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 Level III NICU nurses in the northeastern part of US. 94 of 196 eligible RNs participated in the study. “As a whole, the subjects did not perceive that the situations described in the instrument occurred frequently and did not cause great distress. Subjects’ individual scores displayed wide variations for all dimensions of moral distress ranging from low to high, indicating that individual RNs may be experiencing 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 “…39 questionnaires distributed, 28 were returned” (525) Staff nurses in MICU (medical ICU) Mean MDI: 3.66 = mod. Intensity of moral distress overall Mean MDF: 1.73 = situations associated w/ moral distress do not occur frequently “Items r/t provision of aggressive care thought not to be in a patient’s best interest were the source of the greatest distress and were associated with the highest intensity and frequency of moral distress” (525) “Demographic variables analyzed in relation to moral distress scores were age, sex, educational preparation, years of nursing experience, and years of critical care experience. The years of experience in nursing were positively correlated with moral distress scores” (525) 20 ppl responded to open ended questions – everyone was able to give an example of a detrimental effect 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 “registered nurses employed in a critical care setting for at least 1 month…all shifts…37 qualifying nurses” (between 2 units) -Main distress came from continuing tx when it wouldn’t do pt any good -Issues r/t nurse attitude, staffing, triaging, competency, transferring -Coping: o Talking (co-workers, supervisor) o Family meetings about care o Relaxation, deep breathing, counting to 10, distancing self, humor, patience, professionalism, caring  Adequate most of time but not always  Sometimes still feeling of guilt -Affects personal/professional life o Short temper, less focus -Suggestions: o Support groups o Shorter shifts o Better staffing o Keep personal & work lives separate -MDS result: 0.95 Age increased = overall level moral distress decreased (more experience = know how to cope) ReferenceLevel of EvidenceDesignSampleFindings Comments of the Evidence: Strengths- XXXXXXXX Applicability: XXXXXXXX Evidence Search: PubMed Central, EBSCO, CINAHL Key words: ICU, Moral Distress, Registered Nurses, Ethnical Dilemmas