Moral distress in critical care nurses caring for patients undergoing ECMO: A cross-sectional study

Extracorporeal membrane oxygenation (ECMO) is commonly used now in cases of refractory cardiac and pulmonary failure. Moral distress among nurses is often present; nevertheless, the literature regarding this topic is scarce.

To identify the level of moral distress among nurses providing direct care to patients undergoing ECMO by applying the Moral Distress Scale Revised (MDSR).

This is a cross-sectional study conducted in an Adult Intensive Care Unit (ICU) in Brazil, involving nurses providing direct care to patients undergoing ECMO. Data on nurse sociodemographic and professional characteristics were collected, along with MDSR data and Moral Distress Index (MDI).

A total of 30 nurses were included, of whom 80.0% were female, with an age of 32 (27.7-38.2) years, professional experience time of 5 (3.0-11.2) years, duration of direct support care experience of 2.5 (1.4-4.0) years, and 83.3% had completed an institutional ECMO course. The questions in the MDRS with the highest mean scores which indicate moral distress were 3 (8.57±4.83), 6 (7.20±4.73), 16 (6.10±6.13), 2 (5.87±4.39) and 7 (5.77±4.26), with these collectively resulting in a mean MDI of 70.7±48.02, indicating a significant intensity and frequency of moral distress experienced by the research participants.

Moral distress for nursing professionals caring for ECMO patients appears to be linked to the need for ongoing questioning, discussions, and reflections among the working teams. The greatest intensity and frequency of moral distress were attributed to adhering to the family's wishes to sustain life even when it might not be in the best interest of the patient. The study highlights the importance of developing educational programs to identify and mitigate the presence of moral distress and its triggering factors in critical care teams, aiming to reduce its impact over time.