A survey of moral distress in staff working in intensive care in the UK – A reply

We read with interest the work by Colville et al. in investigating moral distress amongst intensive care unit (ICU) professionals in the UK. ¹ This is an important and concerning subject which is under-researched in the UK and this study is a welcome first step in highlighting its impact on intensive care staff. The paper highlights the scarcity of research into moral distress in UK ICUs. As the authors point out, this is a small single centre study and larger multicentre studies are required to substantiate their preliminary findings and more accurately gauge the extent of the problem.

Before adopting the survey instrument for use more widely in the UK, it will be important to validate it with healthcare professionals working in UK ICUs. The revised moral distress scale (MDS-R) has been developed and validated using qualitative work performed in North American populations.^2–4 These working environments are likely to differ from those in the UK and so some scenarios resulting in moral distress within the UK may not be captured using this tool. We would also recommend that this type of survey-based research is accompanied by a qualitative exploration of moral distress in UK ICUs. This would help understand the specific context that forms the environment in which moral distress occurs. ⁵ Additionally, this would also frame the development of strategies to support professionals experiencing moral distress.

Colville et al. have provided a valuable insight into moral distress in the UK ICU population and have raised the profile of this area of research. Further study of moral distress in the UK should aim to build on this work and investigate moral distress in a qualitative manner in addition to quantitative assessments. This will be key to understanding the nature and context of the UK ICU experience of moral distress and subsequently how it may be tackled.