Addressing Moral Distress in Oncology Nurses: New Program Improves Confidence in Ethical Decision-Making

An educational program to address moral distress in inpatient oncology nurses helped participants gain “new-found confidence in their voice and ethical decision-making.”

Hilary Gorgol, RN, BSN, CHPN, of the Massachusetts General Hospital, and colleagues conducted the program and presented their research during the 49^th Annual Oncology Nursing Society Congress.

Ms. Gorgol and colleagues outlined the need for the program, noting that previous research has shown that inpatient oncology nurses “may experience increased levels of moral distress without adequate training and education in recognizing moral distress.”

Moral distress occurs when “a morally or ethically correct decision is clear, but the corresponding action is challenging to undertake due to internal and external constraints.” These constraints can “cause uneasiness and frustration and can lead to burnout and avoidant behaviors,” according to Ms. Gorgol and colleagues.

It was important to offer and evaluate the program to address moral distress because “controlled implementation of an evidence-based educational program in the oncology setting has not been studied,” the researchers said. The purpose of the quality improvement project was to implement the educational initiative on moral distress in an inpatient oncology unit with the objectives of:

• Educating clinical nurses about moral distress and how it relates to practice by exploring mechanisms to work through their own internal constraints.
• Identifying resources to assist with the mitigation of external constraints to achieve resolution.

The researchers conducted a comprehensive review of the literature on moral distress and evidence-based interventions to inform the development of the educational program, which was guided by Nathaniel’s Theory of Moral Reckoning in Nursing. The interdisciplinary program was a 5-session educational series with didactic and interactive components. It was offered in-person and virtually. Participants also received continuing education hours for each session attended.

The researchers assessed the impact of the educational program by administering the Ethics Self-Efficacy Assessment, adapted for oncology nurses, and the Measure of Moral Distress – Healthcare Professionals (MMD-HP) measures. The 23 nurse participants took the tests before and after the program.

Composite scores for the Ethics Self-Efficacy Scale increased by an average of 21.1 points (112.1 vs 136.4, P<.010), and the change in composite scores for the MMD-HP were “clinically significant,” rising from an average of 136.4 to 170.6 (P=.320).

The researchers reflected on the implications of these results, noting that “nurses reported new-found confidence in their voice and ethical decision-making” after participating in the program.

“The integrative educational sessions proved effective in creating awareness and a safe space for staff to share experiences and find community and support,” Ms. Gorgol and colleagues concluded. “The interdisciplinary development and presentation of the program sessions spoke to the complexity and all-encompassing nature of moral distress in the health care system.”

However, the team identified challenges with program implementation and attendance and outlined how they could address these challenges moving forward.

“Time constraints and staffing requirements hindered attendance of sessions and therefore future programs must be supported by leadership and the hospital system to create lasting change,” the researchers concluded.

Reference

Gorgol H, Robinson E, Gerne K, Marmen C, DeMarco L, and Lundquist D. An educational program to address levels of moral distress in inpatient oncology nurses. Abstract #RS114. Presented at the 49^th Annual Oncology Nursing Society Congress, April 24-28, 2024; Washington, D.C.