Moral Agency, Moral Imagination, and Moral Community: Antidotes to moral distress, as reported by experienced ICU nurses regarding the withdrawal of aggressive treatment

Abstract

Moral distress has been covered extensively in nursing literature and increasingly in the literature of other health professions. Cases that cause nurses’ moral distress mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment over comfort care that is typical in intensive care units, much of the existing moral distress research focuses on the experiences of ICU nurses. However, moral distress does not automatically occur in all end-of-life circumstances, nor does every ICU nurse suffer its damaging effects. What are the practices of these nurses? What specifically do they do to navigate around or through the distressing situations? The nursing literature is lacking in answer to these questions. The purpose of this qualitative, interpretative study is to fill in that gap. It uses narrative analysis to explore the reported practices of experienced ICU nurses who are skilled at and comfortable working with families and physicians regarding the withdrawal of aggressive treatment without evidence of experiencing moral distress as described in the nursing literature. The findings are organized under three major themes: (1) moral agency, (2) moral imagination, and (3) moral community. Further, a total of eight subthemes are identified. The practices that constitute these themes and subthemes are further detailed and discussed in this thesis. Understanding these practices can help identify solutions to reduce ICU nurse moral distress.