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Assessing moral distress in respiratory care practitioners*

Schwenzer, Karen J. MD, FCCM; Wang, Lijuan MA

doi: 10.1097/01.CCM.0000248879.19054.73
Clinical Investigations

Objective: To test the reliability and validity of a modified moral distress tool, originally developed for the nursing profession, on respiratory care practitioners. To describe the relationship between moral distress, career dissatisfaction, and job turnover in respiratory care.

Design: A 28-question survey was developed. Three categories of survey questions were predefined: “individual responsibility,” “not in the patient’s best interest,” and “deception.” Additional questions measured career dissatisfaction, job turnover, and demographic information.

Setting: University Hospital at the University of Virginia Health System, a 552-bed tertiary care hospital.

Subjects: Fifty-seven of 115 (49.6%) of respiratory care practitioners responded to the survey.

Interventions: Exploratory factor analysis was used to investigate the underlying factor structure. After we extracted theoretically meaningful factors, reliability of each factor was estimated. Multiple regression analysis was conducted to test if the underlying factors predicted career dissatisfaction and job turnover.

Measurements and Main Results: The factor analysis yielded a five-factor structure. Several questions in the “not in patient’s best interest” category scored the highest moral distress including disagreements with surrogate decision makers and providing futile care. Higher scores were also found with questions regarding the perception of unsafe staffing and passively or actively participating in deception. None of the demographic variables predicted career dissatisfaction or job turnover. However, the perception of unsafe staffing was found to be a significant factor in predicting career dissatisfaction and job turnover.

Conclusions: In this one-center pilot study, respiratory care practitioners reported experiencing moral distress in many areas of their practice. Distress related to the perception of unsafe staffing may be related to career dissatisfaction and job turnover. Further exploration of the factors that contribute to respiratory care practitioners’ moral distress is needed, as well as implementing ways to ameliorate it.

From the University of Virginia Health System, Charlottesville, VA (KJS); and the Department of Psychology, University of Virginia (LW).

Supported, in part, by the Department of Anesthesiology at the University of Virginia Health System.

The authors have not disclosed any potential conflicts of interest.

Address requests for reprints to: Karen J. Schwenzer, MD, FCCM, University of Virginia Health System, Box 800710, Charlottesville, VA 22908-0710. E-mail:

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins