A Clinical Nurse Specialist Initiative to Address Moral Distress in Military Critical Care Nurses
Topic of Interest
CNS as Project Manager
Capture Value of the CNS
Interprofessional Collaboration
Abstract
Background
The U.S. military prides itself in delivering optimal care to its members often in unpredictable, unforeseeable, and austere conditions. In these types of healthcare environments, moral and ethical situations are likely to occur. Little research has been completed documenting moral distress and/or moral injury in military healthcare providers. A PhD-prepared Clinical Nurse Specialist is optimally trained to address this formidable but critical topic for the best patient, provider and system outcomes. A scientific approach, while incorporating the wholeness and the intricacies of patient care in a military health system, was necessary to produce reliable evidenced-based practice measures for trusted care delivery to our military members.
Methods
The purpose of this project was to examine the topic of moral distress and moral injury in military critical care nurses across all service branches. This project was implemented in three phases: 1) background, 2) tool building workshop, and 3) tool testing. In the background phase of these efforts, the concepts of moral distress in healthcare providers and moral injury in the warfighter were examined by an expert panel according to the Joanna Briggs Institute scoping review methodology. Phase two of the study adapted the existing Moral Distress for Healthcare Professionals (MMD-HP) tool to measure moral distress in military critical care nurses while incorporating the concepts of moral injury as warfighters. In the final phase, testing of the tool is currently being conducted in critical care nurses across all military branches.
Outcomes
A scoping review of the two topics was performed resulting a more explicit understanding of the similarities and differences between the concepts. Next, a three day workshop was conducted to bring thirteen military and civilian representatives assembled to adapt the existing civilian tool to a military critical care nurse application. This tool refinement included integration of moral distress, moral injury, and military and critical care relevant concepts through application of evidenced-based findings, subject matter expert recommendations and tests of validity. A tool testing plan was developed on the last day of the workshop. The workshop resulted in the MMD-HP-M (military version) and is in the data collection phase with dissemination to all critical care nurses, across all military branches. These results will help to validate the psychometric outcomes of the revised tool, as well as, establish reliability of the original questions to this healthcare population.
Implications
Military members practicing in these healthcare environments are simultaneously healthcare providers and warfighters, which may pose situations where both moral distress and moral injury are applicable. These efforts will help to add to our foundational knowledge of the concepts and produce evidenced-based interventions to lessen the long-term consequences of these phenomena. A PhD-trained CNS is one of few advanced practice clinicians trained to incorporate the needs of the provider, patient and families, uniqueness of the system, and complexities of healthcare delivery to optimize outcomes. Direct care expertise, advanced knowledge of the topic and an understanding of the unique military healthcare system was necessary to address moral distress and moral injury to reduce suffering and optimize healthcare delivery.