The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses.

ABSTRACT

BACKGROUND: While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source. OBJECTIVES: to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments. METHODS: This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire. RESULTS: 64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (n = 228, 86.0 %) that their department medical director considers it important for staff to determine patients' end-of-life preferences and that quality of life is of the highest value. CONCLUSIONS: Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.