Have you ever had to do something that was not in line with your beliefs? CHÉOS Scientists Drs. Peter Dodek, Hubert Wong, Najib Ayas and colleagues have new research findings on this phenomenon, known as moral distress, in the context of a health care setting.

Moral distress is the stress experienced when a health care professional feels certain of an ethical course of action, but is constrained from taking that action, in the workplace. Dr. Dodek and colleagues measured levels of moral distress in 13 ICUs in BC. Results were published in the February issue of the Journal of Critical Care.

The researchers distributed a self-administered survey to over 650 nurses, physicians, and other health professionals (e.g. pharmacists, social workers). They measured moral distress levels, as well as age, sex, and years of experience. They found higher levels of moral distress in nurses and other health care professionals than in physicians. Younger age (in other professionals) and years of experience (in nurses) were associated with high levels of moral distress. Issues related to cost control and end-of-life care were associated with higher levels of moral distress than other situations.

Eighteen per cent of nurses, 10 per cent of other health professionals, and 7 per cent of physicians indicated they were considering leaving their job now due to moral distress. About three times that number had considered leaving their jobs in the past due to this problem. Other consequences of moral distress include frustration and anger.

“Moral distress is an important problem,” Dr. Dodek said. “It is associated with staff leaving the workplace and the causes are largely preventable.”

Targeted initiatives to decrease moral distress could include training in teamwork and communication, and more explicit approaches to end-of-life decision-making and care. In light of the associations observed, the investigators recommend targeting younger members of the other health professionals group, and more experienced nurses.

The leaders of each participating ICU were given the results from their own ICU as well as aggregate results. Dr. Dodek and his team are planning to use participatory methods to develop, test, and evaluate solutions to moral distress.