Please enable JavaScript.
Coggle requires JavaScript to display documents.
What are the Causes and Consequences of Moral Distress in Critical Care…
What are the Causes and Consequences of Moral Distress in Critical Care Nursing?
End of life and withdrawal of life sustaining treatment (WLST)
(Hudgins, 2024)
Lack of formal training on end-of-life and palliative care
Diverse ethical beliefs and values regarding withdrawal of life sustaining treatment
MAID legislation (Government of Canada, 2024)
Code Events
Stressful incidents on a regular basis without adequate support or time to process, the expectation to go on with your day (Hudgins, 2024)
Staffing shortages and Economic Burden (Jones, 2025)
Poor retention of staff due to unresolved distress, job disatisfaction and burnout (Dyo, et al., 2016)
Younger and less experienced workforce
Economic burden to hire, train and support newer staff
Sick time and disability costs
Futile care
Feelings that care we are providing is more harmful than helpful (Ananzeh & Miller 2025)
Prolonged Ventilation
Continued treatment despite poor prognosis
Repeat Resuscitations
Increased Costs on System
Ethical Conversations
(Salari et al., 2022)
Disagreeing with patients decisions for treatment
Ethical conversations are not meant to coerce or manipulate patient decisions, but inform, support and guide patients to make the best decisions that align with their values
Power imbalances: Physicians have the final say, nurses ethical concerns may be minimized, ignored or undervalued
Difficulty to get ethics committee consultation
Guided by AHS (2023) Ethics Framework and CNA (2025) Code of Ethics for Nurses: language and ethical expectations of nurses and standard of beneficence
Workload
Critical care patients demand a higher physical and mental workload and lack of support can place nurses in a vulnerable position for moral distress (Prompahakul et al., 2021).
Organizational supports
Current support in Alberta includes:
Peer support with the Critical Incident Stress Management (CISM) team
Short term counselling with the employee and family assistance program (EFAP) (AHS, 2026)
UNA provides $50 per session, requiring a significant portion out of pocket (UNA, 2022)
Inadequate Education and Training
(McAndrew, 2018)
Many CCNs express lack of education and training preparing them for diffcult clinical situations, especially those ethically involved such as palliation, end-of-life, WLST, domestic violence, neglect, suicide attempts, etc.
Burnout (
Butler, 2025)
Burnout symptoms can include anxiety, depression, guilt, exhaustion, difficulty sleeping (shiftwork) & compassion fatigue
Decreased Quality of Patient Care
Threats to professional integrity and lack of trust in the healthcare system
Global Health Concerns
Moral Distress has been documented at an international level, for example there was a study finding moderate level of moral distress in Iranian ICU nurses (Borhani, 2017).
ICN (2021) Code of Ethics for Nurses provides language for nurses to advocate for patients best interests and beneficence, providing respect, dignity and compassion, reducing moral uncertainty.
Conflicting Values
(Salari et al., 2022)
Nurses cultural, religious and moral values may conflict with treatment decisions
Respecting families decisions may conflict with healthcare teams advice
Different definitions of quality of life
Personal Perspective
As a CCN in PICU and NICU I am often faced with ethical conflicts and distressing care situations
COVID-19 Impacts
Covid-19 pandemic has left lasting impacts on CCNs from exhausting working conditions, and a surge of ethical and futile care situations (Andersson et al., 2023)
EDI Concerns
Power imbalances for marginalzed groups (nurses and patients)
Respecting and honouring cultural differences and values, especially during end-of-life and ethical decision making
Systemic racism towards staff and patients may contribute to moral distress especially in racialized and Indigenous nurses
AHS (2015) Diversity and Inclusion framework
Defining Moral Distress
Inability to act according to ones moral judgment due to institutional or external constraints (Morley et al, 2019)
Critical Care Nurses (CCN's) are uniquely susceptible to moral distress, with the highest prevalence of all nursing practice settings (McAndrew, 2018)
Solutions?
Funding and benefits for counselling and therapy to provide nurses with coping strategies to mitigate moral distress (AACN, 2004)
Developing a culture of moral resiliency and fighting the negative stigma around seeking mental health support (Borhani, 2017)
Further research and interventions/resources for CCNs
AACN (2004) Framework
Goal: Recognize moral distress and what to do about it
Determine what is being experienced
Gauge the severity of the distress
Identify causes and constraints
Take action to move forward
