Amos Vanessa, Whitehead Phyllis, Epstein Beth
School of Nursing, University of Virginia, Charlottesville, VA, USA.
Carilion Roanoke Memorial Hospital, Roanoke, VA, USA.
HEC Forum. 2025 Jun;37(2):217-233. doi: 10.1007/s10730-024-09535-4. Epub 2024 Aug 3.
Moral distress reflects often recurrent problems within a healthcare environment that impact the quality and safety of patient care. Examples include inadequate staffing, lack of necessary resources, and poor interprofessional teamwork. Recognizing and acting on these issues demonstrates a collaborative and organizational commitment to improve. Moral distress consultation is a health system-wide intervention gaining momentum in the United States. Moral distress consultants assist healthcare providers in identifying and strategizing possible solutions to the patient, team, and systemic barriers behind moral distress. Moral distress consultants offer unique perspectives on the goals, successes, areas for improvement, and sustainability of moral distress consultation. Their ideas can help shape this intervention's continued growth and improvement. This qualitative descriptive study features 10 semi-structured interviews with moral distress consultants at two institutions with longstanding, active moral distress consultation services. Themes from consultant transcripts included consultant training, understanding the purpose of moral distress consultation, interfacing with leadership teams, defining success, and improving visibility and sustainability of the service. These findings describe the beginnings of a framework that organizations can use to either start or strengthen moral distress consultation services, as well as the first steps in developing an evaluation tool to monitor their utility and quality.
道德困扰反映了医疗环境中经常反复出现的问题,这些问题会影响患者护理的质量和安全。例如包括人员配备不足、缺乏必要资源以及跨专业团队协作不佳等。认识到这些问题并采取行动体现了为改进而做出的协作和组织承诺。道德困扰咨询是一种在美国正逐渐兴起的全卫生系统干预措施。道德困扰顾问协助医疗服务提供者识别道德困扰背后的患者、团队及系统层面的障碍,并制定可能的解决方案策略。道德困扰顾问对道德困扰咨询的目标、成效、改进领域及可持续性提供独特见解。他们的想法有助于推动这种干预措施持续发展和改进。这项定性描述性研究对两个长期提供活跃的道德困扰咨询服务机构的10名道德困扰顾问进行了半结构化访谈。顾问访谈记录中的主题包括顾问培训、理解道德困扰咨询的目的、与领导团队沟通、定义成功以及提高服务的可见性和可持续性。这些研究结果描述了一个框架的雏形,各组织可以利用该框架来启动或加强道德困扰咨询服务,以及开发评估工具以监测其效用和质量的初步步骤。