Moral distress reduction using moral case deliberation in Japan: A mixed-methods study

Aims: This study aims to develop and examine the effectiveness of a support program for reducing moral distress of nurses, based on the moral case deliberation methodology, and to study the feasibility of its implementation.Methods: Study design was an intervention study with pre/post-comparison. The support program included a short lecture and three moral case delibera-tion sessions for nurses working in an acute care hospital. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) and the Euro-MCD (Moral Case Deliberation) 2.0 scale were used for pre/post-comparison, using the Wilcoxons signed-rank test. Furthermore, post-intervention interviews were conducted with consenting participants to determine the reasons for changes in pre/post-intervention quantitative data. Of the 34 participants, 29 completed the post-questionnaire and were included in the quantitative data analysis, and 27 were included in the qualitative data analysis.Results: The mean MMD-HP total scores increased from 147.5 +/- 61.0 to 159.3 +/- 66.7, but not significantly (p = .375). The mean score of moral compe-tence, a sub-scale of the Euro-MCD 2.0, increased significantly from 15.4 +/- 2.4 to 16.4 +/- 2.8 after the intervention (p = .036). A qualitative analysis revealed increased moral sensitivity to ethically difficult situations and improved ana-lytical skills as the reasons for change in scores pre/post-intervention.Conclusion: The results of the qualitative analysis suggested the effectiveness of the intervention. The moral distress score increased, although not signifi-cantly, and moral competence also increased, suggesting the participants' values changed after the intervention. It was found that the support program using MCD is expected to improve participants' moral competence.