New approach to assessing and addressing moral distress in intensive care unit personnel: a case study; [Nouvelle approche pour évaluer et traiter la détresse morale chez le personnel des unités de soins intensifs : une étude de cas]

被引：0

作者：

Dodek P.M. ^{[1
]}

Jameson K. ^{[2
,3
]}

Chevalier J.M. ^{[4
]}

机构：

[1] Centre for Health Evaluation and Outcomes Sciences (CHÉOS) and Division of Critical Care Medicine, St. Paul’s Hospital and The University of British Columbia, 588-1081 Burrard Street, Vancouver, V6Z 1Y6, BC

[2] Vancouver Coastal Health Authority, Vancouver, BC

[3] Centre for Applied Ethics, The University of British Columbia, Vancouver, BC

[4] Carleton University, Ottawa, ON

来源：

Canadian Journal of Anesthesia/Journal canadien d'anesthésie | 2022年 / 69卷 / 10期

基金：

加拿大健康研究院;

关键词：

action research; goals of care; intensive care; moral distress;

D O I：

10.1007/s12630-022-02307-z

中图分类号：

学科分类号：

摘要：

Purpose: To test a new approach to address moral distress in intensive care unit (ICU) personnel. Methods: Using principles of participatory action research, we developed an eight-step moral conflict assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU. Results: During three one-hour sessions, participants described their moral distress that was caused by the use of ongoing life-support for a patient who the team believed did not prefer this course of care, but whose family was requesting it. Participants experienced frustration and discouragement and coping strategies included speaking to colleagues and exercising. They felt that they were unable to take meaningful action to resolve this conflict. Values that were in conflict in the situation included beneficence and patient autonomy. Based on ranking of helping and hindering factors, the team proposed new strategies including improving consistency of care plans and educating patients’ family members and ICU personnel about advance care planning and end-of-life care. After completing this assessment, participants reported less stress and a greater ability to take meaningful action, including some of the proposed new strategies. Conclusions: We found this new approach to address moral distress in ICU personnel to be feasible and a useful tool for facilitating plans for reducing moral distress. © 2022, The Author(s).

引用

页码：1240 / 1247

页数：7

共 27 条

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