Evidence-based recommendations for leaders to address moral distress
| See and seek moral distress |
| • Look for ethical concerns and signs of moral distress. |
| • Inquire and consider whether an Ethics Consultation is indicated. |
| Understand moral distress |
| • Understand through active listening. |
| • Be receptive to diverse perspectives. |
| • Model a self-reflective process: be aware of your own biases, remember that ethical issues often are not black and white, and avoid responding with correction/rebuke. |
| Pay attention and assess workplace climate |
| • Acknowledge ethical challenges and moral distress. |
| • Assess the unit climate, culture, tone. |
| • Work to mitigate power differentials between caregivers. |
| • Explore and note repeated occurrences and problems. |
| • Assess professional risks of speaking up. |
| Promote a receptive environment and engage team members |
| • Encourage and create spaces for moral dialogue. |
| • Encourage and role-model respectful communication across disciplines. |
| • Promote team-based dialogue and discussion when ethical issues arise. |
| Open opportunities for dialogue |
| • Encourage debriefing. |
| • Ask whether members of the team might benefit from further discussion with an ethics expert: consider whether a Moral Distress Reflective Dialogue or Debrief is indicated. |
| • Utilize resources: bring team members to multidisciplinary meetings, invite bedside nurses to family meetings, and participate in Bioethics rounds. |
| Reflect, evaluate, and revise |
| • Establish self-care as a custom, ask team members how they are doing, and explore whether they need any additional support. |
| Transform negative environments |
| • Acknowledge that the environment is changing, be transparent and ready to answer questions. |
Developed and adapted from reference 7.