In February 2018 the Critical Care Council of Nursing Shared Governance began working on an initiative related to burnout and moral distress among critical care nurses at Piedmont Atlanta Hospital. Based on their observations and experiences, the council members hypothesized that some CCU, CVICU, and MSICU nursing staff might be categorized as burnt out or in moral distress. They did a preliminary literature search and found a validated and reliable tool called the Moral Distress Scale (MDS) for use among nurses. The MDS utilizes 21 items on a Likert-type scale to determine the frequency of moral distress in the nurse and the level of disturbance. The council surveyed over 80 critical care nurses (about 30% of the critical care nursing workforce at PAH) using the MDR. The results were clear. End of life care was the one singular topic that caused the most frequent moral distress and the highest level of disturbance among PAH critical care nurses.
The Critical Care Council came up with a multi-faceted approach to combat moral distress among nurses, especially as it relates to end of life care. The first objective was to start the conversation about palliative care at Piedmont Atlanta. The hospital had no palliative care physician at the time and the council encountered several providers who expressed some level of objection to palliative medicine for their patients. The council developed and hosted a 2-day palliative care forum, held in June, to champion palliative care for PAH patients. Topics at the forum included case studies from actual patients, lunch and learns about palliative care, and special lectures by world-renowned palliative care physician Dr. Sandra Gomez, MD of Memorial Hermann Hospital in Houston, Texas. The forum was instrumental in shining a spotlight on palliative care at Piedmont Atlanta.
To further combat overall distress and burnout, the council introduced a standardized debrief tool to be used in the critical care units. Unlike debrief tools that are used after clinical situations (such as cardiac arrest), this tool was meant to be implemented any time a nurse or group of nurses felt distressed as a result of a patient’s psychosocial situation. Furthermore, the council partnered with the Care Management department to set up in-services on topics such as elder abuse, adult protective services, and other issues that may cause moral distress in nurses.
As a result of their work, palliative care has been rebranded as supportive medicine at Piedmont Atlanta. A Supportive Medicine Council was established in July 2018 and includes Critical Care Council members Lindsey Andresen,, RN and Sean Russell, RN as well as CNO Kelly Hulsey and CMO Dr. Mark Cohen. The critical care council also worked with clinical nurse specialist Andrea Wilkins Howard to submit an abstract of their project to the Center to Advance Palliative Care (CAPC). The abstract was accepted and four members from the council will be participating in a poster presentation at CAPC’s national conference later this year.