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Moral distress in the PICU: Development of a nursing intervention
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- Author / Creator
- Deschenes, Sadie
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Background: There is a desperate need for research-based interventions to help minimize nurses’ moral distress, which arises when there is a conflict between what one thinks the morally correct action is and what they are required or capable of doing. While experiences and causes of moral distress have been explored, little is known about how to mitigate the negative effects of moral distress among pediatric critical care nurses. These nurses are the primary caregivers for critically ill and dying children and are highly susceptible to moral distress due to their unique relationship with patients and their families and the daily ethical challenges they may face. Researchers confirm that nurses experience an increase in the intensity of moral distress and pediatric critical care nurses are particularly vulnerable to the phenomenon. Researchers have also demonstrated the negative impact moral distress has on patient care, nurses’ health, and nurse retention. Almost half of nurses who experience moral distress consider or leave their position, further impacting patient safety. Further research in effective moral distress interventions is urgently required to improve nurses’ working environment, nurse retention and patient care.
Purpose: The overarching purpose of my doctoral research was to develop an intervention to mitigate the negative effects of moral distress for PICU and pediatric cardiac intensive care unit (PCICU) nurses. This research consisted of a theoretical paper as the foundation that guides my three-phase research project. The objectives of the research were to: 1) identify existing interventional studies on moral distress and map out research gaps; 2) explore nurses’ views on moral distress and their recommendations for attributes of amoral distress intervention; 3) propose and conceptualize the development of a moral distress intervention.
Methods: A theoretical paper exploring moral distress through relational ethics is used as the foundation that guides my three-phase study. This multi-phase study is comprised of 1) a scoping review synthesizing moral distress interventions among nurses, 2) a qualitative description study exploring nurses’ perspectives and opinions on attributes for a moral distress intervention, and 3) a proposed moral distress intervention applying the findings from phases one and two, and the key elements of relational ethics. The theoretical exploration and subsequent three research phases correspond to the four papers in this dissertation.
Findings: Results from the scoping review highlight that there are limited interventional studies for nurses’ moral distress. Additionally, there is no clear pattern as to which interventions are effective to minimize moral distress. The qualitative description study reveals what pediatric critical care nurses identify as needed moral distress interventions. Participants stated that interventions to increase supports for patients and families, improve supports for nurses, improve patient care communication and provide education would be beneficial to mitigate their moral distress. Integrated findings from study phases and relational ethics, support the need for a proactive, interdisciplinary townhall meeting as a potential moral distress intervention.
Conclusion: This dissertation furthers understanding of moral distress and has laid foundational groundwork to develop an effective intervention to mitigate its effect. This research is the first to synthesize moral distress interventions for nurses, seek nurses’ perspectives to identify interventions needed to mitigate their moral distress, and use relational ethics to inform the development of a moral distress intervention. The results of this research can inform needed rigorous intervention development in this area ultimately leading to improved working environments for nurses. -
- Subjects / Keywords
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- Graduation date
- Fall 2022
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- Type of Item
- Thesis
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- Degree
- Doctor of Philosophy
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- License
- This thesis is made available by the University of Alberta Library with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.