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Salas-Bergüés V, Pereira-Sánchez M, Martín-Martín J, Olano-Lizarraga M. Development of burnout and moral distress in intensive care nurses: An integrative literature review. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00027-2. [PMID: 39025685 DOI: 10.1016/j.enfie.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/24/2024] [Indexed: 07/20/2024]
Abstract
AIMS To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress. METHODS An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality. RESULTS Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress. CONCLUSIONS This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.
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Affiliation(s)
- V Salas-Bergüés
- Clínica Universidad de Navarra, Intensive Care Unit, Pamplona, Spain
| | - M Pereira-Sánchez
- Universidad de Navarra, School of Nursing, Department of Nursing Care for Adult Patients, Pamplona, Spain; Universidad de Navarra, ICCP-UNAV (Innovation for a Person-Centred Care Research Group), Pamplona, Spain
| | - J Martín-Martín
- Universidad de Navarra, School of Nursing, Department of Nursing Care for Adult Patients, Pamplona, Spain.
| | - M Olano-Lizarraga
- Universidad de Navarra, School of Nursing, Department of Nursing Care for Adult Patients, Pamplona, Spain; Universidad de Navarra, ICCP-UNAV (Innovation for a Person-Centred Care Research Group), Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Ahmad AM, Bani-Issa W, Refaat F. Factors contributing to moral distress among intensive care nurses: A scoping review. F1000Res 2024; 11:1574. [PMID: 39015746 PMCID: PMC11249504 DOI: 10.12688/f1000research.127120.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background: The intensive care unit (ICU) is a busy and complex workplace, and several work-related and personal factors are known to make ICU nurses more vulnerable to moral distress than other healthcare professionals. It is crucial to identify these factors to guide future studies and preventive strategies. This scoping review explores such factors to present current knowledge on the factors that trigger moral distress and to guide future research by reviewing studies to explore and summarize factors that trigger moral distress in ICU nurses. Methods: The PubMed, EBSCO, and CINAHL Plus databases were searched to identify potentially relevant studies published between 2011 to 2022. Inclusion criteria: peer-reviewed studies published in English that provided results regarding factors causes or correlated to moral distress in ICU nurses. After removing 618 duplicates, 316 papers were excluded after title and abstract screening, leaving 71 articles for full-text screening. A further 54 articles were excluded as their outcomes did not include factors that caused moral distress, or were not specific to ICU nurses, so 17 studies were eventually analysed using qualitative content analysis through an inductive approach. The findings of the articles were extracted and coded independently by two authors, and data were grouped and categorized. Results: The content categories of factors contributing to ICU nurses' moral distress were organized into themes and subthemes. Four major themes were identified: Powerlessness, end-of-life care, ineffective teamwork, and personal characteristics of ICU nurses. Conclusions: This review highlights the factors that contribute to moral distress in critical care nurses, which are mainly attributable to the organizational climate and the nature of the ICU clinical environment. Descriptive and intervention studies (experimental or action research) must investigate causality between identified variables to inform management strategies to improve support for ICU nurses' coping relative to moral distress.
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Affiliation(s)
| | | | - Fatma Refaat
- University of Sharjah, Sharjah, United Arab Emirates
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Beadle ES, Walecka A, Sangam AV, Moorhouse J, Winter M, Munro Wild H, Trivedi D, Casarin A. Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies. PLoS One 2024; 19:e0303013. [PMID: 38935754 PMCID: PMC11210881 DOI: 10.1371/journal.pone.0303013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/17/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions. METHODS A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic. RESULTS Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients' care options, professionals' beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals' moral comfort. Patients' care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change. CONCLUSION This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals' disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals' beliefs, repercussions on professionals' wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.
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Affiliation(s)
- Emily S. Beadle
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | | | - Amy V. Sangam
- Intensive Care Unit, Royal Free Hospital, London, United Kingdom
| | | | - Matthew Winter
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Helen Munro Wild
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, School of Health and Social Work, The University of Hertfordshire, Hatfield, United Kingdom
| | - Annalisa Casarin
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Rodriguez-Ruiz E, van Mol MMC, Latour JM, Fuest K. Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety. Med Intensiva 2024:S2173-5727(24)00061-4. [PMID: 38594110 DOI: 10.1016/j.medine.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.
