title: Moral distress in intensive care unit professionals is associated with profession, age, and years of experience.
abstract: OBJECTIVE
  To determine which demographic characteristics are associated with moral distress in intensive care unit (ICU) professionals.
  
  
  METHODS
  We distributed a self-administered, validated survey to measure moral distress to all clinical personnel in 13 ICUs in British Columbia, Canada. Each respondent to the survey also reported their age, sex, and years of experience in the ICU where they were working. We used multivariate, hierarchical regression to analyze relationships between demographic characteristics and moral distress scores, and to analyze the relationship between moral distress and tendency to leave the workplace.
  
  
  RESULTS
  Response rates to the surveys were the following: nurses--428/870 (49%); other health professionals (not nurses or physicians)--211/452 (47%); physicians--30/68 (44%). Nurses and other health professionals had higher moral distress scores than physicians. Highest ranked items associated with moral distress were related to cost constraints and end-of-life controversies. Multivariate analyses showed that age is inversely associated with moral distress, but only in other health professionals (rate ratio [95% confidence interval]: -7.3 [-13.4, -1.2]); years of experience is directly associated with moral distress, but only in nurses (rate ratio (95% confidence interval):10.8 [2.6, 18.9]). The moral distress score is directly related to the tendency to leave the ICU job, in both the past and present, but only for nurses and other non-physician health professionals.
  
  
  CONCLUSIONS
  Moral distress is higher in ICU nurses and other non-physician professionals than in physicians, is lower with older age for other non-physician professionals but greater with more years of experience in nurses, and is associated with tendency to leave the job.
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, B.C., Canada. Electronic address: peter.dodek@ubc.ca.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada; School of Population and Public Health, University of British Columbia, Vancouver, B.C., Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Norena
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, B.C., Canada.
authors.forename: Najib
authors.initials: N
authors.lastname: Ayas
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, B.C., Canada; Department of Critical Care, Royal Columbian Hospital, New Westminster, B.C., Canada.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Reynolds
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, B.C., Canada; Department of Critical Care, Royal Columbian Hospital, New Westminster, B.C., Canada.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
authors.affiliation: School of Nursing, Virginia Commonwealth University, Virginia VA, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Hamric
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, B.C., Canada; Providence Health Care Ethics Services, Vancouver, B.C., Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rodney
authors.affiliation: St. Paul's Hospital, Vancouver, B.C., Canada.
authors.forename: Miriam
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Department of Psychology, University of British Columbia, Vancouver, B.C., Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Alden
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D001955:British Columbia; D003695:Delivery of Health Care / Q000941:ethics*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007588:Job Satisfaction; D008297:Male; D008505:Medical Staff, Hospital / Q000941:ethics / Q000523:psychology*; D008875:Middle Aged; D009014:Morals; D015999:Multivariate Analysis; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Demographics; Intensive care unit; Moral distress