Chapter 1: Vicarious trauma & moral distress in the ICU

Moral distress: Disagreement with the plan of care

“It can happen that the team isn’t in agreement with the family’s goals of care. It takes a lot of communication and checking in with the team. It can lead to situations where the nurses or respiratory therapists are administering interventions that they perceive are furthering a patient’s suffering with no sizable benefits or purpose”. - ICU Physician

In addition to being more susceptible to vicarious trauma, ICU clinicians can be more likely to experience moral distress.

Moral distress occurs when someone perceives a moral conflicting dilemma and feels a responsibility to act (or not act) but cannot due to personal, cultural, or institutional constraints. Dilemmas that provoke moral distress are almost inevitable in a complex clinical setting like the ICU.

When a staff member indicates that they are in moral distress based on the treatment plan, your team needs to come together to discuss and revisit the treatment plan. Otherwise, this moral distress can spill over into interactions with the family and undermine the ability to provide effective care as well as lead to staff burnout.

Clinician Tip

Moral distress when doctors and family members aren't on the same page