Nursing Grand Rounds - Increasing Ethical Awareness and Decreasing Moral Distress: An Educational Program with Demonstrated use of the Donabedian Model

Monday, September 22, 2025, 8:00 AM - Friday, September 22, 2028, 9:00 AM

ANCC Nursing Contact Hours (0.75 hours), General Attendance (0.75 hours)

Moral distress poses a significant challenge to the nursing profession, particularly in high-stress environments like the Medical ICU. When nurses are unable to act in accordance with their ethical values, the impact can be severe, potentially leading to nurse migration, emotional distancing from patients, and increased attrition rates. In response, the presenter developed the Nursing Ethics Education Seminars for nurse residents in the Medical ICU, evaluating ethical awareness and moral distress both before and after the intervention. This presentation will review the existing literature on moral distress, outline the development and implementation of this quality improvement initiative, and share the results and implications for practice.

Presenter

Christopher Charles, MSN, RN, CCRN
Clinical Nurse – Medical Intensive Care Unit
Clinical Ethics Consultant – Clinical Ethics Consultation Team
Dartmouth Hitchcock Medical Center

1. Conceptualize the use of ethics education as a tool to combat moral distress in nursing.
2. Explain the tenets of the Donabedian model, including how use of this model provides RNs the opportunity to define and measure their practice as it relates to patient quality outcomes.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 0.75 ANCC contact hour. 

All other learners may claim General Attendance credit. Consult your professional licensing board regarding the applicability and acceptance of General Attendance credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

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Bibliographic Sources

•  Allen R, Butler E. Addressing moral distress in critical care nurses: a pilot study. Int J Crit Care Emerg Med. 2016;2(1):1-6.

• Epstein, E. G., Whitehead, P. B., Prompahakul, C., Thacker, L. R., & Hamric, A. B. (2019). Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals. AJOB empirical bioethics, 10(2), 113–124. https://doi.org/10.1080/23294515.2019.1586008

• Grace PJ, Uveges MK. Nursing Ethics and Professional Responsibility in Advanced Practice. 4 ed. Burlington, MA: Jones & Bartlett Learning; 2023.

• Grace PJ, Robinson EM, Jurchak M, Zollfrank AA, Lee SM. Clinical ethics residency for nurses: an education model to decrease moral distress and strengthen nurse retention in acute care. J Nurs Adm. 2014;44(12):640-6.

• Hickey J. Interventions to Reduce Nurses' Moral Distress in the Intensive Care Unit: An Integrative Review. Dimens Crit Care Nurs. 2022;41(5):274-80.

• Milliken, A., Ludlow, L., DeSanto-Madeya, S., & Grace, P. (2018). The development and psychometric validation of the Ethical Awareness Scale. Journal of advanced nursing, 10.1111/jan.13688. Advance online publication. https://doi.org/10.1111/jan.13688

• Robinson EM, Lee SM, Zollfrank A, Jurchak M, Frost D, Grace P. Enhancing moral agency: clinical ethics residency for nurses. Hastings Cent Rep. 2014;44(5):12-20.

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
ACE Office
Dartmouth Health
[email protected]

Mitigation of Relevant Financial Relationships

Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.