Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness.

背景：对患者护理安全和质量负责但无权实现这些安全和质量的医疗保健提供者会经历道德困境。需要采取干预措施来减轻医疗机构的道德困境。目的：评估既定的全卫生系统干预措施道德困扰咨询对道德困扰和临床医生赋权的影响。方法：使用前/后调查、结构化访谈和咨询主题评估的准实验混合方法研究。当存在道德困扰时，工作人员会要求咨询。咨询的目的是确定道德困扰的原因、行动障碍和改善情况的策略。干预参与者是那些参加道德困境咨询的人。控制参与者在咨询之前接受了工作人员调查。访谈是在与愿意参加的参与者和单位经理协商后进行的。使用道德困境温度计测量道德困境。使用全球赋权量表测量赋权。结果：进行了 21 次咨询。分析包括 116 项干预和 30 项控制调查，以及 11 次访谈。在干预参与者中，尤其是重症监护人员中发现了小幅但显着的下降。授权没有改变。面试主题支持咨询服务作为公开讨论困难情况的有效模式和健康工作环境的重要方面。结论：道德困境咨询是解决道德困境的组织范围内的机制。磋商并不能解决道德困境，但可以帮助员工确定改善情况的策略。包括随访在内的进一步研究可能会阐明咨询的有效性。