Barriers and Values of Moral Distress Among Critical Care Nurses

Friday, 17 March 2017: 4:05 PM

Melissa A. Wilson, PhD, MSN
School of Aerospace Medicine, United States Air Force, Fairborn, OH, USA

Aims. To understand the barriers and values present in civilian and military critical care nurses during moral distress experiences. Background. There is a problem plaguing our healthcare organizations that is causing providers to suffer and putting patients at risk. Working in healthcare is often not without moral or ethical encounters that leads to distress (American Association of Critical Care Nurses [AACN], 2008). These situations are such that an increasing frequency or an intense single encounter could result in a painful, psychological alternation named moral distress. Advances in technology and our capabilities to extend life-saving measures are a few examples that have created a healthcare environment rich with the possibility of moral distress. Moral distress is frequently identified by critical care nurses who experience moral conflict while caring for others in an intensive care environment which results in distress (Burston & Tuckett, 2013). When conflict occurs, moral distress may influence actions and behaviors of that individual. Moral distress situations may result in greater rates of burnout and turnover of nurses, poorer patient outcomes, increased healthcare expenses, poor team collaboration and damage to a nurses’ self-integrity (Cimiotti, Aiken, Sloane & Wu 2012; Pauly, Varcoe & Storch 2012; Epstein & Hamric 2009; AACN, 2008). The purpose of this work is to examine the barriers in both civilian and military healthcare environments that prevents a nurse to act in a morally comforting manner and the moral values that are present in moral distress experiences. Identification of specific barriers and values within the context of moral distress may lead to crucial interventions that could lessen the effects of moral distress on nurses. Design. A series of studies will be presented from both the civilian and military healthcare environments. Two nonexperimental descriptive studies were completed utilizing qualitative interviews with civilian and military critical care nurses who self-report that they have experienced moral distress. Methods. Primary interviews were conducted with seven critical care nurses utilizing a semi-structured approach in the civilian sector and 12-15 critical care nurses from the United States Air Force (USAF) critical care air transport teams (CCATT), who are currently being interviewed. Recruitment occurred through a local chapter of a professional critical care nurse organization and the USAF. Results. If present, establishment of the phenomenon is first needed in CCAT nurses and then barriers and values present in moral distress experiences will be examined. A list of five barriers and associated values from civilian critical care nurses was generated from the first study completed through a content analysis methodology approach. Future measures will examine similarities and differences in civilian and military experiences of moral distress. Relevance to clinical practice. Studying barriers and values present in civilian and military critical care nurses who have experienced moral distress provides direction for targeting interventions to lessen the impact of this detrimental phenomenon in healthcare. Current efforts. Efforts are underway to evaluate the presence of moral distress in CCATT nurses in the United States Air Force. CCATT members’ roles include stabilizing and managing critically ill patients in the confines of air transport during war and peacetime missions. Often these healthcare members are exposed to unpredictable and extreme patient conditions within the confines of an austere environment (Brewer & Ryan-Wenger, 2009). Research is limited in exploring moral distress within military populations and no data was found related to the CCATT experience. This effort seeks to establish the phenomenon of moral distress among CCATT nurses. If established, follow-up studies will examine barriers and values present in other military healthcare members. Identification of similarities and differences between civilian and military critical care nurses will be examined. Efforts in this research area will build on the wealth of knowledge from moral distress research in the civilian sector. It will create a foundation for moral distress interventions within military nurse populations.