The outcomes of a multifaceted educational intervention to reduce moral distress among critical care nurses

Abstract

AIM : To measure the outcome of the implementation of a multifaceted educational intervention on the impact of moral distress among critical care nurses. BACKGROUND : The complex nature of critical care settings exaggerates different morally distressing situations that require ongoing development of interventions to mitigate the impact of moral distress. Despite the availability of research that has addressed moral distress among nurses in the literature, there is a debate about the effectiveness of the applied interventions in reducing moral distress. DESIGN : A quasi-experimental pretest-posttest control group study design. METHODS : Critical care nurses in two public hospitals in the Emirate of Abu Dhabi, UAE enrolled in a study that extended over 6 months. Hospital A was assigned as an experimental group (n = 76) and received four educational sessions and three booster sessions. Hospital B was assigned as a control group (n = 82) and didn't receive any moral distress-related education. The Measure of Moral Distress for Health Care Professionals questionnaire and the Moral Distress Thermometer were utilised to measure the participants' moral distress frequency, intensity, and composite scores pre- and post-intervention and identify the outcomes. RESULTS : The multifaceted educational intervention exhibited statistically significant reductions in the experimental group frequency, intensity, and composite moral distress scores post-test. Conversely, moral distress scores were increased among the control group. Moreover, the intervention significantly reduced the number of nurses who intended to leave their positions from 58 nurses to 47 nurses in the experimental group. CONCLUSION : The multifaceted educational intervention exerts positive outcomes in reducing moral distress across all the dimensions and improving the nurses' retention. RELEVANCE TO CLINICAL PRACTICE : The intervention provides materials that could enhance the nurses' moral knowledge and skills. It provides different tools, techniques, and strategies to help the nurses address and manage their moral distress.

SUMMARY What does this paper contribute to the wider global clinical community? ○ The effectiveness of the multifaceted educational intervention in mitigating the moral distress of critical care nurses in a diverse setting like the United Arab Emirates makes it suitable to be adopted and implemented in other countries with diverse healthcare settings. ○ The developed intervention could be adopted by hospitals to be a part of their continuous education to enhance the moral knowledge and skills among nurses in other disciplines. ○ The developed moral distress self-reflection form provides an alternative method to act against a morally distressing situation. The form can be adopted by healthcare institutions and added to their portal to facilitate anonymous reporting and solving of morally distressing situations. ○ The developed self-screening Moral Distress Pathway guides the nurses in the field step-by-step to promptly recognise their moral distress, take proactive measures to seek proper support, and determine the appropriate action to take.