• Krista Wolcott Altaker, Jill Howie-Esquivel, and Janine K Cataldo.
• Krista Wolcott Altaker is an assistant professor of nursing at Sonoma State University, Rohnert Park, California. Jill Howie-Esquivel is an associate professor of nursing at the University of Virginia, Charlottesville, Virginia. Janine K. Cataldo is a professor and chair of the Department of Physiological Nursing at the University of California, San Francisco. krista.altaker@sonoma.edu.
• Am. J. Crit. Care. 2018 Jul 1; 27 (4): 295-302.

BackgroundIntensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance.ObjectivesTo evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit.MethodsIntensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale-Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed.ResultsOf 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor's degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r = -0.145; P = .02) and ethical climate scores (r = -0.354; P < .001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores.ConclusionsPoor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress. The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.©2018 American Association of Critical-Care Nurses.

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