Amos Vanessa, Whitehead Phyllis, Epstein Beth
School of Nursing, University of Virginia, Charlottesville, Virginia.
Palliative Care Service, Carilion Roanoke Memorial Hospital, Palliative Medicine/Pain Management, Roanoke, Virginia.
J Healthc Manag. 2025;70(1):32-48. doi: 10.1097/JHM-D-24-00028. Epub 2024 Dec 31.
The objective of this study was to better understand how healthcare systems' unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.
A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected. The authors also conducted interviews about moral distress consultation with unit and organizational leaders using a semistructured interview format. They analyzed interview transcripts using both inductive and deductive coding strategies. Relevant themes and categories were then transferred onto a thematic map for final analysis.
Twenty moral distress consults (10 at each institution) were held during the five-month study period. The mean reported moral distress score for all preconsult participants (n = 52) was 6.9 (SD = 2.5), with scores ranging from 0 to 10. In the combined presurvey and postsurvey group (n = 22), the mean moral distress score was 5.9 (SD = 2.2) prior to the consult and 5.3 (SD = 2.7) after the consult. Participants indicated that moral distress causes were primarily team-level-focused prior to moral distress consultation and system-level-focused after consultation. As consult data were collected, eight unit- and system-level leaders were interviewed. Leaders described moral distress consultation as valuable and empowering to unit-based staff. They endorsed the service's ability to create safe spaces for open communication about morally distressing events. Leaders also suggested the need for more diverse professional representation (outside of nursing) among consultants and participants, as well as more transparent and consistent education plans related to the service, not only to increase leaders' knowledge and awareness of moral distress, but also to increase the visibility of the consult service, both within and outside the organization. Finally, leadership teams valued qualitative accounts of morally distressing events from staff.
Addressing moral distress requires intentional and systemic collaboration, including open communication between moral distress consultation leaders, participants, and unit- and system-level leadership teams. Transparent education plans, broad professional representation, and flexible success measures-including both quantitative and qualitative metrics-are necessary and should be considered for any current or developing moral distress consultation services.
本研究的目的是更好地了解医疗保健系统的单位层面和系统层面的领导者如何看待和体验道德困扰咨询服务，包括其效用、效果和可持续性。
在两个长期提供且积极开展道德困扰咨询服务的学术医疗中心同时采用多方法设计。收集了参与道德困扰咨询的医疗保健提供者的道德困扰数据。作者还采用半结构化访谈形式，就道德困扰咨询对单位和组织层面的领导者进行了访谈。他们使用归纳和演绎编码策略对访谈记录进行了分析。然后将相关主题和类别转移到主题地图上进行最终分析。
在为期五个月的研究期间，共进行了20次道德困扰咨询（每个机构10次）。所有咨询前参与者（n = 52）报告的道德困扰平均得分是6.9（标准差 = 2.5），分数范围为0至10。在综合的调查前和调查后组（n = 22）中，咨询前道德困扰平均得分是5.9（标准差 = 2.2），咨询后是5.3（标准差 = 2.7）。参与者表示，道德困扰的原因在道德困扰咨询前主要集中在团队层面，咨询后则集中在系统层面。在收集咨询数据时，对8名单位和系统层面的领导者进行了访谈。领导者将道德困扰咨询描述为对基层员工有价值且能赋予其力量。他们认可该服务能够为就道德困扰事件进行开放沟通创造安全空间。领导者还建议，在咨询顾问和参与者中需要有更多样化的专业代表（护理之外），以及与该服务相关的更透明、一致的教育计划，这不仅是为了提高领导者对道德困扰的认识和了解，也是为了提高咨询服务在组织内外的知名度。最后，领导团队重视员工对道德困扰事件的定性描述。
解决道德困扰需要有意为之的系统性协作，包括道德困扰咨询领导者、参与者以及单位和系统层面的领导团队之间的开放沟通。透明的教育计划、广泛的专业代表以及灵活的成功衡量标准——包括定量和定性指标——是必要的，对于任何当前或正在发展的道德困扰咨询服务都应予以考虑。