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Affiliation(s)
- Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Joseph Maria Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; Curtin School of Nursing, Curtin University, Perth, Australia; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kristina Fuest
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ismaninger Str. 22, 81675 Munich, Germany
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Wilson MA, Shay A, Harris JI, Faller N, Usset TJ, Simmons A. Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review. AJPM FOCUS 2024; 3:100173. [PMID: 38304024 PMCID: PMC10832382 DOI: 10.1016/j.focus.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction Healthcare clinicians are often at risk of psychological distress due to the nature of their occupation. Military healthcare providers are at risk for additional psychological suffering related to unique moral and ethical situations encountered in military service. This scoping review identifies key characteristics of moral distress and moral injury and how these concepts relate to the military healthcare clinician who is both a care provider and service member. Methods A scoping review of moral distress and moral injury literature as relates to the military healthcare clinician was conducted on the basis of the Joanna Briggs Institute scoping review framework. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid), PsycInfo, 2 U.S. Defense Department sources, conference papers index, and dissertation abstracts. Reference lists of all identified reports and articles were searched for additional studies. Results A total of 573 articles, published between the years 2009 and 2021, were retrieved to include a portion of the COVID-19 pandemic period. One hundred articles met the inclusion criteria for the final full-text review and analysis. Discussion This scoping review identified moral distress and moral injury literature to examine similarities, differences, and overlaps in the defining characteristics of the concepts and the associated implications for patients, healthcare clinicians, and organizations. This review included the unfolding influence of the COVID-19 pandemic on moral experiences in health care and the blurring of those lines between civilian and military healthcare clinicians. Future directions of moral injury and moral distress research, practice, and care are discussed.
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Affiliation(s)
- Melissa A. Wilson
- U.S. Air Force Research Laboratory, Dayton, Ohio
- College of Health, Education and Human Services Department of Nursing, Wright State University, Dayton, Ohio
| | - Amy Shay
- School of Nursing, Indiana University, Indianapolis, Indiana
| | | | | | - Timothy J. Usset
- Division of Health Policy & Management, University of Minnesota, Minneapolis, Minnesota
| | - Angela Simmons
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Fantus S, Cole R, Usset TJ, Hawkins LE. Multi-professional perspectives to reduce moral distress: A qualitative investigation. Nurs Ethics 2024:9697330241230519. [PMID: 38317421 DOI: 10.1177/09697330241230519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. RESEARCH OBJECTIVE The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. PARTICIPANTS & RESEARCH CONTEXT Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. RESEARCH DESIGN Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine's National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. ETHICAL CONSIDERATIONS Ethics approval was obtained from the university and medical center institutional review boards. FINDINGS Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. CONCLUSION Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being.
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Liu S, Zhang Y, Liu Y, Han P, Zhuang Y, Jiang J. The resilience of emergency and critical care nurses: a qualitative systematic review and meta-synthesis. Front Psychol 2023; 14:1226703. [PMID: 37849479 PMCID: PMC10578438 DOI: 10.3389/fpsyg.2023.1226703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023] Open
Abstract
Background Due to the unique work environment, emergency and critical care departments nurses face high job pressure, often resulting in burnout and a high turnover rate. Public health emergencies such as the Corona Virus Disease 2019 pandemic tend to exacerbate these problems further. Therefore, improving the resilience of nurses is crucial to enhance their retention rates. Objective This systematic review and meta-synthesis of qualitative studies on the resilience of emergency and critical nurses were conducted to provide a reference for clinical managers to develop strategies for improving the resilience of nurses. Methods Following databases were searched for relevant studies: CINAHL Plus, Elsevier, Cochrane Library, Embase, Medline, OVID, Pubmed, Science Direct, LWW and Web of Science, China National Knowledge Network (CNKI), Wanfang Database (CECDB), VIP Database, and Sinomed. Google Scholar and Opengrey were used to search for gray literature. The literature search period was from the establishment of the database to April 2023. The systematic review of qualitative studies followed the Joanna Briggs Institute (JBI) approach, including critical appraisal using the JBI Checklist and synthesis through meta-synthesis. Confidence of evidence was assessed with JBI's ConQual process. Results A total of 12 articles were identified, with 59 main results and 9 new integrated categories. Also, 3 themes, i.e., risk factors, protective factors, and personal growth, and 9 sub-themes, i.e., working pressure, negative emotion, an organizational issue, active learning, sense of occupational benefit, social support, self-cognition and regulation, learn to adapt, and self-actualization, were formed. Conclusion The resilience of emergency and critical care nurses depends on various factors. Managers should prioritize the mental health of nurses and implement measures to enhance their resilience through social support, team building, and psychological capital development. Additionally, management models can be updated based on domestic and international experience to improve nurses' job involvement, optimize nursing quality, and promote the advancement of the nursing profession.
