Nursing & Healthcare News

Palliative Care and Moral Distress

Study calls for greater education and support

Nurse in pink scrubs is reading to her patient who is in a bed

How much do critical care RNs know about palliative care? Not nearly enough, says a recent institutional study in the October 2019 issue of Critical Care Nurse, which warns that nurses may be paying a psychological price for this lack of knowledge.

Education Deficit

Even in fields like critical care and oncology, many nurses still receive little or no education in palliative care, which prioritizes a seriously ill patient’s quality of life over treatment for treatment’s sake.

According to University of Virginia School of Nursing Professor Ken White, AGACNP-BC, Ph.D., ACHPN, FACHE, FAAN, coauthor of a recent institutional study in the October 2019 issue of Critical Care Nurse, critical care RNs “believe that all the palliative care competencies are important, but they don’t rate themselves as competent in those areas.”

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Moreover, nurses who do receive palliative care training may be unable to apply that knowledge due to institutional resistance and what White calls “a misunderstanding on the part of other care providers of what palliative is.”

Moral Distress

The study found that not being able to provide palliative care when it would benefit patients takes a toll on critical care nurses: moral distress, which White defines as the anxiety that occurs “[w]hen an individual knows the morally correct action to take, but is prevented [from] doing so because of internal or external restraints.”

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Study coauthor Alexander Wolf, RN, DNP, APRN, CCRN, warns, “The consequences of moral distress may have far-reaching effects on nurse well-being, as well as turnover and staffing, which may threaten patient safety and cause needless waste.”

White says the answer is better interprofessional education about palliative care’s benefits as well as “giving the nurse a voice on the team, so they can say, ‘I think it’s time to call in palliative care.’”

He says institutions should also provide greater support for nurses dealing with moral distress, such as offering a “moral distress consult service” to help resolve specific issues.

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