A Program to Address Moral Distress in Nurses Working in the Neonatal Intensive Care Unit

A Program to Address Moral Distress in Nurses Working in the Neonatal Intensive Care Units.

Purpose

The purpose of this program is to gauge the experience of moral distress in nurses working in a neonatal intensive care nursery in a large acute care hospital setting and to assess the impact of specifically designed interventions aimed at reducing the level of moral distress.

Background

It has been estimated that one in three practicing nurses experiences moral distress in the course of practicing their profession. Anecdotally, this phenomenon has been observed with increasing frequency in staff members working in our critical care areas. A collaborative effort of the Nursing Research Council and the Ethics Resource Group established moral distress as a high priority to improve the work-life of nurses in the organization. Measurement of nurse moral distress before and after a series a planned interventions over the course of one year is underway.

Methodology

A voluntary written survey was administered to staff in the NICU. Corley’s Moral Distress Survey which measures the intensity and the frequency of moral distress was chosen. This tool has been utilized in a number of studies of nurse’s in adult critical care areas but no published study has tested the tool in a NICU setting. In order to utilize the tool, nine items were modified with the permission of the author. The items were also reviewed for content validity by advanced practice nurses experienced in neonatal intensive care. Initial scores were calculated and the tool will be re-administered in approximately nine to twelve months after a series of presentations, skill building sessions and focus groups are conducted with the staff in these areas. Case studies will be utilized to further enhance the skill development.

Conclusions and Implications

Results from the initial survey indicate that staff experience their highest degrees of moral distress related to carrying out treatments they feel are unnecessary, violations of patient privacy and staffing they consider insufficient either due to staffing levels or competency. An unexpected occurrence was the contribution of several “home-grown” case studies which staff preferred to discuss over the prepared cases. The program has resulted in increased calls for Ethics Committee support and anecdotally has improved morale and staff participation in professional activities. Results of the re-survey will gauge the degree of change in the experience of moral distress and will be available at the time of the conference.