52
|
Whitehead PB, Herbertson RK, Hamric AB, Epstein EG, Fisher JM. Moral Distress Among Healthcare Professionals: Report of an Institution-Wide Survey. J Nurs Scholarsh 2014; 47:117-25. [DOI: 10.1111/jnu.12115] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Phyllis B. Whitehead
- Epsilon Psi and Tau Phi, Clinical Nurse Specialist, Palliative Care Service, Carilion Roanoke Memorial Hospital; and Assistant Professor, Virginia Tech Carilion, School of Medicine; Roanoke VA USA
| | | | - Ann B. Hamric
- Gamma Omega and Beta Kappa, Associate Dean and Professor, Virginia Commonwealth University School of Nursing, Richmond; VA USA
| | | | - Joan M. Fisher
- Associate Professor of Pediatrics, Stanford University School of Medicine; Department of Pediatric Hematology, Oncology, and Stem Cell Transplant; Palo Alto CA USA
| |
Collapse
|
53
|
Kleinknecht-Dolf M, Frei IA, Spichiger E, Müller M, Martin JS, Spirig R. Moral distress in nurses at an acute care hospital in Switzerland: results of a pilot study. Nurs Ethics 2014; 22:77-90. [PMID: 24917266 DOI: 10.1177/0969733014534875] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. OBJECTIVE The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial indications of the instrument's validity. METHOD The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. ETHICAL CONSIDERATIONS The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. RESULTS The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. CONCLUSION The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups.
Collapse
Affiliation(s)
| | | | - Elisabeth Spichiger
- University of Basel, Switzerland; Bern University Hospital (Inselspital), Switzerland
| | | | | | - Rebecca Spirig
- University of Basel, Switzerland; University Hospital Zurich, Switzerland
| |
Collapse
|
54
|
Bailey FA, Williams BR, Woodby LL, Goode PS, Redden DT, Houston TK, Granstaff US, Johnson TM, Pennypacker LC, Haddock KS, Painter JM, Spencer JM, Hartney T, Burgio KL. Intervention to improve care at life's end in inpatient settings: the BEACON trial. J Gen Intern Med 2014; 29:836-43. [PMID: 24449032 PMCID: PMC4026508 DOI: 10.1007/s11606-013-2724-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings. OBJECTIVE To evaluate the effectiveness of a multi-modal intervention strategy to improve processes of end-of-life care in inpatient settings. DESIGN Implementation trial with an intervention staggered across hospitals using a multiple-baseline, stepped wedge design. PARTICIPANTS Six Veterans Affairs Medical Centers (VAMCs). INTERVENTION Staff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practices from home-based hospice care, supported with an electronic order set and paper-based educational tools. MAIN MEASURES Several processes of care were identified as quality endpoints for end-of-life care (last 7 days) and abstracted from electronic medical records of veterans who died before or after intervention (n = 6,066). Primary endpoints were proportion with an order for opioid pain medication at time of death, do-not-resuscitate order, location of death, nasogastric tube, intravenous line infusing, and physical restraints. Secondary endpoints were administration of opioids, order/administration of antipsychotics, benzodiazepines, and scopolamine (for death rattle); sublingual administration; advance directives; palliative care consultations; and pastoral care services. Generalized estimating equations were conducted adjusting for longitudinal trends. KEY RESULTS Significant intervention effects were observed for orders for opioid pain medication (OR: 1.39), antipsychotic medications (OR: 1.98), benzodiazepines (OR: 1.39), death rattle medications (OR: 2.77), sublingual administration (OR: 4.12), nasogastric tubes (OR: 0.71), and advance directives (OR: 1.47). Intervention effects were not significant for location of death, do-not-resuscitate orders, intravenous lines, or restraints. CONCLUSIONS This broadly targeted intervention strategy led to modest but statistically significant changes in several processes of care, indicating its potential for widespread dissemination to improve end-of-life care for thousands of patients who die each year in inpatient settings.
