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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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Miranda ACR, Fernandes SD, Ramos S, Nunes E, Fabri J, Caldeira S. Moral Distress of Nurses Working in Paediatric Healthcare Settings. Healthcare (Basel) 2024; 12:1364. [PMID: 38998898 DOI: 10.3390/healthcare12131364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
This scoping review aims to map the evidence on moral distress of nurses working in paediatric healthcare settings from homecare to hospital. It was conducted according to the Joanna Briggs Institute. International databases were searched according to the specific thesaurus and free search terms. Independent screening and analysis were conducted using Rayyan QCRI. This review considered a total of 54 studies, including quantitative and qualitative studies, systematic reviews, and grey literature; English and Portuguese languages were included. Moral distress is a phenomenon discussed in nursing literature and in the paediatric context but is considered absent from discussion in clinical practice. It is caused by disproportionate care associated with overtreatment. Nurses can present a variety of symptoms, characterising moral distress as a highly subjective experience. The paediatric contexts of practice should promote a healthy ethical climate and work towards a moral community built with peer support, education, communication, leadership, and management involvement. Moral distress is still a complex and challenging multidimensional concept, and the aim should be to promote a culture of prevention of the devastating consequences of moral distress and work towards moral resilience.
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Affiliation(s)
| | | | - Sílvia Ramos
- Nursing School Lisbon, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Elisabete Nunes
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, 1600-190 Lisbon, Portugal
| | - Janaína Fabri
- Faculty of Nursing, Universidade Estadual do Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
| | - Sílvia Caldeira
- Center for Interdisciplinary Research in Health, Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
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Edwin HS, Trinkoff AM, Mills ME, Zhu S. Psychological distress symptoms in nurses and their intention to leave: A cross-sectional secondary data analysis. J Adv Nurs 2024. [PMID: 39031572 DOI: 10.1111/jan.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/24/2024] [Accepted: 06/07/2024] [Indexed: 07/22/2024]
Abstract
AIM This study aimed to examine the psychological symptoms of distress among nurses in relation to their intention to leave. DESIGN This study was a secondary data analysis of a cross-sectional survey collected between November 2020 and March 2021. METHODS Chi-square was used to examine the associations between the demographic characteristics and intention to leave and psychological distress symptoms-feeling depressed, anxious and worried. Multiple linear regression analyses were performed to examine if work settings, position (staff, charge, administrators, educators/researchers and advanced practice registered nurses) and years of experience were associated with psychological distress and intention to leave. A mediation analysis examined if psychological distress mediated the relationship between years of experience and intention to leave. RESULTS Overall, psychological distress was significantly positively associated with intention to leave and negatively associated with years of experience. Nurses with less than 2 years of experience had increased psychological distress, while nurses with >25 years of experience had decreased psychological distress. Both groups of nurses had increased intention to leave compared to those with 16-25 years of experience. Psychological distress partially mediated intention to leave in nurses with less than 2 years of experience and more so among nurses with >25 years of experience. CONCLUSIONS This study suggests that nurses encounter psychological distress symptoms, such as feeling anxious, depressed and worried, that contribute to an increased intention to leave. Among the workplace locations, nurses practicing in nursing homes had the highest intention to leave. IMPACT The study emphasizes that organizations need to focus on mitigating distress across all levels of nurses to promote retention efforts and intention to stay. REPORTING METHOD The authors adhered to the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient contribution. Completion of the survey in the original study (NWWS) implied consent from the participating nurses.
