Critical care nurses’ moral distress in end-of-life decision making

Abstract

Moral distress is a phenomenon in which a healthcare professional perceives an ethically preferable or morally right course of action to take, but internal or external constraints make it nearly impossible to pursue that course. Although healthcare professionals' moral distress has been studied for over twenty years, we have not reached a point of full understanding and appreciation of this complex phenomenon. Attempts to define moral distress and refine our understanding of it have been frustrated by tendencies to interchange or mislabel very distinct-yet related-concepts. A comprehensive knowledge base of root causes and the interrelationships between individual and team or system factors is timely and critical. We qualitatively interviewed 29 healthcare professionals of various backgrounds in two intensive care units at a tertiary, academic medical center with the goal of understanding interrelationships between team and individual factors of moral distress. Herein, we report our findings with regard to nurses' moral distress and suggest a list of practical strategies to mitigate this moral distress.