SUPPORT: An Evidence-Based Model for Leaders Addressing Moral Distress.

OBJECTIVE: The aim of this study is to explore nurse leaders' experiences working in ethically difficult situations and helping nurses cope with moral distress.

BACKGROUND: Moral distress is associated with ethically complex situations where nurses feel voiceless and powerless. Moral distress can lead to disengagement, burnout, and decreased quality of care.

METHODS: The critical incident technique was used to collect descriptions of ethically complex situations from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and subsequently counted.

RESULTS: Participants noted affective, behavioral, cognitive, physical, and relational signs of moral distress. System-level factors along with team conflict and different perspectives were perceived to increase the probability of ethical conflicts. Key actions to address moral distress included acknowledging its presence, creating a culture of care, and increasing nurses' resilience to difficult circumstances through education, support, and collaboration.

CONCLUSIONS: On the basis of study findings, we created the SUPPORT model as an action guide for addressing moral distress.