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.