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Affiliation(s)
- Shuyang Liu
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu Zhang
- Community health service center of Pengpu new village street of Shanghai Jing’an District, Shanghai, China
| | - Yue Liu
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peng Han
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yugang Zhuang
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jinxia Jiang
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Fischer-Grönlund C, Brännström M, Isaksson U. Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Med Ethics 2023; 24:35. [PMID: 37254086 DOI: 10.1186/s12910-023-00916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). METHODS Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole. RESULTS The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912). CONCLUSIONS We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.
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Affiliation(s)
| | - Margareta Brännström
- Department of Nursing, Umeå University, Campus Skellefteå, 93187, Skellefteå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Linnaeus v 9, 90736, Umeå, Sweden
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Kissel KA, Filipek C, Jenkins J. Impact of the COVID-19 Pandemic on Nurses Working in Intensive Care Units: A Scoping Review. Crit Care Nurse 2023; 43:55-63. [PMID: 36804825 DOI: 10.4037/ccn2023196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in significant system strain, requiring rapid redeployment of nurses to intensive care units. Little is known about the impact of the COVID-19 pandemic and surge models on nurses. OBJECTIVE To identify the impact of the COVID-19 pandemic on nurses working in intensive care units. METHODS A scoping review was performed. Articles were excluded if they concerned nurses who were not caring for critically ill adult patients with COVID-19, did not describe impact on nurses, or solely examined workload or expansion of pediatric intensive care units. RESULTS This search identified 417 unique records, of which 55 met inclusion criteria (37 peer-reviewed and 18 grey literature sources). Within the peer-reviewed literature, 42.7% of participants were identified as intensive care unit nurses, 0.65% as redeployed nurses, and 72.4% as women. The predominant finding was the prevalence of negative psychological impacts on nurses, including stress, distress, anxiety, depression, fear, posttraumatic stress disorder, and burnout. Women and members of ethnic minority groups were at higher risk of experiencing negative consequences. Common qualitative themes included the presence of novel changes, negative impacts, and mitigators of harm during the pandemic. CONCLUSIONS Nurses working in intensive care units during the COVID-19 pandemic experienced adverse psychological outcomes, with unique stressors and challenges observed among both permanent intensive care unit and redeployed nurses. Further research is required to understand the impact of these outcomes over the full duration of the pandemic, among at-risk groups, and within the context of redeployment roles.
