Moral Distress: Moral distress occurs when one knows the ethically correct thing to do but is prevented from acting on that perceived obligation. It is a well documented phenomenon with negative consequences that may be experienced by nurses. Although a good deal of empirical and theoretical research has identified the problem of moral distress among nurses as causing significant professional turmoil and leading to nursing burnout and intent to leave the profession, no organization has developed, implemented, and evaluated workable strategies for managing this important ethical problem. The Fairbanks Program in Nursing Ethics focuses research efforts to identify interventions that diminish moral distress for nurses.
Moral Distress Thermometer: Creating an instrument to effectively and efficiently measure moral distress in a timely way has been identified as a priority for nursing. The Moral Distress Thermometer (MDT) is a new valid screening tool to measure moral distress in nurses who practice in the hospital setting . The MDT is a single item tool with an 11 point scale from 0 – 10 with verbal descriptors to help anchor the degree of the distress in a meaningful way. Click here to access the Moral Distress Thermometer. The MDT builds on the work of Dr Ann Cook and Helena Hoas who created a Moral Distress Scale in the form of a bookmark (MDB ). The MDB has not been tested for reliability or validity. The MDT has potential for use as a screening tool for moral distress which may facilitate identification of nurses at risk for moral distress related problems.
Unit Based Ethics Conversations: In 2005, FCME developed a program of clinical Unit-Based Ethics Conversations which provide a forum for nurses to share and discuss their ethical concerns. A formal evaluation of this growing program suggests that it is improving moral distress for nurses who participate. UBECs have identified areas which require further empirical research (e.g. Does framing the nurses’ described turmoil as an ethical issue help to diminish moral distress?). Issues identified in UBECs have been adopted for further study by participants in the Clinical Ethics Fellowship and targeted for novel interventions by the Fairbanks Center’s Program on Translational Ethics of Applied Health and Medical Communication (TEAMc).
ICU Demonstration Project: The Fairbanks Program in Nursing Ethics evaluated the impact of a focused Nurse Ethicist intervention regarding coaching bedside nurses in communication with patients, families and other clinical care providers around end-of-life (EOL) conversations. During nurse-to-nurse report the nurse ethicist provided individual coaching for nurses regarding initiating treatment limit setting and other EOL related conversations with either colleagues or the patient’s family. Evaluation of the nurse ethicist intervention was overwhelmingly positive and suggests a potential opportunity for one time and on-going support for bedside nurses from the nurse ethicist. Click here to access an abstract on the ICU Demonstration Project.