Moral Distress Matters: A Quality Improvement Project to Identify, Educate, and Manage Moral Distress in Critical Care Nurses

Abstract Background: Moral distress becomes a significant factor contributing to nurse burnout, turnover and negative impact on patient safety and quality of care. Critical care nurses (CCN’s) experience moral distress at higher rates than non-CCN’s. The original, in-person 4A’s To Rise Above Moral Distress (4A’s) has shown a positive impact on reducing moral distress; however, an online format has not been evaluated. Purpose: 1) Describe CCN’s moral distress level, 2) Adapt and evaluate the online 4A’s program in reducing CCN’s moral distress, and 3) Evaluate the CCN’s acceptability of online 4A’s program. Methods: A quasi-experimental pretest-posttest design was used to describe baseline then post-intervention changes in moral distress using the Moral Distress Scale-Revised (MDS-R). The 4A’s in-person education program was adapted to an online format. Nurses’ acceptability of the program was evaluated using an acceptability survey. Results: CCN’s (N=27) were recruited from a hospital in Central Pennsylvania. Results showed that CCNs’ experienced moderate levels of moral distress (N=27, M=74.9, SD =35.5, range=9-164). Among the five participants who completed the pretest and posttest assessments, four participants had a decreased moral distress levels (decreases ranged from 12 to 76 points) post- intervention, while one had increased distress (increased 20points). The 4A’s online program was reported as helpful and acceptable (N=6, M=100%). Discussion: This 4A’s online program could be a feasible and sustainable approach to reduce moral distress for CCN’s. Due to the large missing data for post-intervention results, the findings need to be verified in future research.



Work Title Moral Distress Matters: A Quality Improvement Project to Identify, Educate, and Manage Moral Distress in Critical Care Nurses
Penn State
  1. DNP Project, moral distress, critical care nurses, 4A's, intervention
License All rights reserved
Work Type Project
  1. Kelly A. Wolgast DNP, RN, FACHE, FAAN
  2. Ying-Liing Jao PhD, RN
  3. Michael M. Evans PhD, MS Ed., RN, ACNS, CMSRN, CNE
Publication Date April 16, 2018
  1. Intervention to reduce moral distress
DOI doi:10.18113/S1291M
Deposited April 16, 2018




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