Moral Distress Consultation Services: Insights From Unit- and Organizational-Level Leaders

Abstract

Goal: The objective of this study was to better understand how healthcare systems' unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.

Methods: A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected. The authors also conducted interviews about moral distress consultation with unit and organizational leaders using a semistructured interview format. They analyzed interview transcripts using both inductive and deductive coding strategies. Relevant themes and categories were then transferred onto a thematic map for final analysis.

Principal findings: Twenty moral distress consults (10 at each institution) were held during the five-month study period. The mean reported moral distress score for all preconsult participants (n = 52) was 6.9 (SD = 2.5), with scores ranging from 0 to 10. In the combined presurvey and postsurvey group (n = 22), the mean moral distress score was 5.9 (SD = 2.2) prior to the consult and 5.3 (SD = 2.7) after the consult. Participants indicated that moral distress causes were primarily team-level-focused prior to moral distress consultation and system-level-focused after consultation. As consult data were collected, eight unit- and system-level leaders were interviewed. Leaders described moral distress consultation as valuable and empowering to unit-based staff. They endorsed the service's ability to create safe spaces for open communication about morally distressing events. Leaders also suggested the need for more diverse professional representation (outside of nursing) among consultants and participants, as well as more transparent and consistent education plans related to the service, not only to increase leaders' knowledge and awareness of moral distress, but also to increase the visibility of the consult service, both within and outside the organization. Finally, leadership teams valued qualitative accounts of morally distressing events from staff.

Practical applications: Addressing moral distress requires intentional and systemic collaboration, including open communication between moral distress consultation leaders, participants, and unit- and system-level leadership teams. Transparent education plans, broad professional representation, and flexible success measures-including both quantitative and qualitative metrics-are necessary and should be considered for any current or developing moral distress consultation services.