Author Affiliations: Department of Medical Ethics and Health Policy, University of Pennsylvania School of Nursing, Philadelphia (Dr Ulrich) (firstname.lastname@example.org); and Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland (Dr Grady).
To the Editor: Moral distress is a common problem in today's health care environment. Dr Piers and colleagues1 shed light on this important ethical concept in their international study of ICU nurses and physicians. They showed that a perception of providing inappropriate care was associated with moral distress and intent to leave one's job. This study raises awareness of the impact of ethics in day-to-day clinical care and attention to the concerns of direct caregivers, but also raises a number of questions.
Ulrich CM, Grady C. Perceptions of Appropriateness of Care in the Intensive Care Unit. JAMA. 2012;307(13):1370-1372. doi:10.1001/jama.2012.394