An Integrative Review of Moral Distress in Pediatric Intensive Care Unit Nurses

PROBLEM: Nurses in the Pediatric Intensive Care Unit (PICU) face clinical situations that challenge their own morals and values and result in moral distress. Increased rates of moral distress have been correlated with increased job dissatisfaction, higher job turnover, as well as increased burnout. ELIGIBILITY CRITERIA: This integrative review included qualitative and quantitative studies published between 2015 and 2019 that examined nurses’ perceptions of moral distress in the PICU. SAMPLE: Eight studies were selected from CINAHL, PsychInfo, and PubMed for inclusion in the review. RESULTS: Nathaniel’s Theory of Moral Reckoning provided structure for organizing and integrating the literature. Situational binds are encountered regularly by PICU nurses, and include ineffective communication, providing care negatively impacting a patient’s quality of life, and providing care perceived as not in the best interest of the patient. Nurses may move through the resolution and reflection stages of moral reckoning as combined or separate stages. CONCLUSIONS: Recurrent and unresolved situational binds have the potential to cause detrimental, lasting effects on nursing staff including post-traumatic stress disorder, decreased staff retention, and increased burnout. IMPLICATIONS: This review endorses the importance of adequate resources for PICU nurses facing grief, stress, and moral distress, and calls for increased autonomy for nurses on system-wide, unit, and individual levels. Further research is needed to promote healthy adaptation strategies for PICU nurses, as well as programs and policies to support nurses facing moral distress.Bachelor of Scienc