Countering Moral Distress in ECMO nurses with Case-Review Debriefings

Abstract Background: Moral Distress occurs when nurses know the ethically correct action to take, but they are restrained from taking it. It is especially prevalent in nurses caring for critically ill patients, such as those on extra-corporeal membrane oxygenation (ECMO). Effectively addressing moral distress is crucial to the growth and health of the nursing profession, which is the cornerstone of quality and safety in healthcare. Purpose: The purpose of this project was to evaluate the effectiveness of case-review debriefings on moral distress of ECMO nurses. Conceptual Framework: Analysis of Moral Distress Process was utilized. This framework addresses moral distress as a process that articulates various concepts such as uncertainly, moral sensitivity and moral deliberation. The processes of moral competencies guided the intervention and tools utilized in this project. Methodology: Thirty-nine critical care registered nurses with specialty training in ECMO were invited to participate in this quasi-experimental study with a pre/post intervention survey design. The intervention was two case-review debriefings. The Moral Distress Scale-Revised for Health Care Providers (MDS-HP) and the Moral Distress Thermometer (MDT) were used for the pre- and post-survey to measure long-term and “acute” or short-term moral distress. Results:Based on a potential range of 0-336, the MDS-HP pre-intervention mean was 134.0 and the post-intervention mean was 131.8 (n=20 pre, n=19 post; p =.84). MDT scores decreased for 80% of participants and increased for 20%; the decrease was significant over time (p Mean = 42.55 and post, Mean = 42.53), but the level of moral distress increased following the intervention (pre, Mean 57.9 and post, Mean = 59.47). Five items related to perceptions of prolonging death and suffering were revealed to be root causes of most of the moral distress. Discussion: Use of case review debriefing interventions implemented in this study were not effective for decreasing chronic moral distress. However, in the short-term, they proved beneficial in decreasing acute moral distress. Conclusion: Moral Distress is a complex experience that ECMO nurses face due to repeated exposures to a myriad of ethically challenging patient situations. Developing strategies and providing opportunities to mitigate moral distress is crucial to a healthy future nursing workforce. Implications include the potential for improved patient care, decreased turnover rates and therefore costs, as well as improving nurse satisfaction rates