Moral distress among intensive care unit professions in the UK: a mixed-methods study

Objective To assess the experience of moral distress among intensive care unit (ICU) professionals in the UK.Design Mixed methods: validated quantitative measure of moral distress followed by purposive sample of respondents who underwent semistructured interviews.Setting Four ICUs of varying sizes a...

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Main Authors: Joyce Yeung, Christopher Bassford, Anne-Marie Slowther, Adam Jonathan Boulton
Format: Article
Language:English
Published: BMJ Publishing Group 2023-04-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/13/4/e068918.full
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author Joyce Yeung
Christopher Bassford
Anne-Marie Slowther
Adam Jonathan Boulton
author_facet Joyce Yeung
Christopher Bassford
Anne-Marie Slowther
Adam Jonathan Boulton
author_sort Joyce Yeung
collection DOAJ
description Objective To assess the experience of moral distress among intensive care unit (ICU) professionals in the UK.Design Mixed methods: validated quantitative measure of moral distress followed by purposive sample of respondents who underwent semistructured interviews.Setting Four ICUs of varying sizes and specialty facilities.Participants Healthcare professionals working in ICU.Results 227 questionnaires were returned and 15 interviews performed. Moral distress occurred across all ICUs and professional demographics. It was most commonly related to providing care perceived as futile or against the patient’s wishes/interests, followed by resource constraints compromising care. Moral distress score was independently influenced by profession (p=0.02) (nurses 117.0 vs doctors 78.0). A lack of agency was central to moral distress and its negative experience could lead to withdrawal from engaging with patients/families. One-third indicated their intention to leave their current post due to moral distress and this was greater among nurses than doctors (37.0% vs 15.0%). Moral distress was independently associated with an intention to leave their current post (p<0.0001) and a previous post (p=0.001). Participants described a range of individualised coping strategies tailored to the situations faced. The most common and highly valued strategies were informal and relied on working within a supportive environment along with a close-knit team, although participants acknowledged there was a role for structured and formalised intervention.Conclusions Moral distress is widespread among UK ICU professionals and can have an important negative impact on patient care, professional wellbeing and staff retention, a particularly concerning finding as this study was performed prior to the COVID-19 pandemic. Moral distress due to resource-related issues is more severe than comparable studies in North America. Interventions to support professionals should recognise the individualistic nature of coping with moral distress. The value of close-knit teams and supportive environments has implications for how intensive care services are organised.
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spelling doaj.art-ea72fa8d85c3439788a7cb7b7fa546f02024-11-07T05:55:12ZengBMJ Publishing GroupBMJ Open2044-60552023-04-0113410.1136/bmjopen-2022-068918Moral distress among intensive care unit professions in the UK: a mixed-methods studyJoyce Yeung0Christopher Bassford1Anne-Marie Slowther2Adam Jonathan Boulton3associate clinical professor of anaesthesia and critical care medicineWarwick Medical School, University of Warwick, Coventry, UKWarwick Medical School, Coventry, UKWarwick Medical School, University of Warwick, Coventry, UKObjective To assess the experience of moral distress among intensive care unit (ICU) professionals in the UK.Design Mixed methods: validated quantitative measure of moral distress followed by purposive sample of respondents who underwent semistructured interviews.Setting Four ICUs of varying sizes and specialty facilities.Participants Healthcare professionals working in ICU.Results 227 questionnaires were returned and 15 interviews performed. Moral distress occurred across all ICUs and professional demographics. It was most commonly related to providing care perceived as futile or against the patient’s wishes/interests, followed by resource constraints compromising care. Moral distress score was independently influenced by profession (p=0.02) (nurses 117.0 vs doctors 78.0). A lack of agency was central to moral distress and its negative experience could lead to withdrawal from engaging with patients/families. One-third indicated their intention to leave their current post due to moral distress and this was greater among nurses than doctors (37.0% vs 15.0%). Moral distress was independently associated with an intention to leave their current post (p<0.0001) and a previous post (p=0.001). Participants described a range of individualised coping strategies tailored to the situations faced. The most common and highly valued strategies were informal and relied on working within a supportive environment along with a close-knit team, although participants acknowledged there was a role for structured and formalised intervention.Conclusions Moral distress is widespread among UK ICU professionals and can have an important negative impact on patient care, professional wellbeing and staff retention, a particularly concerning finding as this study was performed prior to the COVID-19 pandemic. Moral distress due to resource-related issues is more severe than comparable studies in North America. Interventions to support professionals should recognise the individualistic nature of coping with moral distress. The value of close-knit teams and supportive environments has implications for how intensive care services are organised.https://bmjopen.bmj.com/content/13/4/e068918.full
spellingShingle Joyce Yeung
Christopher Bassford
Anne-Marie Slowther
Adam Jonathan Boulton
Moral distress among intensive care unit professions in the UK: a mixed-methods study
BMJ Open
title Moral distress among intensive care unit professions in the UK: a mixed-methods study
title_full Moral distress among intensive care unit professions in the UK: a mixed-methods study
title_fullStr Moral distress among intensive care unit professions in the UK: a mixed-methods study
title_full_unstemmed Moral distress among intensive care unit professions in the UK: a mixed-methods study
title_short Moral distress among intensive care unit professions in the UK: a mixed-methods study
title_sort moral distress among intensive care unit professions in the uk a mixed methods study
url https://bmjopen.bmj.com/content/13/4/e068918.full
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