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Moving from Moral Distress to Moral Integrity: Fostering Ethical Practice in Intensive Care Units

Principal Investigator: Dr. Peter Dodek

Status: Ongoing

Providing effective care for seriously ill elderly patients requires that health care team members function well together and are able to practice safely and ethically. This is especially true in intensive care units (ICUs), where the technological environment is intense and uncertainty regarding appropriate levels of treatment for critically ill elderly patients is pervasive.

Research has shown significant levels of moral distress in ICU professionals, especially nurses. Moral distress is the anger, frustration, guilt, and powerlessness that health care professionals experience when they are unable to practice according to their ethical standards. Studies have linked moral distress to burnout and attrition, which jeopardize the sustainability of the ICU workforce, jeopardize the quality of clinical decision-making and care for seriously ill patients and their family members, and increase health care costs as new health care professionals must be recruited and educated to work in ICU settings.

In Dr. Peter Dodek’s quantitative (survey) and qualitative (focus group) study of moral distress in 13 intensive care units in B.C., they found that moral distress was common and that nurses and other non-physician health professionals report higher moral distress than physicians. Survey items that correlate most strongly with the overall magnitude of moral distress are related to end of life and communication issues; qualitative assessment corroborates these findings. Consequences of moral distress include feelings of frustration and propensity to leave the job.

Researchers are now poised to develop, implement, and evaluate interventions to decrease moral distress and to help providers enact their moral integrity (the converse of moral distress). The objective of this research project is to develop and test interventions at one tertiary and one community ICU. Using participatory action research methods, investigators will describe the current moral climate in the ICUs and work with clinicians and administrators to develop strategies to improve it, as well as evaluate and improve the effectiveness of these strategies using surveys and focus groups. They will also analyze the correlations between changes in these measures and provider outcomes (e.g., sick time, quitting the job) and measures of family satisfaction. The researchers aim to translate the knowledge from this pilot project into a subsequent larger project in more ICUs.

Health research in the heart of Vancouver