Introducing Clarity into Moral Distress Discernment: A 5-step Intergrated Approach for Palliative Care Leaders

Key Message: This session introduces a five-step moral distress debriefing tool designed to help healthcare leaders create team-based, structural responses to moral distress. By shifting the burden from individuals to systems, the tool fosters shared responsibility, reduces provider isolation, and promotes sustainable, values-driven practice in today’s complex healthcare environment.

Abstract: Background / Purpose
The burden of moral distress is too often placed solely on individual healthcare providers, accompanied by calls for resilience, self-care, and the proverbial "stiff upper lip." However, a paradigm shift is underway—one that urges healthcare leaders to move beyond individual coping strategies and instead foster institutional culture change (1). This presentation introduces a concrete, five-step moral distress debriefing tool that integrates elements from several existing frameworks (2, 3, 4, 5).

Approach
Designed for palliative care and healthcare leaders, the debriefing tool aims to normalize and operationalize team-based responses to moral distress. It draws from trauma-informed principles, relational ethics, and systems thinking, offering a practical structure for reflection and dialogue after ethically challenging events. By embedding structured, relational practices at the team and organizational levels, the experience of moral distress becomes a shared responsibility reducing feelings of powerlessness and isolation among staff.

Implications / Lessons Learned
This approach proactively addresses the risk of burnout by promoting sustainable practice grounded in courage, connection, and, most critically, clarity. As healthcare systems continue to face mounting uncertainty and systemic injustice, cultivating moral clarity is not only necessary, but urgent. When organizations embrace moral distress as a relational and systemic issue—not just an individual burden—they move closer to cultures of ethical sustainability and collective moral integrity.

References: 1. Rushton, C. H. (2024). Moral resilience: Transforming moral suffering in healthcare. Oxford University Press.

2. Alberta Health Services. (2022). Responding to moral distress with reflective debriefing. https://www.albertahealthservices.ca/assets/about/msd/ahs-msd-ahs-moral-distress-resource-guide.pdf

3. Dudzinski, D. M. (2016). Navigating moral distress using the moral distress map. Journal of medical ethics, 42(5), 321-324.

4. PositivePsychology.com (2023, June 1). Understanding the circles of control, influence & concern. PositivePsychology.com. Retrieved July 9, 2025, from PositivePsychology.com website: https://positivepsychology.com/circles-of-influence/

5. Rushton, C. H. (2006). Defining and addressing moral distress: tools for critical care nursing leaders. AACN advanced critical care, 17(2), 161-168.