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Affiliation(s)
- Katherine A Kissel
- Katherine A. Kissel is a clinical nurse specialist, Department of Critical Care Medicine, Alberta Health Services, Alberta, Canada
| | - Christine Filipek
- Christine Filipek is a clinical nurse educator, Department of Critical Care Medicine, Alberta Health Services
| | - Jessica Jenkins
- Jessica Jenkins is a nurse practitioner, Department of Critical Care Medicine, Alberta Health Services, and a clinical associate, Faculty of Nursing, University of Calgary, Alberta, Canada
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Digby R, Manias E, Haines KJ, Orosz J, Ihle J, Bucknall TK. Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia. Aust Crit Care 2023; 36:66-76. [PMID: 36464524 PMCID: PMC9574938 DOI: 10.1016/j.aucc.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission. AIM The aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale. METHODS This was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members. Data were analysed using thematic analysis. FINDINGS Four major themes were derived from the data: (i) Communication and connection, (ii) Psychological casualties, (iii) Caring for our patients, and (iv) Overcoming challenges. Patient care was affected by diminished numbers of critical care qualified staff, limited staff entry to isolation rooms, and needing to use alternative techniques for some practices. The importance of effective communication from the organisation and between clinicians, families, and staff members was emphasised. personal protective equipment hindered communication between patients and staff and inhibited nonverbal and verbal cues conveying empathy in therapeutic interactions. Communication with families by phone or videoconference was less satisfying than in-person encounters. Some staff members suffered psychological distress, especially those working with COVID-19 patients requiring extracorporeal membrane oxygenation. Moral injury occurred when staff members were required to deny family access to patients. Workload intensified with increased patient admissions, additional infection control requirements, and the need to communicate with families using alternative methods. CONCLUSION The results of this study reflect the difficulties in communication during the early stages of the COVID-19 pandemic. Communication between staff members and families may be improved using a more structured approach. Staff reported experiencing psychological stress when separating families and patients or working in isolation rooms for prolonged periods. A flexible, compassionate response to family presence in the ICU is essential to maintain patient- and family-centred care.
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Affiliation(s)
- Robin Digby
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC 3220 Australia,Alfred Health, 55 Commercial Rd, Melbourne VIC 3004 Australia,Corresponding author
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC 3220 Australia
| | - Kimberley J. Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria,Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, Victoria
| | - Judit Orosz
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Joshua Ihle
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Tracey K. Bucknall
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC 3220 Australia,Alfred Health, 55 Commercial Rd, Melbourne VIC 3004 Australia
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Khalafi A, Sarvi Sarmeydani N, Adarvishi S. Workplace health in anesthesia team: A qualitative study in Iran. Front Public Health 2023; 11:1141447. [PMID: 36935702 PMCID: PMC10020197 DOI: 10.3389/fpubh.2023.1141447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Background All anesthesia providers, including nurse anesthetists and anesthesiologists work in a stressful environment with diverse tasks. The profession is characterized by high workload, both dependent and independent job descriptions, and unpredictable conditions. This study was designed and conducted to explain the factors affecting the workplace health of Iranian anesthesia teams. Methods Twenty anesthesia team members including nurse anesthetists and anesthesiologists from 7 different hospitals were enrolled in this phenomenological research. The data were collected in 2022. Semi-structured interviews were used for data collection, and the transcripts were analyzed using qualitative content analysis. Findings The most notable theme emerging from the data which was found to affect workplace health was consistency of anesthesia team. Other themes derived from the data included team tranquility and physical well-being. Conclusion The participants' emphasis was more on behavioral and managerial factors affecting workplace health, and desirable interpersonal cooperation to create a suitable work environment for them was more prominent. These findings can raise the awareness of chief nurse anesthetists and planners to provide more effective teamwork, modify the job description structure, and reduce staff conflicts.
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Affiliation(s)
- Ali Khalafi
- Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nooshin Sarvi Sarmeydani
- Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- *Correspondence: Nooshin Sarvi Sarmeydani
| | - Sara Adarvishi
- Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Козігора М. ВПРОВАДЖЕННЯ ЕКСПЕРИМЕНТАЛЬНОЇ ПРОГРАМИ З ПРОФІЛАКТИКИ МОРАЛЬНОЇ ТРАВМИ У МАЙБУТНІХ ВЧИТЕЛІВ ПІД ЧАС ВОЄННОГО СТАНУ. PSYCHOLOGICAL PROSPECTS JOURNAL 2022. [DOI: 10.29038/2227-1376-2022-40-koz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Мета. У статті розглянуто вивчення поняття моральної травми (МТ) у науковій літературі. Мета нашого дослідження – висвітлення та обґрунтування експериментальної програми спецкурсу для майбутніх вчителів.
