Recognizing and Responding to Moral Distress (FR463)

•Define moral distress and identify individual, case-specific, and institutional risk factors for developing it.•Discuss the experience of moral distress and strategies for identifying and managing it in ourselves and others.•Explain how facilitated ethics conversations can address moral distress at an institutional level. Moral distress occurs when you can’t do what you believe is right because of institutional barriers and feel forced to act contrary to your core values. Although moral distress has been studied most in nursing, it has been documented in numerous healthcare professions and in healthcare managers. Palliative care and hospice providers may personally experience moral distress, and also may interact with colleagues who are experiencing it. “Untreated” moral distress can lead to burnout, to individuals leaving their positions, and even to individuals leaving their professions. This can be psychologically costly for individuals and financially costly for institutions. Members of the palliative care team may be able to recognize moral distress in themselves and their colleagues, and then may help institute interventions to prevent its adverse outcomes. First, Dr. Vig, a palliative care specialist/ethicist, will provide an overview of moral distress through presentation and discussion of a case. She will define moral distress, review the disciplines at risk for developing it, and discuss risk factors (individual, clinical, and institutional) for developing moral distress in the context of the case. She will use an Internet-based poll embedded in the PowerPoint for audience participation. Second, Dr. Wocial, a nurse/ethicist, will describe the experience of having moral distress and ways to identify it. She will explain the “crescendo effect” that moral residue builds over time and describe the consequences for institutions of having staff with moral distress. Next, Dr. Wocial will discuss an intervention aimed at reducing moral distress. This program, titled Unit-Based Ethics Conversations, at Indiana University Health, provides a forum for hospital-wide discussion and awareness of moral distress. She will show a short video of this intervention. This presentation is geared toward clinicians with a range of experience who practice palliative care and hospice in different settings.