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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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Open Access 23-08-2022 | Care | Reports of Original Investigations

New approach to assessing and addressing moral distress in intensive care unit personnel: a case study

Authors: Peter M. Dodek, MD, MHSc, Kim Jameson, MA, Jacques M. Chevalier, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 10/2022

Abstract

Purpose

To test a new approach to address moral distress in intensive care unit (ICU) personnel.

Methods

Using principles of participatory action research, we developed an eight-step moral conflict assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU.

Results

During three one-hour sessions, participants described their moral distress that was caused by the use of ongoing life-support for a patient who the team believed did not prefer this course of care, but whose family was requesting it. Participants experienced frustration and discouragement and coping strategies included speaking to colleagues and exercising. They felt that they were unable to take meaningful action to resolve this conflict. Values that were in conflict in the situation included beneficence and patient autonomy. Based on ranking of helping and hindering factors, the team proposed new strategies including improving consistency of care plans and educating patients’ family members and ICU personnel about advance care planning and end-of-life care. After completing this assessment, participants reported less stress and a greater ability to take meaningful action, including some of the proposed new strategies.

Conclusions

We found this new approach to address moral distress in ICU personnel to be feasible and a useful tool for facilitating plans for reducing moral distress.

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Title: New approach to assessing and addressing moral distress in intensive care unit personnel: a case study
Authors: Peter M. Dodek, MD, MHSc
Kim Jameson, MA
Jacques M. Chevalier, PhD
Publication date: 23-08-2022
Publisher: Springer International Publishing
Keyword: Care
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 10/2022
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02307-z

At a glance: The STEP trials

Springer Medicine

New approach to assessing and addressing moral distress in intensive care unit personnel: a case study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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