Методи. У статті ми використали метод теоретичного аналізу й узагальнення та метод природнього експерименту з впровадження програми спецкурсу для майбутніх вчителів «Моральна травма: діагностика та профілактика у майбутніх вчителів під час воєнного стану». У дослідженні взяли участь студенти 3-х курсів освітнього ступеня «бакалавр» спеціальності 013 Початкова освіта Комунального закладу вищої освіти «Луцький педагогічний коледж» Волинської обласної ради». Програма розрахована на один семестр 2022/2023 н.р. та включає 11 лекційних та 5 практичних занять.
Результати аналізу наукових джерел дають змогу стверджувати, що МТ на сучасному етапі може виникати не тільки у військовослужбовців, а й у цивільних, найчастіше у медичних працівників та вчителів. В Україні відсутні дослідження, що стосуються саме МТ у вчителів, хоча це дуже актуальна тема в період широкомасштабної війни в країні. В рамках дослідження проявів МТ під час воєнного конфлікту ми розробили експериментальну програму для майбутніх вчителів. Наш спецкурс базується на основі духовно-орієнтованої когнітивно-процесуальної терапії. При МТ може виникати сором, гнів, почуття провини, втрата віри, а такі моральні поняття, як милосердя, прощення, молитва, покаяння, справедливість можуть запобігати цьому. Для роботи ми обрали теми, які в названій терапії вважаються найефективнішими: поняття МТ, події, значення події для в житті людини, духовні ресурси, поняття провини та визнання провини, самопрощення, повага, духовне партнерство під час переживання МТ, посттравматичне зростання. Під час практичних занять здобувачі освіти розглядають практичні вправи для допомоги учням заспокоїтись, пережити травматичну ситуацію. Для щоденного використання ми пропонуємо використовувати вправи для контролю власних емоцій, спілкування з оточуючими, вирішення конфліктних ситуацій; техніки самодопомоги в екстремальних ситуаціях.
Висновки. Отримані знання зі спецкурсу «Моральна травма: діагностика та профілактика у майбутніх вчителів під час воєнного стану» є корисними, практичні навички можуть використовувати у професійній діяльності.
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Alvarez A. Exploring the "Other" Role of Philosophy in Bioethics: The Case of Addressing Moral Distress and Rediscovering Meaning and Purpose. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:67-69. [PMID: 36416424 DOI: 10.1080/15265161.2022.2134495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Quek CWN, Ong RRS, Wong RSM, Chan SWK, Chok AKL, Shen GS, Teo AYT, Panda A, Burla N, Wong YA, Chee RCH, Loh CYL, Lee KW, Tan GHN, Leong REJ, Koh NSY, Ong YT, Chin AMC, Chiam M, Lim C, Zhou XJ, Ong SYK, Ong EK, Krishna LKR. Systematic scoping review on moral distress among physicians. BMJ Open 2022; 12:e064029. [PMID: 36691160 PMCID: PMC9442489 DOI: 10.1136/bmjopen-2022-064029] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians. METHODS A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows. RESULTS A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions. CONCLUSIONS Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.
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Affiliation(s)
- Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Rui Song Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Kun Woo Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Gabrielle Hui Ning Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Emmanuel Jian Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Song Yi Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore
| | - Xuelian Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
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Cooke S, Booth R, Jackson K. Moral distress in critical care nursing practice: A concept analysis. Nurs Forum 2022; 57:1478-1483. [PMID: 35962765 DOI: 10.1111/nuf.12786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
AIM To provide a critical analysis of the concept of moral distress (MD) in critical care (CC) nursing. BACKGROUND Despite extensive inquiry pertaining to the legitimacy of MD within nursing discourse, some authors still question its relevancy to the profession. However, amid the global COVID-19 pandemic, MD is generating a significant amount of discussion anew, warranting the further exploration of the concept within CC nursing to provide clarity and expand on the definition. DESIGN Rodger's Evolutionary Concept Analysis method was used to guide this analysis. METHODS Related terms, attributes, antecedents, and consequences of MD were identified using current literature. RESULTS The results of this analysis demonstrate strong congruence between the attributes, antecedents, and negative consequences pertaining to MD. However, a new theme has emerged from this review of the contemporary literature, highlighting the potential unexpected positive outcomes perceived by nurses who experience MD, including the provision of better care, increased levels of empathy, and enhanced opportunities for ethical reflection.
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Affiliation(s)
- Samantha Cooke
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kimberley Jackson
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Gaetani M, Min KS, Proulx C, Mema B. Reflection, refraction, resilience: the transformative potential of art. Can J Anaesth 2022; 69:568-571. [PMID: 34782998 PMCID: PMC8592672 DOI: 10.1007/s12630-021-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Melany Gaetani
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kyung-Seo Min
- Department of History of Art, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine Proulx
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Briseida Mema
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Dodek PM, Jameson K, Chevalier JM. New approach to assessing and addressing moral distress in intensive care unit personnel: a case study. Can J Anaesth 2022; 69:1240-1247. [PMID: 35997856 PMCID: PMC9499887 DOI: 10.1007/s12630-022-02307-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To test a new approach to address moral distress in intensive care unit (ICU) personnel. METHODS Using principles of participatory action research, we developed an eight-step moral conflict assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU. RESULTS During three one-hour sessions, participants described their moral distress that was caused by the use of ongoing life-support for a patient who the team believed did not prefer this course of care, but whose family was requesting it. Participants experienced frustration and discouragement and coping strategies included speaking to colleagues and exercising. They felt that they were unable to take meaningful action to resolve this conflict. Values that were in conflict in the situation included beneficence and patient autonomy. Based on ranking of helping and hindering factors, the team proposed new strategies including improving consistency of care plans and educating patients' family members and ICU personnel about advance care planning and end-of-life care. After completing this assessment, participants reported less stress and a greater ability to take meaningful action, including some of the proposed new strategies. CONCLUSIONS We found this new approach to address moral distress in ICU personnel to be feasible and a useful tool for facilitating plans for reducing moral distress.
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Affiliation(s)
- Peter M. Dodek
- grid.17091.3e0000 0001 2288 9830Centre for Health Evaluation and Outcomes Sciences (CHÉOS) and Division of Critical Care Medicine, St. Paul’s Hospital and The University of British Columbia, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Kim Jameson
- grid.417243.70000 0004 0384 4428Vancouver Coastal Health Authority, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Centre for Applied Ethics, The University of British Columbia, Vancouver, BC Canada
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Lespérance S, Anaraki N, Ashgari S, Churchill A. Systemic challenges and resiliency in rural family practice. CANADIAN JOURNAL OF RURAL MEDICINE 2022; 27:91-98. [DOI: 10.4103/cjrm.cjrm_39_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Honarmand K, Danesh V. When duty to care causes collective sorrow and shame: assessing and addressing moral distress in intensive care unit clinicians. Can J Anaesth 2022; 69:1191-1195. [PMID: 35997857 PMCID: PMC9397158 DOI: 10.1007/s12630-022-02308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Kimia Honarmand
- Critical Care Medicine, Mackenzie Health, Vaughan, ON Canada
| | - Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Health, Dallas, TX USA
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Fischer-Grönlund C, Brännström M. The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). BMC Med Ethics 2021; 22:151. [PMID: 34772400 PMCID: PMC8588668 DOI: 10.1186/s12910-021-00722-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one's convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context. METHODS The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0-4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts. RESULTS The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items' had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible. CONCLUSION The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context.
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The Societies' Responsibility for Wellness: Healing for the Healer. Ann Am Thorac Soc 2021; 18:1458-1460. [PMID: 34468289 PMCID: PMC8489862 DOI: 10.1513/annalsats.202106-713ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bernuzzi C, Setti I, Maffoni M, Sommovigo V. From moral distress to burnout through work-family conflict: the protective role of resilience and positive refocusing. ETHICS & BEHAVIOR 2021. [DOI: 10.1080/10508422.2021.1955682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chiara Bernuzzi
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia
| | - Ilaria Setti
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia
| | - Marina Maffoni
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS
| | - Valentina Sommovigo
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia
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McCracken C, McAndrew N, Schroeter K, Klink K. Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members. Clin J Oncol Nurs 2021; 25:E35-E43. [PMID: 34269348 DOI: 10.1188/21.cjon.e35-e43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncology healthcare professionals (HCPs), particularly nurses, experience moral distress. However, little is known about the impact of moral distress on oncology teams. OBJECTIVES The purpose of this study was to describe moral distress as it is experienced by oncology teams in practice. METHODS 32 oncology team members participated in eight focus groups. Content analysis was used to identify key themes. Two investigators collaboratively analyzed the data, and findings were independently reviewed by two additional investigators. FINDINGS The following six themes emerged.
