By Stacey Kusterbeck
Ethicists often help nurses and other clinicians to identify and address moral distress during ethics consults. However, ethicists struggle to identify the most effective approaches. Lucia Wocial, PhD, FAAN, RN, HEC-C, and colleagues conducted a study to determine the effect of a two-phased moral stress intervention.1
The researchers interviewed 20 participants, including nurses and other clinical care providers. The study showed a clear inverse relationship between moral distress and moral agency. ”This has implications for interventions. If we can bolster agency, people may feel less constrained when facing situations — when in the past, they may have felt constrained from acting,” says Wocial, a senior clinical ethicist at MedStar Washington Hospital Center in Washington, DC.
The study findings suggested that Facilitated Ethics Conversations can enhance the work environment for clinicians. At IU Health, Facilitated Ethics Conversation training has been available for more than a decade. “The comments from participants reinforced the importance of skillful facilitation,” says Wocial. The facilitator is responsible for keeping the discussion focused on the ethical challenges that contribute to moral distress and not focusing on the emotions that may accompany moral distress. “Emotion has to be acknowledged. But it cannot be the focus of the discussion,” explains Wocial.
Ethicists in the hospital setting should develop skills in facilitating these discussions, advises Wocial. Facilitating the conversations requires ethicists to listen to the stories, as told by the participants, from an ethical perspective. Next, ethicists must identify the key ethical elements of the stories, allowing participants to become more familiar with the language of ethics. ”Facilitation skills are part of core competencies for conducting ethics consultations. It is crucial that ethicists are able to create a brave space where people can share these stories,” says Wocial.
Time is probably the biggest challenge for ethicists in this regard. Clinicians often have trouble stepping away from the bedside, making individual conversations difficult. ”The group discussion offers a better opportunity for participants to learn from each other and build a sense of community,” offers Wocial. For ethicists, Wocial says it is important to track moral distress and assume that people will experience it. Notably, of the study participants, 16% stated an intent to leave their current role specifically because of moral distress.
Simply asking clinicians if they are experiencing moral distress is one way to start the discussion. “Moral distress is often experienced in situations where there is an unintended values imposition of the clinician on a patient situation. The clinician would not choose what a patient or surrogate chooses. That does not make it unethical. When people share their perceptions, it can clarify the ethical challenges,” says Wocial.
Reference
- Wocial LD, Miller G, Montz K, et al. Evaluation of interventions to address moral distress: A multi-method approach. HEC Forum. 2024;36(3):373-401.
