1. Moral Distress in the ICU CAT Critically Appraised Topic Caitlin McCabe SN, Leah Miller SN & Kelcie Chyla SN Carroll University, Waukesha, WI Collaborating ICU Practice Council Member: Cindy Zielke ICU Charge RN Waukesha Memorial Hospital, Waukesha, WI PICO QUESTION: What are the facilitators and manifestations of moral distress among ICU nurses and what coping strategies are most effective? CLINICAL BOTTOM LINE: The facilitators and manifestations of moral distress among ICU nurses include: Most effective coping strategies are: Van Eijk, M., Van Marum, R., Cavaliere, T., Daly, B., Dowling, D., & Montgomery, K. (2010). Moral distress in neonatal intensive care unit rns. Advances in Neonatal Care, 10(3), 145-156. X Descriptive Convenience sample of Ninety-four registered nurses from level III NICUs in two flagship hospitals of a large healthcare system in the northeastern United States (Cavaliere, Daly, Dowling, & Montgomery, 2010, p. 147). The primary situation leading to moral distress was providing aggressive care even though the patient would not benefit. Coping strategies recommended in this study involved becoming morally sensitive, being knowledgeable about the distressing situation and its effects, and using moral values to make changes in the workplace. Strategies recommended for the institutions to utilize include encouraging interdisciplinary team collaboration during times of moral distress, providing access to support services, and creating education and training programs specific to moral distress. Elpern, E., Covert, B., Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American Journal Of Critical Care, 14(6), 523-530. X Descriptive Twenty-eight registered nurses from the Medical Intensive Care Unit at Rush University Medical Center, Chicago, Illinois Increased levels of moral distress happened in situations when nurses gave extensive patient care when they felt that the patients’ status would not improve. Manifestations of moral distress included feeling malcontent with job, burnout, and an increase in nurses choosing to quit their job or leave the profession entirely. Unexpected manifestations of moral distress included increased desire to create advance directives and decreased desire to donate blood and organs. McClendon, H., Buckner, E.B., (2007). Distressing situations in the intensive care unit: A descriptive study of nurses’ responses. Dimensions of Critical Care Nursing, 26(5), 199-206. X Descriptive Nine registered nurses from “the intensive and coronary care units at a regional urban hospital in southeastern United States” (McClendon & Buckner, 2007, p. 202). Situations leading to moral distress most often included families wishing to continue treatment when the nurse felt it would not improve the patients’ outcome. Recommended coping strategies include being truthful regarding the patient’s status, relaxation techniques, and emotionally disengaging self from the distressing situation. Additional coping strategies include support systems, and changes in the workplace such as shorter shifts, better staffing, and improving patient and family education. Manifestations of moral distress on nurses’ personal life include feelings of irritability, impatience, and conflict with families. Additional consequences on nurses’ professional life include burnout, loss of focus, insufficient time for tasks, less time to care for families, less patience, and feeling ineffective. ReferenceLevel of Evidence DesignSampleFindings Comments of the Evidence: Weaknesses of the evidence include small sample sizes, poor generalizability, low levels of rigor, and lack of experimental evidence. Strengths include evidence provided by first hand accounts, broad spectrum of settings, inclusion of recommendations to improve moral distress, building up of evidence from previous research, and recent evidence gathered within the past nine years. Applicability: Moral distress is experienced frequently among healthcare professionals, especially in intensive care. It greatly affects nurses’ personal and professional lives. Unfortunately, there is not a way to prevent morally distressing situations from occurring, however understanding the facilitators and manifestations of moral distress and how to cope effectively will help to prepare for and manage such situations. The most applicable part of these studies are the coping strategies. All of the methods stated have been proven to help, and are all very doable for a nurse or healthcare provider. Evidence Search: PubMed Central, EBSCO, CINAHL Key words: ICU, Moral Distress, Registered Nurses, Ethnical Dilemmas