RT Article
T1 Moral distress: Developing strategies from experience
JF Nursing ethics
VO 27
IS 4
SP 1147
OP 1156
A1 Helmers, Andrew
A1 Palmer, Karen Dryden
A1 Greenberg, Rebecca A
LA English
PB Sage
YR 2020
UL https://www.ixtheo.de/Record/1779459467
AB BackgroundMoral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress.ObjectivesWe explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience.Research designAn exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers.ParticipantsMid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital.Research contextThis work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies.Ethical considerationsThe study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project.FindingsParticipants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports.DiscussionFindings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting.ConclusionThis exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice.
K1 Resilience
K1 pediatric
K1 moral/ethical climate of organizations
K1 Moral Distress
K1 intensive care
DO 10.1177/0969733020906593