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J Soc Work End Life Palliat Care. 2018 Jan-Mar;14(1):44-72. doi: 10.1080/15524256.2018.1437588. Epub 2018 Feb 28.

Reflective Debriefing: A Social Work Intervention Addressing Moral Distress among ICU Nurses.

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a Palliative Care Department , Temple University Hospital , Philadelphia , Pennsylvania , USA.


Health-care workers may experience moral distress when they are unable to act as they believe is ethically appropriate in their clinical work. A social worker-facilitated protocol called Reflective Debriefing was developed and tested for alleviating moral distress through regular debriefings with nursing staff on an intensive care unit (ICU). Forty-two ICU nurses completed a Moral Distress Scale-Revised (MDS-R) at the beginning and end of a 6-month period, during which time regular debriefings were offered. The overall level of moral distress on the ICU surveyed was found to be low to moderate. The top three most frequent situations causing moral distress reported by most nurses in this study were related to the provision of nonbeneficial care in the ICU. Participants reported gaining the most benefit from feeling empowered to constructively confront other staff members about truth-telling in giving a prognosis. Nurses' overall response to the intervention was positive, with 100% of participants requesting to continue the Reflective Debriefing sessions either on a monthly or on an as-needed basis. The response to the intervention emphasized the importance of interprofessional collaboration to successfully combat moral distress among health-care workers and may protect them from burnout, detachment, and even quitting their profession.


Critical care; interdisciplinary debriefing; moral distress; palliative care social work; reflective practice

[Indexed for MEDLINE]

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