Handling Moral Distress Accredited Course

by Kat Williams

To continuously improve the mental wellbeing of veterinary teams, a Handing Moral Distress Accredited Course could be delivered to empower employees and employers with individual AND systemic strategies to handle the moral distress and ethical trauma we inevitably face in our profession.

The wellbeing and strategies of individuals and organisations interact and affect one another, so a holistic approach is needed to order to champion effective and sustainable solutions for our veterinary ecosystem.

The course would be accessible to all roles in the profession (e.g., veterinarians, technician, nurses, customer care representatives, HR, regional managers, CEOs) and at all career stages (ideally fully subsidised for veterinary, nursing and technician students) with unique incentives for both employee and employer participation and accreditation.

Course objectives:

  • Participants can identify and label moral conflict and moral distress.
  • Participants can identify the situations commonly associated with moral conflict and moral distress in veterinary practice (e.g., objectionable euthanasia, lack of patient analgesia, unnecessary procedures, client cost constraints) 
  • Participants understand the individual (e.g., trait perfectionism, moral integrity) and organisational (e.g., staffing ratios, workplace policies) factors that contribute to moral distress.
  • Participants understand the outcomes of moral distress (i.e., to the individual, organisation, patients, and clients).
  • Participants understand interventions to reduce moral distress can be targeted at the individual, organisational, and external (e.g., profession, government) level. Participants appreciate the efficacy of different interventions and the effect of interventions simultaneously applied at multiple levels.
  • Participants are trained in a suite of evidence-based individual strategies to reduce moral distress and promote resilience (e.g., conflict resolution skills, moral competency, self-care, coping strategies, help-seeking).
  • Participants understand evidence-based organisational strategies to reduce moral distress and promote resilience (e.g., clinic moral climate, psychological safety).
  • Participants feel competent to apply individual strategies.
  • Participants know when, how, and where to seek individual or organisational support for managing moral distress.

Course design:

Initial 3-day group training – direct teaching of content, facilitated group discussion incorporating case studies and real participant experiences, interactive-learning components (e.g., scenario-based roleplay with peer and facilitator feedback)
Followed by 6x monthly group facilitated sessions – online, consolidates learning and application, troubleshooting implementation challenges, reflection, and peer support for recent ethical conflicts/distress
Long term support – assistance for participant to connect with tailor-fit mentors (accredited in this course) in collaboration with other mentorship organisations

Pre-and post-measures

To monitor course effectiveness, voluntary, anonymous measures of participant outcomes at pre- and post-intervention and 12-month follow up can include:


Moral distress (e.g., using the MSD-R tool)
Moral competence self-efficacy
Conflict resolution self-efficacy
Self-care activities (e.g., using the SASS-14 tool)
Self-efficacy in understanding moral distress organisational interventions

Individual and organisation accreditation:

Beyond participation, individuals and organisations can complete an additional assessment to attain summative course accreditation. This becomes a point of difference for employees and employers:

Individuals
Attractive accreditation on resume to for employers, showcases extra-clinical competency
Individual demonstrates knowledge, skills, and application via exam and/or assignment

Organisations

Attractive accreditation for recruitment and retention, showcases employer commitment to employee wellbeing and ethical responsibilities, desirable workplace culture
Organisation meets criteria via workplace assessment (e.g., appropriate leaders have current course accreditation, demonstration of appropriate organisational moral distress management strategy implementation, current Employee Assistance Program with appropriate accessibility to staff)

Costs and how to resource:

Initial course creation – garner support from academic organisations and individuals to assist with reviewing scientific literature for the course; consult with industry trainers, coaches and consultants when designing course structure and delivery
Course delivery – consult with current industry trainers, coaches, and consultants as potential course trainers; consider a “train the trainer” model

Accreditation process – approach key industry bodies and employment platforms for potential provision of subsidies

Possible future directions:
Further collaboration with educational institutes, mutual sharing of resources, possible integration into university curriculum
Collaboration with welfare groups, investigating their role in assisting with moral and ethical conflicts
Collaboration with pet insurance and financing companies, investigating their role in preventing moral conflicts
Research to assess program efficacy including assessing individual and organisational outcomes

Disclaimer:
The listed examples of contributing factors, outcomes and interventions must be verified via in-depth review of the current literature. Related psychological constructs should also be explored during course content creation. Below are recommended papers as starting points.

Arbe Montoya, A. I., Hazel, S., Matthew, S. M.,& McArthur, M. Moral distress in veterinarians. Vet Record, 185(20), 1-7. https://doi.org/10.1136/vr.105289
Burston, A. S., & Tuckett, G. A. (2012). Moral distress in nursing: Contributing factors, outcomes and interventions. Nursing Ethics, 20(3). https://doi.org/10.1177/0969733012462049
Giannetta, N., Villa, G., Pennestri, F., Sala, R., Mordacci, R., & Fiorenzo Manara, D. (2020). Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. International Journal of Nursing Studies, 111, 1-34. https://doi.org/10.1016/j.ijnurstu.2020.103767
Moses, L., Malowney, M. J., & Wesley Boyd, J. (2018). Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. Journal of Veterinary Internal Medicine, 32, 2115-2122. https://doi.org/10.1111/jvim.15315

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