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Affiliation(s)
| | | | - Mary Etta Mills
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Jazzaa Alruwaili A, Jamil Alkuwaisi M, Jazzaa Alruwaili E. The moral distress and resilience among emergency nurses in Arar city: Saudi Arabia. Int Emerg Nurs 2024; 74:101447. [PMID: 38688205 DOI: 10.1016/j.ienj.2024.101447] [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: 06/08/2023] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Understanding moral distress and resilience is crucial for supporting the well-being of emergency nursing staff and improving patient care. However, there is limited research specifically examining moral distress and resilience among emergency nursing staff in ARAR city hospitals. AIMS This study aims to examine moral distress and resilience levels among emergency nursing staff in ARAR city hospitals. Specifically, the study seeks to determine the correlation between moral distress and resilience among emergency nursing staff and examine differences in the levels of moral distress and resilience among different demographic and occupational characteristics. METHODS A cross-sectional study design was employed, involving a non-probability stratified sample of emergency nursing staff from two hospitals in ARAR city. The participants completed a Brazilian Moral Distress Scale in Nurses (MDSN-BR) and Rushton Moral Resilience Scale in Nurses (RMRS). Statistical analyses, including descriptive statistics and one-way- ANOVA, were conducted to analyze the data. RESULTS The study found that emergency nursing had a moderate level of moral distress, with a mean frequency of 2.70 (SD = 1.02) and a mean intensity of 2.79 (SD = 1.04). The overall self-reported moral resilience was also moderate, with a mean score of 2.48 (SD = 0.77). Significant positive correlations were observed between resilience and both moral distress frequency (r = 0.48, p = 0.001) and intensity (r = 0.48, p = 0.001). Educational levels and nursing positions were associated with variations in moral distress and resilience. Postgraduate diploma emergency nursing reported the highest levels of moral distress frequency (3.12, SD = 1.14) and intensity (3.21, SD = 1.16). A bachelor's degree in nursing exhibited higher levels of personal integrity (3.06, SD = 0.87), while a master's degree in nursing showed higher levels of moral efficacy (2.88, SD = 1.09). Head nurses experienced higher levels of moral distress compared to other positions (3.08, SD = 1.37 for frequency; 3.18, SD = 1.29 for intensity). CONCLUSION The study revealed that emergency nursing experienced relatively moderate levels of moral distress, which could be attributed to insufficient multidisciplinary teams and unprepared actions. The findings also highlighted moderate levels of moral resilience, particularly in relational integrity. Educational levels and nursing positions were found to influence moral distress and resilience. These results underscore the need for targeted interventions to support the well-being of emergency nurses and enhance ethical decision-making.
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Affiliation(s)
| | | | - Eman Jazzaa Alruwaili
- Prince Abdullah bin Abdulaziz bin Musaed Specialized Dental Center, Arar, Saudi Arabia.
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Catania G, Zanini M, Cremona MA, Landa P, Musio ME, Watson R, Aleo G, Aiken LH, Sasso L, Bagnasco A. Nurses' intention to leave, nurse workload and in-hospital patient mortality in Italy: A descriptive and regression study. Health Policy 2024; 143:105032. [PMID: 38460274 DOI: 10.1016/j.healthpol.2024.105032] [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: 06/16/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
Higher nurse-to-patient ratios are associated with poor patient care and adverse nurse outcomes, including emotional exhaustion and intention to leave. We examined the effect of nurses' intention to leave and nurse-patient workload on in-hospital patient mortality in Italy. A multicentered descriptive and regression study using clinical data of patients aged 50 years or older with a hospital stay of at least two days admitted to surgical wards linked with nurse variables including workload and education levels, work environment, job satisfaction, intention to leave, nurses' perception of quality and safety of care, and emotional exhaustion. The final dataset included 15 hospitals, 1046 nurses, and 37,494 patients. A 10 % increase in intention to leave and an increase of one unit in nurse-patient workload increased likelihood of inpatient hospital mortality by 14 % (odds ratio 1.14; 1.02-1.27 95 % CI) and 3.4 % (odds ratio 1.03; 1.00-1.06 95 % CI), respectively. No other studies have reported a significant association between intention to leave and patient mortality. To improve patient outcomes, the healthcare system in Italy needs to implement policies on safe human resources policy stewardship, leadership, and governance to ensure nurse wellbeing, higher levels of safety, and quality nursing care.
