NEW YORK (Reuters Health) – Healthy work environments that promote collegial relationships may help reduce moral distress among critical care workers, researchers suggest.
“Moral distress occurs when individuals are faced with situations in which their moral beliefs regarding life and death and right versus wrong are challenged,” explained Dr. Catherine Hiler, who led the research project as a doctoral student at Case Western Reserve University, in Cleveland, and is now at Jefferson College of Health Sciences in Roanoke, Virginia.
“Moral distress is a symptom of unhealthy work environments and inadequate supports for critical care nurses,” she said in an email to Reuters Health.
“Similar to most symptoms,” she added, “moral distress can have damaging effects . . . such as heightened states of job dissatisfaction, turnover, and reductions in the quality of nursing care delivered.”
Hiler and colleagues conducted an online survey that included a national sample of more than 300 critical care nurses (87% women; 86% white) to assess relationships among moral distress severity and the practice environment.
Participants completed a demographic questionnaire, the Moral Distress Scale-Revised, and the Practice Environment Scale of the Nursing Work Index.
As reported in the January issue of the American Journal of Critical Care, most participants (59%) were satisfied with their current job, but 73% had contemplated leaving it within the past six months. The severity of moral distress, as indicated in the scale, was significantly associated with a nurse’s intention to leave his or her current position.
Overall, higher states of job dissatisfaction, lower practice environment index scores, and age were statistically significant predictors of moral distress frequency.
By contrast, moral distress decreased as nurses participated more in hospital programs and activities, perceived collegial relationships with physicians, received support from leadership, and reported adequate staffing.
Only 19% of nurses reported working in an ICU with a Beacon designation – an indicator of a healthy practice environment. Nurses employed in a Beacon-recognized unit experienced less moral distress, according to the study, although the designation was not a predictor of moral distress frequency.
“On the basis of the study results, it is recommended that adoption of the American Association of Critical-Care Nurses’ (AACN’s) standards for creating and sustaining healthy work environments is essential,” the authors state. (http://bit.ly/2Df3ZoS)
“Additionally, the results of this study support interventions to promote collaboration between critical care nurses and physicians, as well as educational and emotional support for critical care nurses who provide end-of-life care,” they conclude.
Beth Steinberg, Associate Chief Nursing Officer, Critical Care and Emergency Services at The Ohio State University Wexner Medical Center, in Columbus, told Reuters Health that to help prevent moral distress, she “integrates interventions such as mindfulness, yoga and other interprofessional resilience-building activities into the workday.”
“We know that some aspects of hospital and unit environments will not change,” she said by email. “Patients will continue to be incredibly ill, their illnesses are complicated by multiple social and family issues, and coping mechanisms are limited.”
“Staff have to be able to step away from the situation, even for a few minutes, reframe, breathe and talk with coworkers to be able to build their resiliency,” she noted. “My hypothesis is that if we have less stressed, more resilient providers, this will lead to better patient safety, satisfaction and quality outcomes, as well as more-engaged and productive employees.”
Critical care nurse Patricia Flynn of Northwell Health Long Island Jewish Forest Hills, New York City, told Reuters Health that at her institution, “we have successfully incorporated aspects of the AACN standards into our practice.”
“Information is disseminated to staff, and safety issues are discussed through daily briefs and huddles,” she said by email. “The management team is highly visible on the unit and sponsors an ‘open door policy,’ which allows for real-time communication and resolution of concerns.”
In addition, she noted, “the ICU has a unit Collaborative Care Council that meets regularly to discuss unit matters and empowers the staff to be active participants in any unit decisions and initiatives to improve care, not only for patients but to optimize working conditions for the staff.”
Charlene Ruggiero, Nurse Manager, Neuro ICU and ICU at Overlook Medical Center in Summit, New Jersey, told Reuters Health she does not believe there is a high level of moral distress at her institution. “Of course, we have seen some incredibly sad, emotional scenarios – our patients tend to be young and their illness strikes suddenly – but for as many tragedies we have witnessed, there have been many more triumphs, and that is what is sustaining for nurses.”
“Our unit typically has high levels of job satisfaction, and nurses consider themselves to work in a healthy work environment,” she said by email. “I also believe it is important to debrief about situations that can be morally distressing.”
“Supporting nurses’ feelings when the healthcare teams’ goals of care may differ from the families’ is also key in reducing moral distress,” Ruggiero concluded.
SOURCE: http://bit.ly/2mkNSuB
Am J Crit Care 2018.
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