Document Type

Dissertation/Thesis

Date Created

10-2023

Abstract

Moral distress is recognized in the literature as a significant problem for nurses working in the intensive care unit (ICU). Moral distress occurs when one knows the right course of action but is unable to follow it due to team or organizational constraints. Moral distress may lead to physical and psychological symptoms resulting in burnout, job attrition, and a negative impact on patient care. While interventions for reducing moral distress among ICU nurses are limited in the literature, one potentially promising approach is reflective debriefing. This Doctor of Nursing Practice (DNP) scholarly project aimed to explore the intensity, frequency, and root causes of moral distress among registered nurses in an adult ICU setting and the feasibility of reflective debriefing as a potential intervention. Using the knowledge to action framework as a guide for project development, this exploratory project utilized a valid and reliable survey to assess the level and root causes of moral distress among a sample of 42 ICU nurses at the project site. The results indicated a moderate level of moral distress with 33% (n = 14) of nurses indicating they were considering vacating their current position due to this issue. Root causes of moral distress were primarily related to aggressive end-of-life treatment decisions. An evidence-based debriefing guide was developed and implemented over a total of 10 sessions attended by 15 nurses. Barriers to participation in reflective debriefing at the project site were attributed to heavy workloads and high patient acuity. Findings from this project might influence support iv mechanisms for nurses at the personal, team, and organizational levels at the project site and more broadly in the critical care setting.

Keywords

moral distress; intensive care unit; nurse; debriefing

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