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Affiliation(s)
- Gianluca Catania
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy.
| | - Marzia A Cremona
- Department of Operations and Decision Systems, Université Laval Research Center, CHU de Québec Quebec G1V 4G2, Canada
| | - Paolo Landa
- Department of Operations and Decision Systems, Université Laval Research Center, CHU de Québec Quebec G1V 4G2, Canada
| | - Maria Emma Musio
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Roger Watson
- Academic Dean, Southwest Medical University, Luzhou, PR China
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd, Philadelphia PA 19104, USA
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via A. Pastore 1 16132, Genoa, Italy
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Mills CS, Michou E, Bellamy MC, Siddle HJ, Brennan CA, Bojke C. Worth a try or a last resort: Healthcare professionals' experiences and opinions of above cuff vocalisation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:932-946. [PMID: 37902100 DOI: 10.1111/1460-6984.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Above cuff vocalisation (ACV) involves the application of an external flow of air via the subglottic port of a tracheostomy. ACV can facilitate vocalisation and may improve swallowing and quality of life for patients with a tracheostomy. A recent systematic review highlighted the limited evidence available for the acceptability, effectiveness, safety or optimal implementation of ACV. AIMS To explore the experience of healthcare professionals (HCPs) using ACV and their perceptions of best practice. METHODS AND PROCEDURES Semi-structured interviews were conducted with a range of HCPs with experience using ACV. Topics included: experiences with ACV, management of ACV, opinions about ACV, impact of COVID-19, future directions for ACV and impact on length of stay. Interviews were conducted online from December 2020 to March 2022. Data were analysed using reflexive thematic analysis. OUTCOMES AND RESULTS Twenty-four HCPs were interviewed from seven countries and five professional groups. Four interconnected themes were developed: (1) moral distress amplifying the need to fix patients; (2) subjectivity and uncertainty leading to variations in practice and purpose; (3) knowledge and experience leading to control and caution; and (4) worth a try or a last resort. Theme four contained three sub-themes: (a) part of the toolbox; (b) useful but limited tool; and (c) following the patient's lead. The moral distress experienced by HCPs and their essential 'need to fix' patients seems to underpin the varied opinions of ACV. These opinions appear to be formed primarily on the basis of experience, because of the underlying subjectivities and uncertainties. As knowledge and experience with ACV increased, and adverse events were experienced, most HCPs became more cautious in their approach to ACV. CONCLUSIONS AND IMPLICATIONS More research is needed to reduce the subjectivities and uncertainties surrounding ACV. The implementation of standardised procedures, processes, and competencies may help to reduce the frequency of adverse events and support a more controlled approach. Widening the focus of the purpose of ACV to include swallowing may help to maximise the potential benefits. WHAT THIS PAPER ADDS What is already known on the subject There is limited and low-quality evidence for above cuff vocalisation (ACV) and clinical application and practice varies substantially. However, the reasons for this variation in practice and healthcare professionals' (HCPs') opinions of ACV were unclear. What this study adds HCPs' experiences and opinions of ACV vary as a result of the uncertainty and subjectivity surrounding ACV compounded by their personal experiences with it. A need for caution also appears to emerge as HCPs become more familiar and experienced with using ACV. What are the clinical implications of this work? Implementing standardised procedures, safety processes and competencies may help to compensate for the uncertainty and subjectivity surrounding ACV and may reduce the frequency of adverse events. Widening the focus of purpose of ACV, including swallowing in addition to communication, may increase the number of potential candidates and increase the potential benefits of ACV. Using multidisciplinary team (MDT) simulation training for ACV competency development might help to improve MDT working and ACV implementation.
