Using Evidence-Based Debriefing to Combat Moral Distress in Critical Care Nurses

Abstract

Moral distress (MD) is a problem for nurses which may cause helplessness, despair, or disempowerment. MD is an ongoing reality for nurses and is often experienced in critical care when caring for patients at the end-of-life life or when care is futile. MD can have long-term consequences when not acknowledged and resolved. Repeated exposure to MD can result in moral residue which can eventually result in burnout, dissatisfaction, and resignation from the nursing profession. However, some nurses appear more resilient to MD than others. Creating opportunities for critical care nurses to debrief about their MD might equip them with the tools needed to build moral resilience. Measuring MD, using the Moral Distress Thermometer (scored as 0 to 10), could provide insight into how debriefings help nurses manage MD. The purpose of this project was to examine the impact of evidence-based debriefing sessions on critical care nurses’ sense of moral distress. This project used a quasi-experimental, one-group, before-during-after design. Critical care registered nurses (N = 21) were recruited from one critical care unit at a large academic medical center. Four 30-minute debriefing sessions were held every two weeks. Participants completed the Moral Distress Thermometer two weeks before the first debriefing session, at the end of each session they attended, and at one-month after the debriefing sessions ended. Partial participation was allowed. There was no statistically significant change in MDT scores when comparing pre- with post-intervention scores (t(12) = .78, p = .450). There was no correlation between the number of sessions attended and the one-month post-intervention MDT score (r = .02, p = .937). Mean MDT scores were 3.12 pre-intervention, rose after each of the first three sessions to 5, and then lowered to 3.31 on the post-intervention survey. In the post-survey, participants felt that debriefing was helpful by increasing their self-awareness, giving them time to commune with colleagues, and encouraging them to improve self-care habits. MD is a reality. The use of evidence-based debriefing may help nurses gain self-awareness of and improve their ability to deal with moral distress. Debriefing may offer nurses strategies to build moral resilience.