (2016). Addressing moral distress in critical care nurses: A pilot study. International Journal of Critical Care and Emergency Medicine, 2(1), 1–6. doi:10.23937/2474-3674/1510015
Beumer, C. (2008). Innovative solutions: The effect of a workshop on reducing the experience of moral distress in an intensive care unit setting. Dimensions of Critical Care Nursing, 27(6), 263–267. doi:10.1097/01.DCC.0000338871.77658.03
Browning, E., & Cruz, J. (2018). Reflective debriefing: A social work intervention addressing moral distress among ICU nurses. Journal of Social Work in End-of-Life & Palliative Care, 14(1), 44–72. doi:10.1080/15524256.2018.1437588
Covell, C., & Sidani, S. (2013). Nursing intellectual capital theory: Implications for research and practice. The Online Journal of Nursing Issues, 18(2), 2.
Hamric, A. B., Borchers, C. D. & Epstein, E. G. (2012). Development and Testing of an Instrument to Measure Moral Distress in Healthcare Professionals. AJOB Primary Research, 3(2), 1–9. doi.org/10.1080/21507716.2011.652337
Hamric, A., & Epstein, E. (2017). A health system-wide moral distress consultation service: Development and evaluation. HealthCare Ethics Committee Forum: An Interprofessional Journal on Healthcare Institutions' Ethical and Legal Issues, 29(2), 127–143. doi:10.1007/s10730-016-9315-y
Higgins, J., & Green, S. (2008). Cochrane handbook for systematic reviews of interventions. Chichester, England: Wiley-Blackwell.
Higgins, J. P. T., Altman, D. G., & Sterne, J. A. C. (2011). Chapter 8: Ass essing risk of bias in included studies. In J. P. T.Higgins & S.Green (Eds.), Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Retrieved from www.handbook.cochrane.org.
Hiler, C. A., Hickman, R. L., Jr., Reimer, A. P., Wilson, K. (2018). Predictors of Moral Distress in a US Sample of Critical Care Nurses. American Journal of Critical Care, 27(1), 59–66. doi:10.4037/ajcc2018968.
Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall.
Leggett, J., Wasson, K., Sinacore, J., & Gamelli, R. (2013). A pilot study examining moral distress in nurses working in one United States burn center. Journal of Burn Care and Research: Official Publication of the American Burn Association, 34(5), 521–528. doi:10.1097/BCR.0b013e31828c7397
McAndrew, N., Leske, J., & Schroeter, K. (2016). Moral distress in critical care nursing: The state of the science. Nursing Ethics, 25(5), 552–570. doi:10.1177/0969733016664975
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine, 6(7), e1000097. doi:10.1371/journal.pmed.1000097
Molazem, Z., Tavakol, N., Sharif, F., Keshavarzi, S., & Ghadakpour, S. (2013). Effect of education based on the “4A Model” on the Iranian nurses' moral distress in CCU wards. Journal of Medical Ethics and History of Medicine, 6(1), 1–8.
Pipe, T., Bortz, J., Dueck, A., Pendergast, D., Buchda, V., & Summers, J. (2009). Nurse leader mindfulness meditation program from stress management: A randomized controlled trial. The Journal of Nursing Administration, 39(3), 130–137. doi:10.1097/NNA.0b013e31819894a0
