Surgical Intensive Care Unit Nurses' Coping With Moral Distress and Moral Residue: A Descriptive Qualitative Approach

Area of Science:

• Nursing
• Medical Ethics
• Healthcare Quality

Background:

• Moral distress arises when healthcare professionals know the ethically correct action but are prevented from performing it by institutional barriers.
• This phenomenon is particularly relevant in high-stress environments like surgical intensive care units (SICUs).

Purpose of the Study:

• To explore the lived experiences of nurses in surgical intensive care units (SICUs) concerning moral distress.
• To investigate the relationship between moral distress, moral residue, coping mechanisms, and the perceived quality of patient care.

Main Methods:

• Employed a descriptive qualitative research design.
• Conducted in-depth, semistructured individual interviews with SICU nurses.
• Data collection continued until theoretical saturation was achieved in a metropolitan academic medical center.

Main Results:

• Identified five key themes from 21 interviews, revealing root causes of moral distress such as end-of-life care, management conflicts, staffing shortages, and resource limitations.
• Highlighted the profound emotional toll on nurses, with unacknowledged moral distress negatively impacting patient care quality and personal well-being.
• Observed severe consequences, including nurses seeking psychiatric treatment, leaving critical care careers, or pursuing further education to transition out of the SICU.

Conclusions:

• The study validates Epstein and Hamric's Crescendo Effect framework, demonstrating how unaddressed moral distress accumulates, leading to moral residue.
• Confirmed that persistent moral distress and resulting moral residue significantly compromise both the quality of patient care and nurses' overall well-being.
• Emphasizes the critical need for interventions to address moral distress and its consequences within SICU nursing environments.