Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses.

对于医疗保健提供者 (HCP) 来说，道德困扰是一种有据可查的现象。使用定性和定量方法探索 HCP 对参与道德困扰干预措施的看法，可以增强对干预效果的理解。本研究的目的是衡量和描述两阶段干预对参与者道德困扰的影响。该项目采用交叉设计，旨在确定干预措施是否会减少道德困扰、增强道德能动性并改善对工作环境的看法。我们使用定量工具并通过半结构化访谈探讨参与者对干预的看法。参与者来自美国中西部大型城市医疗保健系统的三个主要医院的住院机构。参与者包括护士（80.6%）和其他临床护理人员。使用广义线性混合模型，我们评估了每个结果变量随时间的变化，控制了组。采访被录音并经过专业转录。书面叙述被编码成主题。研究仪器上的分数变化趋势符合预期方向，但未达到统计显着性。定性访谈显示，干预效果源自学习效益、心理效益和建立促进道德能动性的社区的结合。研究结果表明，道德困境和道德能动性之间存在明显的联系，并表明促进道德对话可以改善工作环境。研究结果为开发基于证据的方法来解决医院护士的道德困境提供了见解。