Clinical PotpourriMoral distress in intensive care unit professionals is associated with profession, age, and years of experience☆
Introduction
Moral distress is the stress experienced when a health care professional feels certain of an ethical course of action but is constrained from taking that action [1]. For example, a difference of opinion between a professional and the rest of the health care team about direction of care (eg, full life-support versus comfort care) can cause moral distress. Moral distress can be measured using a validated survey [2], [3]. Based on scores from this survey, it is known that intensive care unit (ICU) nurses experience more moral distress than do ICU physicians [1], [3], [4]; respiratory therapists also experience moral distress [5]. Consequences of moral distress in ICU personnel include burn-out and attrition [3], [6]. However, it is not known which characteristics of health professionals are independently associated with moral distress. The purpose of this study was to determine the relationship between moral distress scores in Canadian ICU personnel and their demographic and professional characteristics.
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Setting and participants
We administered the revised Moral Distress Scale [3] to all full-time and part-time health professionals in the ICUs of 13 tertiary and community hospitals in southwestern British Columbia; these included 3 tertiary, 3 large community, and 7 small community hospitals—all of the acute care hospitals within 2 jurisdictions of care (Supplementary Table 1). There were 1390 recipients of the survey—870 nurses, 452 other health professionals (non-physician, non-nurse clinicians including respiratory
Results
The response rates to the moral distress surveys were the following: nurses—428/870 (49%); other health professionals—211/452 (47%); physicians—30/68 (44%). Most of the nurses and other health professionals were female whereas most of the physician respondents were male (Table 1). In addition, nurses and other health professionals had been working in their ICU for a shorter period than had the physicians (Table 1).
Nurses and other health professionals had higher moral distress scores than
Discussion
Moral distress is the powerlessness, anger, and guilt that health care professionals experience when they are unable to practice according to their ethical standards [5], [6]. Moral distress occurs in the context of interactions between individuals in fiscally constrained workplaces with increasingly ill patients, and challenging differences in power dynamics among health care personnel [7], [8]. This context creates ethical conflicts between health care providers and their organizations for
Conclusions
We found that moral distress is higher in ICU nurses and other non-physician professionals than in physicians, is inversely associated with age in other non-physician professionals, and is associated with years of experience in nurses. Moral distress is associated with past and present tendency to leave a position in nurses and other non-physician professionals. In the interest of retention of staff, at least, causes of moral distress such as cost-control and end-of-life controversies ought to
Acknowledgements
The authors thank Sarah Carriere for coordinating this study and all of the ICU leaders at each site for engaging their staff in this survey. Drs Dodek, Wong, Ayas, Keenan, Hamric, Rodney, and Alden contributed to the design, execution, analysis, interpretation, and writing of this study. Ms Norena contributed to the analysis, interpretation, and writing up of this study. Dr Reynolds and Ms. Stewart contributed to the execution, interpretation, and writing up of this study. This work was funded
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None of the authors have any conflict of interest related to this manuscript.