Collapse
Affiliation(s)
- F. Amos Bailey
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| | - Beverly R. Williams
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| | - Lesa L. Woodby
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| | - Patricia S. Goode
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| | - David T. Redden
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| | - Thomas K. Houston
- />Department of Veterans Affairs, VA eHealth Quality Enhancement Research Initiative, Bedford, MA USA
- />University of Massachusetts Medical School, Worcester, MA USA
| | - U. Shanette Granstaff
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| | - Theodore M. Johnson
- />Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Decatur, GA USA
- />Emory University, Atlanta, GA USA
| | | | - K. Sue Haddock
- />William Jennings Bryan Dorn VA Medical Center, Columbia, SC USA
| | | | | | | | - Kathryn L. Burgio
- />Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), 11G, 700 South 19th Street, Birmingham, AL 35233 USA
- />University of Alabama at Birmingham, Birmingham, AL USA
| |
Collapse
|
57
|
Obstacles and helpful behaviors in providing end-of-life care to dying patients in intensive care units. Dimens Crit Care Nurs 2013; 32:99-106. [PMID: 23388871 DOI: 10.1097/dcc.0b013e3182808429] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Death can be difficult to accept, unimaginable, and unexpected. Critical care nurses are directly involved with patients and their families, and their experience can identify the best practices for end-of-life care. The purpose of this descriptive study was to identify the relative importance of helpful behaviors and obstacles that affect caring for dying patients and families in both adult and pediatric intensive care units as perceived by critical care nurses. The results show that for end-of-life care, nurses most strongly value factors that focus on the well-being of the family, and similar opinions were held by nurses from both adult and pediatric intensive care units.
Collapse
|
58
|
Edwards MP, McClement SE, Read LR. Nurses' responses to initial moral distress in long-term care. JOURNAL OF BIOETHICAL INQUIRY 2013; 10:325-336. [PMID: 23793936 DOI: 10.1007/s11673-013-9463-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/12/2013] [Indexed: 06/02/2023]
Abstract
While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses' experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses' experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts.
Collapse
Affiliation(s)
- Marie P Edwards
- Faculty of Nursing, University of Manitoba, 381 Helen Glass Centre for Nursing, Winnipeg, Manitoba, Canada, R3T 2N2,
| | | | | |
Collapse
|
61
|
Wocial LD, Weaver MT. Development and psychometric testing of a new tool for detecting moral distress: the Moral Distress Thermometer. J Adv Nurs 2012; 69:167-74. [PMID: 22607094 DOI: 10.1111/j.1365-2648.2012.06036.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To report the development and psychometric testing of the Moral Distress Thermometer. The Moral Distress Thermometer is a new screening tool to measure moral distress in nurses who practise in the hospital setting. BACKGROUND Moral distress occurs when one knows the ethically correct thing to do, but is prevented from acting on that perceived obligation. It is a well documented phenomenon with negative consequences that may be experienced by nurses. Creating an instrument to effectively and efficiently measure moral distress in a timely way has been identified as a priority for nursing. DESIGN This study used a cross-sectional survey design. METHODS Data collection for this research occurred in 2009. Participants simultaneously completed either the adult or pediatric version of the Moral Distress Scale version 2009 and the Moral Distress Thermometer. A total of 529 participants from various clinical areas completed both tools. RESULTS Coefficients alpha were adequate for both Adult (0·90) and Pediatric (0·92) Moral Distress Scale 2009 scales. Statistically significant Pearson correlations were found for the Moral Distress Thermometer with Adult Moral Distress Scale 2009 and Pediatric Moral Distress Scale 2009 and higher Moral Distress Thermometer, Adult Moral Distress Scale 2009 and Pediatric Moral Distress Scale 2009 means for participants who had left or who considered leaving a position because of moral distress. CONCLUSION These findings provide support for the validity of the Moral Distress Thermometer.
Collapse
Affiliation(s)
- Lucia D Wocial
- Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indiana University School of Nursing, Indianapolis, Indiana, USA.
| | | |
Collapse
|