• Alexander T Wolf, Kenneth R White, Elizabeth G Epstein, and Kyle B Enfield.
• Alexander T. Wolf is a palliative care nurse practitioner, TriHealth, Cincinnati, Ohio. Kenneth R. White is a professor of nursing and medicine and Associate Dean of Strategic Partnerships and Innovation, School of Nursing, University of Virginia, and a palliative care nurse practitioner, University of Virginia Medical Center, Charlottesville, Virginia. Elizabeth G. Epstein is an associate professor of nursing, University of Virginia, Charlottesville. Kyle B. Enfield is an associate professor of medicine, University of Virginia, and director of the medical intensive care unit, University of Virginia Medical Center, Charlottesville atw3dy@virginia.edu.
• Crit Care Nurse. 2019 Oct 1; 39 (5): 38-49.

BackgroundThe need for palliative care in the intensive care unit is increasing. Whether gaps and variations in palliative care education and use are associated with moral distress among critical care nurses is unknown.ObjectivesTo examine critical care nurses' perceived knowledge of palliative care, their recent experiences of moral distress, and possible relationships between these variables.MethodsIn this quantitative, descriptive study, survey questionnaires were distributed to 517 critical care nurses across 7 intensive care units at an academic health center in Virginia. Validated instruments were used to measure participants' perceptions of palliative care in their practice setting and their recent experiences of moral distress.ResultsA total of 167 completed questionnaires were analyzed. Fewer than 40% of respondents reported being highly competent in any palliative care domain. Most respondents had little palliative care education, with 38% reporting none in the past 2 years. Most respondents reported moral distress during the study period, and moral distress levels differed significantly on the basis of perceived use of palliative care (P = .03). Respondents who perceived less frequent use of palliative care tended to experience higher levels of moral distress.ConclusionsMany critical care nurses do not feel prepared to provide palliative care. When palliative care access is perceived as inadequate, nurses may be more apt to experience moral distress. Health system leaders should prioritize palliative care training for critical care nurses and their colleagues and empower them to reduce barriers to palliative care.©2019 American Association of Critical-Care Nurses.

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