Moral Distress and Structural Empowerment among a National Sample of Israeli ICU Nurses

Authors: FDeKeyser Ganz, N Farkash Fink, O Raanaan, M Bruttin, M Ben Nun, Rhaliah J Benbinishty

Moral distress [MD] is defined as knowing the "right" thing to do but not being able to do so due to institutional constraints. High levels of MD have been found among ICU caregivers1. MD has been associated with increased job dissatisfaction, burnout and worker turnover2. Another work related characteristic that might be associated with MD is structural empowerment [SE] or worker perception of access to sources of power in an organization (opportunity, information, support, resources, informal power and formal power)3. This association has been implied by others but has not been investigated.

Aims: The aims of this study were to determine the levels of MD and SE and their association with one another among a national sample of Israeli ICU nurses.

Methods: A convenience sample of 291 ICU nurses were asked to complete 3 questionnaires; a demographic and work characteristics questionnaire, the Moral Distress Scale and the Conditions of Work Effectiveness Questionnaire II.

Results: Participant mean age was 37.9+ 9.2 years with mean ICU experience of 9.4+8.6 years. MD intensity [MDI] was higher than frequency [MDF]. MDIwas not related to SE or any demographic or work characteristics. Significant correlations were found between MDF and general SE (r=-.18, p<.01), MDI (r=.14, p<.05), and age (r=-.14, p=.03).

Conclusions: Levels of MD and SE were similar to previous studies. Personal characteristics were not found to be risk factors for MDI. There is some minor evidence that MDF might be related to SE. There is a need to repeat this study with other populations and to investigate how other aspects of the work environment affect moral distress. Interventions to decrease MD could be especially aimed at younger nurses, those with a lower general feeling of SE, and high feelings of MDI.

1: Corley, M.C. (2002). Nurse moral distress: a proposed theory and research agenda. Nursing Ethics, 9, 636-650.

2. DeKeyser Ganz, F. (2010). Moral distress in critical care healthcare workers. In E. Azoulay (Ed.). End of life care in the Intensive Care Unit-from advanced disease to bereavement. OxfordUniversity Press.

3: Kanter, R.M. (1993). Men and women of the corporation. 2nd ed. New York: Basic Books.

Key words: moral distress, structural empowerment