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Palliative Care Consultation Policy Change and Its Effect on Nurses' Moral Distress in an Academic Medical Center

Bosshardt, Maribeth H., MD; Coyne, Patrick J., MSN, ACHPN, ACNS-BC, FAAN, FPCN; Marsden, Justin, BS; Su, Zemin, MS; Melvin, Cathy L., PhD, MPH, BA(Hons)

Journal of Hospice & Palliative Nursing: August 2018 - Volume 20 - Issue 4 - p 325–329
doi: 10.1097/NJH.0000000000000456
Ethics Series

Moral distress affects workplace environment, burnout, employee retention, and patient safety. Palliative care is frequently involved in complex care for patients that may cause moral distress among staff. The goal of this study was to measure change in moral distress among nurses after implementation of a policy that allows nurses to consult palliative care. Before the policy change, data were gathered via email using the Moral Distress Scale-Revised. The scale was redistributed 6 months after implementation of the consult policy. Pre and post Moral Distress Scale-Revised results were analyzed. Qualitative thematic analyses of the nurses' comments were conducted.

A significantly lower percentage of nurses reported providing care for a hopelessly ill patient frequently or very frequently (34.6% vs 23.1%, P = .0397) after the policy change. However, a significantly higher percentage of nurses postpolicy reported frequently or very frequently providing less-than-optimal care because of pressures from administrators/insurers (14.4% vs 21.1%, P = .0378), caring for patients they did not feel qualified to care for (5.3% vs 14.8%, P = .0055), and working with providers who were not competent to care for the patient (13.9% vs 26.9%, P = .0059). Themes from nurses' comments were inadequate staffing, communication, ethical concerns, and lack of education.

Maribeth H. Bosshardt, MD, was an assistant professor of medicine, Medical University of South Carolina, Charleston at the time of the study.

Patrick J. Coyne MSN, ACHPN, ACNS-BC, FAAN, FPCN, is director of palliative care, Medical University of South Carolina, Charleston.

Justin Marsden, BS, is program coordinator II, Medical University of South Carolina, Charleston.

Zemin Su, MS, is research instructor, Division of General Internal Medicine& Geriatrics, Medical University of South Carolina, Charleston.

Cathy L. Melvin, PhD, MPH, BA(Hons), is professor, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston.

Address correspondence to Patrick J. Coyne, MSN, ACHPN, ACNS-BC, FAAN, FPCN, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425 (

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.