The relationship between moral distress and perception of futile care in the critical care unit

• Published in: Intensive & critical care nursing Vol. 23; no. 5; pp. 256 - 263
• Main Authors: Mobley, Melinda J., Rady, Mohamed Y., Verheijde, Joseph L., Patel, Bhavesh, Larson, Joel S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2007; Elsevier Limited
• Subjects: Adaptation, Psychological; Adult; Attitude of Health Personnel; Attitude to Death; Burnout; Burnout, Professional - prevention & control; Burnout, Professional - psychology; Chi-Square Distribution; Conflict (Psychology); Critical care; Critical Care - ethics; Critical Care - psychology; Critical care unit; Cross-Sectional Studies; Deception; Ethics; Female; Futile care; Hedonic adaptation; Hospitals, Teaching; Humans; Likert scale; Male; Medical Futility - ethics; Medical Futility - psychology; Medical practices; Middle Aged; Models, Psychological; Moral distress; Morals; Nurse's Role - psychology; Nursing; Nursing Methodology Research; Nursing Staff, Hospital - ethics; Nursing Staff, Hospital - psychology; Organ donation; Ostomy; Patients; Professional Autonomy; Prospective Studies; Surveys and Questionnaires; Critical care unit; Ethics; Organ donation; Burnout; Moral distress; Futile care; Hedonic adaptation
• DOI: 10.1016/j.iccn.2007.03.011
• ISSN: 0964-3397

Study the relationship between moral distress (MD) and futile care in the critical care unit (CCU). A cross-sectional survey consisting of 38 clinical situations associated with MD related to 6 categories: physician practice, nursing practice, institutional factors, futile care, deception and euthanasia was distributed to 100 nurses at a single CCU. The intensity and frequency of MD were scored with Likert scale: 0—lowest and 6—highest. The survey was completed by 44 (44%) nurses. Median age was 33 years, 80% females. Median intensity of MD was high for the six categories and had no relationship with age, time in CCU or nursing practice. The encounter frequency of MD for futile care was the highest and was significantly related to age >33 years ( p = 0.03), time in CCU >4 years ( p = 0.04) and nursing practice >7 years ( p = 0.01). MD associated with clinical situations representing futile care increased with time in CCU. Future interventions are required to minimize the exposure to futile care situations and develop mechanisms to mitigate the effects of MD in the CCU.