Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses

BACKGROUND: Intensive 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. OBJECTIVES: To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. METHODS: Intensive 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. RESULTS: < .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. CONCLUSIONS: Poor 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.