SUPPORT: An Evidence-Based Model for Leaders Addressing Moral Distress

The aim of this study is to explore nurse leaders' experiences working in ethically difficult situations and helping nurses cope with moral distress.

Moral distress is associated with ethically complex situations where nurses feel voiceless and powerless. Moral distress can lead to disengagement, burnout, and decreased quality of care.

The critical incident technique was used to collect descriptions of ethically complex situations from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and subsequently counted.

Participants noted affective, behavioral, cognitive, physical, and relational signs of moral distress. System-level factors along with team conflict and different perspectives were perceived to increase the probability of ethical conflicts. Key actions to address moral distress included acknowledging its presence, creating a culture of care, and increasing nurses' resilience to difficult circumstances through education, support, and collaboration.

On the basis of study findings, we created the SUPPORT model as an action guide for addressing moral distress.