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Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: a qualitative interview study.

Arends, S.A.M., Steenbergen, M., Thodé, M., Francke, A.L., Jongerden, I.P. Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: a qualitative interview study. Patient Education and Counseling: 2022, 105(7), p. 2531-2536
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Objective
To explore whether nurses in hospital settings experience moral distress when involved in potentially life-prolonging treatments in adults with a short life expectancy.

Methods
A qualitative study using semi-structured interviews.

Results
23 Registered nurses working in inpatient or outpatient hospital settings participated. The nurses stated they were often not involved in decisions regarding life-prolonging treatments. They reported signs of moral distress such as feeling powerless when they when they were not being listened to in the decision-making process and when confronted with negative treatment outcomes. Nurses felt frustrated when their own values were not reflected in the decision-making or when physicians created unrealistic expectations.

Conclusions
Hospital nurses experience moral distress when they are involved in life-prolonging treatment because of the patient’s advanced condition and their own lack of involvement in the decision-making process about the treatment. In these situations, moral distress is characterised by feelings of powerlessness and frustration.

Practice implications
Nurses need to be empowered by training programmes that focus on an active role in the decision-making process. Further research is needed to evaluate effective tools and training programmes that help nurses in shared decision-making processes.