The relationship between moral distress and perception of futile care in the critical care unit☆

Summary 

Purpose

Study the relationship between moral distress (MD) and futile care in the critical care unit (CCU).

Subjects and methods

A cross-sectional survey consisting of 38 clinical situations associated with MD related to 6 categories: physician practice, nursing practice, institutional factors, futile care, deception and euthanasia was distributed to 100 nurses at a single CCU. The intensity and frequency of MD were scored with Likert scale: 0—lowest and 6—highest.

Results

The survey was completed by 44 (44%) nurses. Median age was 33 years, 80% females. Median intensity of MD was high for the six categories and had no relationship with age, time in CCU or nursing practice. The encounter frequency of MD for futile care was the highest and was significantly related to age >33 years (p=0.03), time in CCU >4 years (p=0.04) and nursing practice >7 years (p=0.01).

Conclusion

MD associated with clinical situations representing futile care increased with time in CCU. Future interventions are required to minimize the exposure to futile care situations and develop mechanisms to mitigate the effects of MD in the CCU.

Keywords: Moral distress, Futile care, Critical care unit, Hedonic adaptation, Burnout, Organ donation, Ethics