• Am. J. Crit. Care · Jan 2025

    From Moral Distress to Moral Integrity: Qualitative Evaluation of a New Moral Conflict Assessment Tool.

    • Soudabeh Jolaei, Patricia Rodney, Rosalie Starzomski, and Peter Dodek.
    • Soudabeh Jolaei is a research ethics and regulatory specialist, Fraser Health Authority, and a research assistant, Center for Advancing Health Outcomes, St Paul's Hospital, Vancouver, Canada.
    • Am. J. Crit. Care. 2025 Jan 1; 34 (1): 525952-59.

    BackgroundMoral distress affects the well-being of health care professionals and can lead to burnout and attrition. Assessing moral distress and taking action based on this assessment are important. A new moral conflict assessment (MCA) designed to prompt action was developed and tested.ObjectiveTo evaluate the utility of the MCA.MethodsAll intensive care unit professionals in 3 hospitals were invited to attend a presentation about the MCA and to participate in semistructured interviews that followed the steps of the MCA. Transcriptions of interviews were interpreted by using qualitative content analysis.ResultsAnalysis of individual interviews of 7 participants and 1 focus group of 3 participants revealed that the MCA was a catalyst for expressing feelings and characterizing moral distress, but optimal use required a facilitator. Participants noted that prevention and amelioration of moral distress were determined by organizational culture issues such as consistent understanding of what can be accomplished in the intensive care unit, resolution of power imbalances among staff, and psychological safety to mention moral issues. Structural determinants included disparate work and education schedules between nurses and physicians. Leader determinants included listening to staff and ensuring accountability to address causes and consequences of moral distress. Education and communication were proposed most often as solutions for moral distress.ConclusionsThe evaluation revealed positive and negative features of the MCA. Prevention and amelioration of moral distress require attention to cultural, structural, and leadership issues through education and communication.©2025 American Association of Critical-Care Nurses.

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