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Critical care nurses encounter issues related to transitions to end of life and end-of-life care on a daily basis, and the consequences of these encounters are well documented, particularly in relation to moral distress and burnout (Epstein and Hamric, 2009). Jameton's (1984) seminal work introduced the concept of moral distress in nursing, and outlined how professional and moral integrity are challenged when nurses find themselves in situations that do not support maintaining integrity, and it becomes hard to ‘do the right thing’. Furthermore, these situations make it difficult to maintain professional identity and a moral compass. Where this fails, worsening moral distress is likely to occur. When nurses are aware that they are acting against their own and professional moral code, the net result can be anger, disengagement, frustration, dysfunction and anxiety, which is known to adversely affect patient care (Epstein and Hamric, 2009). Moreover, burnout is associated with intention to leave (Heinen et al., 2013) and, coupled with the acute staffing crisis across the critical care nursing sector in the UK, the result is critical care nurses who may have even less emotional and physical resources to care for these high-need end-of-life patients. It is incumbent on nurse leaders in particular, to find ways to address the factors associated with moral distress and ensure nurses avoid compassion fatigue, the phenomenon where nurses do not have capacity for empathic understanding and compassion (Lombardo and Eyre, 2011). In addition to experiencing compassion fatigue and moral distress, moral discord might arise in end-of-life situations as critical care nurses are not ultimately making the decisions, and sometimes not even involved in them. However, they bear witness to the consequences of those decisions, which in this case is whether or not the patient experiences a timely, good death. As the APPROPRICUS study demonstrated, there are emotional consequences and inter-professional conflict resulting from providing what is viewed as disproportionate levels of treatment (Piers et al., 2014). A recent call for action suggests that the issue of moral distress and burnout needs to be taken seriously across all critical care professions (Moss et al., 2016). By dealing with moral challenges, and not letting them escalate towards a ‘moral crescendo’, threats and violations of moral integrity can be avoided (Thomas and McCullough, 2015). Given that the evidence suggests all of these issues related to moral dissonance in providing end-of-life care are inextricably linked, the question remains: how should critical care nurses deal with such complex and entwined issues? Teasing out the ethical and moral implications of making decisions regarding transitions to end of life, can develop understanding, and thus help clinical reasoning and acceptance of situations. In turn, this can improve nurses' discomfort at giving end-of-life care in cases where the process of decisions to transition to end of life has been difficult. Indeed, disruption of moral integrity is reinforced where there is a lack of ethical training and understanding for nurses dealing with these situations. Grady et al. (2008) highlighted that, perhaps unsurprisingly, confidence in moral actions increases with ethics education. Ethical training through application of ethical principles to clinical cases might be one way forward, through innovative approaches such as low-fidelity simulation education scenarios and peer-led learning. By promoting organisational cultures that are transparent in decision-making, open to enquiry or challenge, and ensuring everyone in the team is respected and has a voice in patient care, there is less likely to be a threat to individual moral integrity. Openness is critical for developing ethical competence, the concept of displaying behaviours congruent with one's feelings, being morally sensitive and critically reflective and showing the ability to enact ethical behaviours aligned with personal values (such as speaking up), and a pre-requisite for resilience and mitigating against moral distress (Rushton, 2016). Threats to moral integrity are positioned against a threat to professional integrity (Thomas and McCullough, 2015), where one's values are threatened in each domain, meaning nurses feel less in control. For instance, at end of life in critical care there is often a tension between providing care for the patients, and meeting the families' needs (Pattison et al., 2013), leading to nurses feeling compromised between allowing families time to reach resolution towards dying and prolonging patients' dying. A person knows the right thing to do yet is hampered by organisational constraints (Thomas and McCullough, 2015) and ethical quandary. Person-centred care helps reconcile these tensions, allowing for consideration of both patient and staff within the concept of ‘person’ (McCormack and McCance, 2010). Adopting this approach to care can ameliorate feelings of moral distress. Rattray and McKenna (2012) outlined the challenges for critical care nurses associated with providing person-centred care, particularly in relation to organisation of care and the need to avoid ritual and routine. Person-centredness is an oft-used term in the context of patient care, denoting a focus on a person's needs, preferences and strengths above all else, and shaping care around those precepts. When nurses fail to think of patients as ‘persons’, and sometimes consider them from a more reductionist perspective such as illnesses, and consequently do not live up to their own ideals, they are at risk of increased moral distress (McAndrew et al., 2011; Peter and Liaschenko, 2013). Mclean et al. (2016) suggest that critical care nurses' ideal of ‘whole person’ care is unachievable because they have to move between different ways of thinking about patients in their care, appropriate to that moment. Therefore, while it is understood that critical care nurses are exposed to moral distress in providing end-of-life care and the emotional labour associated with that, distress also arises from how nurses perceive mismatch between the ideal and actual provision of person-centred care. In exploring person-centred care, in the context of the consequences of moral discord and disruption for nurses, the corollary to that is the effect on patients. Perhaps this is the most important consideration. Large-scale international research found that care ratings were associated with burnout (Poghosyan et al., 2010; Aiken et al., 2012); where there was more depersonalised care, there was a poorer rating for care. Conceptual analysis of person-centred care in critical care suggests that the consequences of focusing on this will not only improve patient satisfaction and lead to positive patient experiences but also result in better job satisfaction and retention (Jakimowicz and Perry, 2015). Therefore, it is paramount and our professional and moral duty to consider how critical care nursing will address this issue and avoid accusations of nurses' navel-gazing. Avoiding over-ritualisation of care, remaining authentic to one's feelings, speaking out when appropriate, willingness to adapt, and contributing to a nurturing environment will enhance person-centred care and minimise moral distress. As critical care nurses, we can maintain moral integrity through actions such as developing greater understanding, being empathic, dealing with challenge and conflict in a healthy manner, finding meaning in work, and committing to uphold professional values. Critical care nurses are challenged to provide the best possible, person-centred end-of-life care for patients and simultaneously support families. Being authentic, open and compassionate will help develop resilience and encourage nurses to be even better.