PHASE 3: Approximately 6-12 months (October 2017– June 2018)

Designing an intervention.

Based on what was learned in phases 1 and 2, and in close collaboration with Covenant Health/Covenant Care leadership, we will select two intervention sites (and two control sites) in order to develop and test an intervention designed to reduce moral distress. The research team will work closely with the staff on the intervention sites: we plan to create a small working group specific to each of two Covenant sites, co-led by a member of the research team and the site champion. We are committed to ensuring that members of site staff, leadership and the site educational team have opportunities to have input into the development of the intervention.

Working collaboratively, the working group will design an intervention and a feasible pilot, mindful from the outset of the need to design it with the need to consider feasibility, sustainability, practicality and ongoing evaluation of its effectiveness. Further, we will base the intervention development process on sound science that will guide us in identifying factors that are essential to consider in implementing a practice change intervention. Specifically, we will ensure that the developed intervention includes and addresses relevant predisposing, enabling, and reinforcing factors discovered during the first two phases of the study.

Evaluation. A pretest-posttest design will be used to evaluate the intervention. The frequency, severity, and effects of moral distress will be assessed at baseline (prior to the intervention) with the MDDCS evaluation instrument and then again at 1 and 3 months post-intervention. We will also evaluate the processes used to implement the intervention, so that we can learn what works, and what doesn’t. To do this, the researchers will conduct short interviews with participating nursing care providers at three time points (pre-intervention and at 1 and 3 months post intervention).