A great big thank you for years of ethics support in the hospital AND for a great Grand Rounds on How to Mitigate Moral Distress among Providers by our very own Sutter Senior Bioethicist, Dr.Shilpa Shashidhara. 

A recording of her presentation is available HERE. Please watch it if you can!

And here are my notes:

What is moral distress? 

Moral Distress was first defined by Dr. Andrew Jameton (1984) as a natural response to violation of one's core values. In healthcare, it is a feeling of uncomfortableness that arise when providers are unable to do the thing they believe is the "right" thing to do. It is an inability to act within our individual and/or professional values. 

These are ethically challenging situations, where providers feel powerless. 

Moral Distress can lead to disengagement and burnout, can have negative impact on patient care. Prevalent in high stress environments (e.g. ICU: critically ill patients, family members in distress, etc). Has been magnified by the pandemic: challenging clinical situations, managing really ill patients, not having PPE, concerns about allocating resources in stressed healthcare system

• "I don't know if this is the right thing to do"
• "I feel stuck"
• "Both options are equally bad"
• "I feel like I am causing harm to someone"

If not addressed, moral distress takes toll on personal and professional well-being

3 areas that cause moral distress

• clinical situations (e.g. non-beneficial treatments that family is requesting, sense false hope with discordant prognosis by different providers, unrepresented patients that cannot make decisions for self and we don't know their values and acceptable quality of life)
• internal constraints (e.g. fear of speaking up, self doubt, anxiety, wish to not cause conflict, lack of confidence, feeling "stuck" in the middle)
• external constraints (e.g. power imbalance: RN vs. MD, resident vs. attending; fear of legal action,  poor communication)

Moral distress is a root cause of burnout. 

• 42% physicians experience burnout (long hours, overwhelming workload, lack of support)
• 54% of nurses experience moderate burnout with emotional exhaustion,28% high burnout
• significant role of burnout in organizational turnover

How do we mitigate moral distress to best support providers to reduce burnout?

Identify the problem--> Express a concern

Use debriefing sessions, specifically interdisciplinary debriefing sessions

• mitigate negative effects
• normalize and validate experience of negative emotions
• supports providers
• uncovers gaps
• promotes team cohesion
• opportunity to explore systemic problems

Debriefing sessions: goal is NOT just venting session, but also action planning. Both together are more effective

Part 1: Preparatory: identify needs of healthcare provider, gather relevant information, set goals, plan logistics

Part 2: Implemental: 8 step method

4 As to Rise Above Moral Distress (Developed by the American Academy of Critical Care Nurses)

Can be done as individual or ina group

What else can we do?

Targeted education training for providers, promoting provider ethical decision-making. What is appropriate in a complex situation?

Communication skills and practice

Don't forget to take concerns to hospital/clinic administration to be sure they understand what is happening and look at systems-based solutions