Interim Director of Academic Programs, University of Virginia School of Nursing, University of Virginia Center for Health Humanities and Ethics, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
Icahn School of Medicine At Mt. Sinai, 50 E 98th St. #2A-1, New York City, NY, 10029, USA.
HEC Forum. 2023 Mar;35(1):21-35. doi: 10.1007/s10730-021-09449-5. Epub 2021 Apr 3.
Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed.
To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation.
A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale.
Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment.
Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness.
负责患者护理安全和质量但没有权力实现这些目标的医疗保健提供者会经历道德困境。需要在医疗保健组织中采取干预措施来减轻道德困境。
评估一种既定的、全系统范围的干预措施，即道德困境咨询，对道德困境和临床医生赋权的影响。
使用预/后调查、结构化访谈和咨询主题评估进行了一项准实验、混合方法研究。当出现道德困境时，工作人员会请求咨询。咨询的目的是确定道德困境的原因、行动障碍以及改善情况的策略。干预参与者是参加道德困境咨询的人员。对照组是在咨询前接受调查的员工。在咨询后，对愿意参与的员工和单位管理人员进行访谈。使用道德困境温度计测量道德困境。使用全球赋权量表测量赋权。
进行了 21 次咨询。分析包括 116 次干预和 30 次对照调查，以及 11 次访谈。干预组参与者，尤其是重症监护病房的工作人员，发现了一个小但显著的下降。赋权没有改变。访谈主题支持咨询服务作为公开讨论困难情况的有效模式，以及健康工作环境的重要方面。
道德困境咨询是解决道德困境的全组织机制。咨询并不能解决道德困境，但有助于员工确定改善情况的策略。进一步的研究包括随访可能阐明咨询的有效性。
