By Stacey Kusterbeck
As an early career nurse in 2020, Preston H. Miller, PhD, RN, CCRN-CMC, PCCN, CFRN, experienced the many effects of the COVID-19 pandemic on nursing practice and healthcare in general. At that time, Miller was progressing through the Joint PhD in Nursing Science Program at The University of Alabama in Huntsville College of Nursing and University of Alabama Capstone College of Nursing. Miller began conducting various literature reviews related to nurse well-being, burnout, and ethics. “During my early research, I identified a phenomenon that perfectly conveyed what I was experiencing at the bedside as a critical care nurse: moral distress,” recalls Miller. He conducted a small qualitative study to explore how unit-based critical care nurse leaders navigate moral distress.1 “While at the time I had not completed a formal literature review, I was familiar enough with the literature to know that few, if any, studies had explored this,” says Miller, now an assistant professor in the College of Nursing at The University of Alabama in Huntsville.
Miller wanted to know if unit-based critical care nurse leaders were incorporating known moral distress intervention and mitigation strategies. The study was small, consisting of only five participants from a single hospital in Alabama. “However, I was able to identify that the participants did not feel supported by their organization in navigating moral distress on their units and often felt morally distressed themselves, due to their inability to effectively address the moral distress of their staff,” says Miller. Subsequently, Miller conducted a formal literature review and found that what literature did exist was qualitative in nature.2 “The findings of this review revealed a lack of research on moral distress among unit-based critical care nurse leaders,” says Miller.
Many hospitals lack formal programs to address moral distress. However, some participants in the qualitative study reported that when resources were available (such as ethics consultation services), they often were perceived as ineffective or inconvenient. Most participants detailed their use of external resources, support systems, and self-education as a way to alleviate their moral distress. “They perceived these as more effective than the internal resources at their hospital. This confers with a factor often reported in the literature known as ‘organizational distrust,’” says Miller. For clinicians, Miller says it is important to recognize that moral distress may be unavoidable, but it is possible to mitigate the impact. Ethicists can help nurse leaders by offering programs that are relevant to clinician needs — and convenient. “Ethicist-led training programs may be a way to increase the awareness of nurse leaders surrounding moral distress and enable them to effectively address and mitigate any precipitating causes,” suggests Miller.
- Miller PH, Epstein EG, Smith TB, et al. Critical care nurse leaders addressing moral distress: A qualitative study. Nurs Crit Care 2024; Feb 23. doi: 10.1111/nicc.13045. [Online ahead of print].
- Miller PH, Epstein EG, Smith TB, et al. Moral distress among nurse leaders: A qualitative systematic review. Nurs Ethics 2023;30:939-959.