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Affiliation(s)
| | - Natalie McAndrew
- Froedtert and the Medical College of Wisconsin Froedtert Hospital
| | | | - Katie Klink
- Froedtert and the Medical College of Wisconsin Froedtert Hospital
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Stocchetti N, Segre G, Zanier ER, Zanetti M, Campi R, Scarpellini F, Clavenna A, Bonati M. Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6102. [PMID: 34198849 PMCID: PMC8201217 DOI: 10.3390/ijerph18116102] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/16/2023]
Abstract
The COVID-19 pandemic had a massive impact on the Italian healthcare systems, which became overwhelmed, leading to an increased risk of psychological pressure on ICU workers. The present study aimed to investigate the prevalence of distress (anxiety, depression and insomnia symptoms), burnout syndrome and resilience in healthcare workers during the COVID-19 pandemic and to detect potential factors associated with their psychological response. This cross-sectional, survey-based study enrolled 136 healthcare workers assisting COVID-19 patients in the new COVID-19 ward (Intensive Care Unit), at Milano Fiera, Lombardy. Participants completed an online survey that comprised different validated and standardized questionnaires: Maslach Burnout Inventory (MBI), Resilience Scale for adults (RSA), Hospital Anxiety and Depression scale (HADS) and Insomnia Severity Index (ISI). Socio-demographic and work characteristics were also collected. Out of 136 ICU specialists, there were 84 nurses (62%) and 52 physicians (38%). Over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression (of whom 13.9% in the clinical range) and most of the staff showed moderate to high levels (82.4%) of resilience. The COVID-19 pandemic can have a significant impact on ICU staff. Effective interventions are needed to maintain healthcare professionals' mental health and relieve burnout. Follow-up and tailored procedures should be provided to alleviate the psychological burden in the frontline staff at highest risk.
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Affiliation(s)
- Nino Stocchetti
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Giulia Segre
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.S.); (M.Z.); (R.C.); (F.S.); (A.C.)
| | - Elisa R. Zanier
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Michele Zanetti
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.S.); (M.Z.); (R.C.); (F.S.); (A.C.)
| | - Rita Campi
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.S.); (M.Z.); (R.C.); (F.S.); (A.C.)
| | - Francesca Scarpellini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.S.); (M.Z.); (R.C.); (F.S.); (A.C.)
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.S.); (M.Z.); (R.C.); (F.S.); (A.C.)
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.S.); (M.Z.); (R.C.); (F.S.); (A.C.)
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Nursing Education: Students' Narratives of Moral Distress in Clinical Practice. NURSING REPORTS 2021; 11:291-300. [PMID: 34968206 PMCID: PMC8608063 DOI: 10.3390/nursrep11020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Research indicates that newly graduated nurses are often unprepared for meeting challenging situations in clinical practice. This phenomenon is referred to as a "reality shock". This gap in preparedness may lead to moral distress. The aim of this article is to provide knowledge of moral distress in clinical nursing practice. METHODS Bachelor and further education nursing students were invited to write a story about challenging situations from their own clinical practice, resulting in 36 stories. Analysis was based on hermeneutical reading inspired by a narrative method; therefore, six stories were selected to represent the findings. RESULTS A finding across the stories is that the students knew the right thing to do but ended up doing nothing. Four themes were related to moral distress: (a) undermining of professional judgement, (b) disagreement concerning treatment and care, (c) undignified care by supervisors, and (d) colliding values and priorities of care. CONCLUSION Nursing education should emphasize to a greater extent ethical competency and training for the challenging situations students will encounter in clinical practice.
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