Moral distress and patients who forego care due to cost

BACKGROUND: In the US, many patients forgo recommended care due to cost. The ANA Code of Ethics requires nurses to give care based on need. Therefore, US nurses are compelled to practice in a context which breaches their professional ethical code. RESEARCH OBJECTIVES: This study sought to determine if nurses do care for patients who forgo treatment due to cost (PFTDC) and if so, does this result in an experience of moral distress (MD). RESEARCH DESIGN: Semi-structured interviews were transcribed and analyzed using a qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A convenience sample of 20 nurses in practice for at least one year from a variety of health care setting participated. ETHICAL CONSIDERATIONS: This project was approved by the Michigan State University Biomedical Institutional Review Board. RESULTS: There were 19 female and one male nurse-participants, averaging 47 years old with an average of 10 years in practice. 18 reported caring for PFTDC. These 17 nurse-participants experienced a moderate degree of MD as a result, averaging 5.4 of 10 on the Moral Distress Thermometer. In the interviews, the following themes were identified, strategies to help PFTDC, and the broken US health care system which had the subthemes of preference for business over patient-oriented benefit, PFTDC using the emergency department, and limited support for treatment/management of PFTDC. CONCLUSIONS: The existence of this phenomenon places the profession of nursing in the US in a position of moral compromise and threatens to corrupt the institution of nursing in the US.