Moral distress in nursing: Can palliative care access help?

Critical care nurses who believe their patients have access to palliative care tend to feel less moral distress than nurses who don’t believe that type of resource is available, according to a survey.

The survey, published in the October issue of Critical Care Nurse, discussed how palliative care focuses on enhancing the lives of seriously ill patients and their families. Moral distress is common among nurses in many settings and can lead to nurses’ burning out — leaving their jobs and careers.

Alexander Wolf, RN

Moral distress is different from a moral dilemma, said study author Alexander Wolf, DNP, RN, APRN, CCRN, an advanced practice nurse in palliative care at TriHealth in Cincinnati, Ohio.

A moral dilemma suggests a nurse is unsure about the most ethical action to take. Moral distress is a situation in which a nurse has identified the morally correct action to take using his or her own professional integrity. But the nurse feels unable to take the action because of some type of perceived constraint, according to Wolf.

“I think just about any nurse you talk to will describe some situation in which they felt moral distress,” Wolf said. “I was an ICU nurse for about three years in Denver. For me the personal experiences with moral distress were in situations where I felt we were just causing suffering for people who had incurable illnesses. There were situations where I felt all I did that day was prolong someone from dying or basically made their final days, weeks or months very painful and debilitating.”

That was before palliative care was a recognized specialty, Wolf said. It was up to nurses to provide what have become essential palliative care competencies, according to Wolf. Those competencies include the ability to sit down and communicate effectively with a patient, elicit a patient’s goals and understanding of an illness, determine what the patient wants to accomplish in the time they have left, and more.

“My experience with moral distress was in situations where I felt like I couldn’t do that,” Wolf said. “I felt like either I wasn’t being listened to by the team, the patient and family were unrealistic or something was keeping me from being able to do what I felt was the right thing to do.”

Today’s critical care nurses agree

Researchers surveyed more than 500 critical care nurses in critical care units at the University of Virginia Medical Center, Charlottesville. In total, 167 completed the questionnaires about their perceptions of palliative care in practice and recent experiences in moral distress.

Nearly all of the nurses — about 95% — indicated they thought it was very or extremely important to have palliative care training and education. The remaining 5% said it was somewhat important. Yet, Wolf and colleagues found fewer than 40% of nurses felt highly competent in any palliative care domain.

“Of the 10 competency domains assessed, the team communication domain had the highest proportion of respondents self-rating as highly competent (38%), while only 11% of respondents rated themselves as highly competent in …read more

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