critical care, ethics, moral distress, palliative care



  1. Wolf, Alexander T. DNP, RN, APRN, CCRN


Moral distress is a harmful emotional experience that often afflicts health care providers who care for dying patients. First described among nurses, morally distressing situations are particularly common in critical care, where nurses and other providers can feel forced to prolong their patients' death and suffering in pursuit of curative treatment. Meanwhile, the role of palliative care in the intensive care unit (ICU) continues to evolve, necessitating inquiry about how access to palliative care might affect the moral distress of ICU clinicians. The purpose of this review was to examine the relationship between palliative care and moral distress among health care providers in the adult ICU. An integrative review methodology was used to examine theoretical and empirical literature from 6 databases. Four studies-2 qualitative and 2 quantitative descriptive studies-met the final criteria for inclusion. Overall, inadequate palliative care seems to contribute to moral distress in ICU clinicians, and palliative care education alone is not sufficient to prevent moral distress in nurses and other providers. Further research is needed to examine how specific palliative interventions impact health care provider moral distress and to determine the effects of clinician moral distress on ICU patient outcomes and satisfaction.