A multi-centre quantitative assessment of moral distress amongst intensive care unit professions in the UK

Abstract Background:Moral distress is a damaging experience that impacts adversely on healthcare professional wellbeing, however remains poorly studied in the UK. This study aimed to explore how widespread and severe moral distress is amongst intensive care professionals in the UK. Methods: Prior to the COVID-19 pandemic, a paper questionnaire that quantitatively assessed moral distress using the validated Measure of Moral Distress for Healthcare Professionals (MMD-HP) was distributed at four intensive care units of varying size and speciality facilities. Results: 227 questionnaires were returned, including 165 nurses and 40 doctors with a mean age and ICU experience of 38.1 and 10.1 years, respectively. The median moral distress score was 108 (IQR = 78.2, range 0 to 288). Moral distress was greatest in situations related to delivering aggressive treatment that was perceived as futile or not in the patient’s best interests, closely followed by situations related to lack of resources compromising care. Moral distress was independently influenced by profession (p = 0.02) (nurses 117.0 vs doctors 78.0) and had no relationship with participant age and ICU experience. One-third indicated their intention to leave their current post due to moral distress and this was greater amongst nurses than doctors (37.0% vs 15.0%). Multiple logistic regression models included profession, gender, hospital type, age and ICU experience as covariates and had good discrimination and ability to predict intention to leave. Moral distress was associated with an intention to leave their current post in unadjusted and adjusted analyses (adjOR = 1.011 per 1 unit increase in moral distress, 1.006–1.017, p < 0.0001) and a previous post (adjOR = 1.009, 1.004–1.014, p = 0.001). Conclusions: Moral distress appears widespread amongst UK ICU professionals and is worse amongst nurses. Moral distress due to resource-related issues was more severe than comparable studies in North America. Its relationship with an intention to leave a post and the high proportion of ICU nurses considering leaving their current post due to moral distress is concerning, particularly as this study was performed prior to the COVID-19 pandemic. Addressing moral distress should be a priority, however the ideal interventions remain unclear.