Abstract

Objectives:

This implementation project aimed to evaluate evidence-based practices for addressing moral distress among nurses working in hematology wards of university hospitals.
Introduction: The hospital ward participating in this project provides nursing care to patients who put their last hope in HLA-haploidentical hematopoietic stem cell transplantation. Many of these patients are adolescent or young adults. Their prognosis worsens as they are repeatedly hospitalized. Some of them are transferred to terminal care with a unstable physical condition. In these situations, nurses have a higher chance of facing moral distress resulting from ethical issues than in other situations.

Methods:

A clinical audit was performed using the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) approach. Three audit criteria that represented best practice recommendations for preventing and addressing moral distress were used. Baseline data were collected from 22 nurses in one hematology ward. Afterwards, multiple strategies were implemented during a 12-month period. Both baseline and postimplementation audits were performed to determine changes in practice.

Results:

The performance of all evidence-based criteria during the baseline audit was poor. We implemented strategies to improve barriers identified through baseline, and the project team carried out and implemented developed strategies following Getting Research into Practice resources. At follow-up, Criteria 1 and 3 improved by a few percent, while Criterion 2 improved from 34% to 49%.

Conclusion:

Education about moral distress and conferences discussing clinical ethics cases might increase nurses' ethical sensitivities.