title: SUPPORT: An Evidence-Based Model for Leaders Addressing Moral Distress.
abstract: OBJECTIVE
  The aim of this study is to explore nurse leaders' experiences working in ethically difficult situations and helping nurses cope with moral distress.
  
  
  BACKGROUND
  Moral distress is associated with ethically complex situations where nurses feel voiceless and powerless. Moral distress can lead to disengagement, burnout, and decreased quality of care.
  
  
  METHODS
  The critical incident technique was used to collect descriptions of ethically complex situations from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and subsequently counted.
  
  
  RESULTS
  Participants noted affective, behavioral, cognitive, physical, and relational signs of moral distress. System-level factors along with team conflict and different perspectives were perceived to increase the probability of ethical conflicts. Key actions to address moral distress included acknowledging its presence, creating a culture of care, and increasing nurses' resilience to difficult circumstances through education, support, and collaboration.
  
  
  CONCLUSIONS
  On the basis of study findings, we created the SUPPORT model as an action guide for addressing moral distress.
authors.affiliation: Author Affiliation: Associate Professor (Dr Pavlish), Student Research Assistant (Mss So and Wong), School of Nursing, University of California, Los Angeles; Codirector of Ethics Center (Ms Brown-Saltzman), Quality and Safety Specialist (Ms So), University of California, Los Angeles, Health System.
authors.forename: Carol
authors.initials: C
authors.lastname: Pavlish
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown-Saltzman
authors.forename: Loretta
authors.initials: L
authors.lastname: So
authors.forename: Julia
authors.initials: J
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D003220:Conflict, Psychological; D004993:Ethics, Nursing; D055318:Evidence-Based Nursing; D005260:Female; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009718:Nurse Administrators / Q000523:psychology*; D057184:Practice Patterns, Nurses' / Q000941:ethics*; D011795:Surveys and Questionnaires