title: Understanding the moral distress of nurses witnessing medically futile care.
abstract: OBJECTIVE
  To explore the topic of moral distress in nurses related to witnessing futile care.
  
  
  METHODS
  Literature related to moral distress and futility; analysis of narratives written by 108 nurses attending one of two national continuing education courses on end-of-life care regarding their experiences in the area.
  
  
  RESULTS
  Nurses were invited to share a clinical situation in which they experienced moral distress related to a patient receiving care that they considered futile. Nurses described clinical situations across care settings, with the most common conflict being that aggressive care denies palliative care. Conflicts regarding code status, life support, and nutrition also were common. Patients with cancer were involved quite often, second only to geriatric patients and patients with dementia. The instances created strong emotional responses from nurses, including feeling the need for patient advocacy and that futile care was violent and cruel. Important spiritual and religious factors were cited as influencing the clinical experiences.
  
  
  CONCLUSIONS
  Instances of futile care evoke strong emotional responses from nurses, and nurses require support in dealing with their distress.
  
  
  CONCLUSIONS
  The ethical dilemma of futile care is complex. Additional research and support are needed for patients, families, and nurses.
authors.affiliation: Department of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA. bferrell@coh.org
authors.forename: Betty R
authors.initials: BR
authors.lastname: Ferrell
mesh_terms: D006801:Humans; D018447:Medical Futility / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000523:psychology*; D009014:Morals; D009726:Nurses / Q000523:psychology*; D009859:Oncology Nursing; D013315:Stress, Psychological