title: Causes of moral distress in the intensive care unit: A qualitative study.
abstract: The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs.
  
  
  
  We used focus groups and coding of transcripts into themes and subthemes in 2 tertiary care ICUs and 1 community ICU.
  
  
  
  Based on input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported causes of moral distress were concerns about the care provided by other health care workers, the amount of care provided (especially too much care at end of life), poor communication, inconsistent care plans, and issues around end of life decision making.
  
  
  
  Causes of moral distress vary among ICU professional groups, but all are amenable to improvement.
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Henrich
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: peter.dodek@ubc.ca.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
authors.affiliation: Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Alden
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
authors.affiliation: Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Reynolds
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rodney
mesh_terms: D001955:British Columbia; D003657:Decision Making; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D009014:Morals; D010348:Patient Care Team; D013315:Stress, Psychological; D013727:Terminal Care / Q000941:ethics / Q000523:psychology*
keywords: Focus groups; Intensive care; Moral distress