Respiratory Therapy Blog

In the most recent issue of Critical Care Medicine, Schwenzer and Wang (1) looked at the validity of a moral distress tool, developed for nurses, modified for respiratory therapists. Moral distress develops in situations when one cannot fulfill there their moral obligations to patients or they fail to pursue what they believe to be the correct course of action due to forces often out of their control. This leads to psychological pain and stress symptoms including frustration, anger, and anxiety. Moral distress in nurses has been researched for a number of decades and it is a growing concern and may be a major reason why nurses leave one job for another or abandon the profession.

In Schwenzer and Wang’s pilot study they adapted a 28 question Moral Distress Scale by Corley et al. (2) to better suit respiratory therapists. The questions were listed using a five response Likert scale; never, rarely, sometimes, often and always. The survey questions were broken down into three main categories: “individual responsibility”, “not in the patient’s best interest”, and “deception”. Within each category, questions were also divided into subcategories such as “competency” and “futile care”. The survey was made available to 115 respiratory therapists at the University of Virginia Health System through a Web-based survey instrument. Of the 115 respiratory therapists only 57 (49.6%) responded to the survey. The number of male and female respondents were equally divided, most were older than 40 (61.4%), most worked with adult patients (52.6%) and most had greater than ten years of experience in respiratory care (77.2%). When analyzing the questions, data showed that a higher mean indicated higher moral distress. The means ranged from 3.78 to 1.11 and several questions in the “not in the patient’s best interest” category scored the highest. There was also some demographic differences such as older respiratory therapists had greater moral distress over “futile care” than did younger therapists.

When the authors looked to see if any factors correlated with career dissatisfaction or job turnover the major factor was the perception of unsafe staffing. This is consistent with a previous report by Stoller et al. (3) who found job turnover rate by respiratory therapists correlated significantly with the ratio of hospital beds to respiratory therapists. Also, other previous studies have reported job stress as the strongest predictor of carer dissatisfaction and job turnover but the sources of job stress were not specific to moral distress or inadequate staffing.

The authors did find that their results support the reliability and validity of their modified moral distress scale. They also found that moral distress in respiratory therapists is a major and frequent problem at their institution and they were able to link the perception of unsafe staffing levels to career dissatisfaction and job turnover rate. This was a small pilot study and we must be cautious in reading too much into this study. It would be nice to see this study expanded to a larger population so we could get a better understanding of the causes of moral distress in respiratory therapists. Hopefully it well soon be recognized that all health care professionals suffer from moral distress and steps can be taken to reduce it.

_______________

(1) Schwenzer KJ, Wang L: Assessing moral distress in respiratory care practitioners. Crit Care Med 2006; 34: 2967-2973.

(2) Corley M, Elswick RK, Gorman M, et al: Development and evaluation of a moral distress scale. J Adv Nursing 2001; 33: 250-256.

(3) Stoller JK, Orens DK, Kester L: The impact of turnover among respiratory care practitioners in a health care system: Frequency and associated costs. Respir Care 2001; 46: 238-242.