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Affiliation(s)
- Claire S Mills
- Speech & Language Therapy Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Emilia Michou
- Centre for Gastrointestinal Sciences, The University of Manchester, Manchester, UK
- Speech Language Therapy Department, University of Patras, Patras, Greece
| | - Mark C Bellamy
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Cathy A Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Mũrage A, Morgan R, Samji H, Smith J. Gendered and racial experiences of moral distress: A scoping review. J Adv Nurs 2024; 80:1283-1298. [PMID: 37849045 DOI: 10.1111/jan.15901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research. DESIGN Scoping review. METHODS The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted. DATA SOURCES Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022. RESULTS After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals. IMPACT This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings. CONCLUSION There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Alice Mũrage
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
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Atli Özbaş A, Kovanci MS, Yilmaz S. The relationship between moral distress, individual and professional values in oncology nurses: A structural equation study. Palliat Support Care 2024; 22:80-87. [PMID: 36606320 DOI: 10.1017/s1478951522001730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study examined the relationship between moral distress, individual and professional values in oncology nurses. METHODS Employing structural equation modeling, a descriptive-correlational study was conducted among 116 oncology nurses. Data were collected using the Moral Distress Scale-Revised Adult Nurses, the Nursing Professional Values Scale, and the Values Scale. RESULTS The mean moral distress frequency was evaluated as low (1.6 ± 0.7) and the intensity as moderate (1.9 ± 0.8). Both the Nursing Professional Values Scale and Values Scale subdimension mean scores were at levels evaluated as high. There was no specific value that stood out from the others. Structural equation modeling analysis showed that individual values were found to have a direct and negative significant effect on moral distress intensity (β = -0.70, p < 0.01) and frequency (β = -0.58, p <0.01) and professional values had a direct positive and significant effect on moral distress intensity (β = 0.37, p < 0.05) and frequency (β = 0.25, p < 0.05). SIGNIFICANCE OF RESULTS It is believed that more national and international studies need to be conducted to examine the relationship between the moral distress concept and values. While individual values were found to have a direct and negative significant effect on moral distress, professional values had a direct positive and significant effect on moral distress.
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Affiliation(s)
- Azize Atli Özbaş
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
| | - Mustafa Sabri Kovanci
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
| | - Sakine Yilmaz
- Faculty of Health Sciences, Midwifery Department, Çankırı Karatekin University, Çankırı, Turkey
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Sherman M, Klinenberg E. Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge. Soc Sci Med 2024; 340:116471. [PMID: 38061219 DOI: 10.1016/j.socscimed.2023.116471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 01/23/2024]
Abstract
The U.S. is facing a national shortage of healthcare workers, as waves of clinicians quit their jobs or leave the profession entirely. Much of the public discourse around this exodus characterizes it as the result of widespread "burnout." This study draws on in-depth interviews with 22 healthcare workers in New York City to gain deeper understanding of what is leading them to abandon their roles despite the abundant need for their services. It finds that "burnout" in healthcare may be largely explained by moral distress and moral injury inflicted on healthcare workers struggling to care for patients during the COVID-19 pandemic. After presenting a review of the recent literature on moral injury and moral distress, this study lays out five kinds of experiences that emerged during the interviews as the most salient contributors to moral distress, on the one hand, and moral injury, on the other, among healthcare workers. Taken together, these experiences are referred to as "moral suffering." The key finding from this research is that moral suffering, even when undiagnosed and unnamed, affects HCWs' ability to provide care and influences their decisions to leave the healthcare profession. Ultimately, this article suggests a need to rethink the ways in which moral distress and moral injury are applied in social scientific research and concludes by indicating how future research can promote the transformation of networks of injury in healthcare into networks of care.
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Affiliation(s)
- Melina Sherman
- Knology, 40 Exchange Pl. Suite 1403, New York, NY, 10005, USA.
| | - Eric Klinenberg
- New York University, Department of Sociology, 295 Lafayette Street, 4th Floor, New York, NY, 10012, USA.
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Arbe Montoya AI, Matthew SM, Jarden A, Hazel SJ, McArthur ML. The moral deliberation pathway in veterinary practice: a qualitative study. Vet Rec 2023; 193:e3173. [PMID: 37455249 DOI: 10.1002/vetr.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Veterinarians may face various ethical decisions and potential moral conflicts in clinical practice. The ethical decision-making process often leads to a satisfying resolution. However, when such a process is accompanied by a perceived inability to act according to a person's values, it can lead to psychological distress that characterises moral distress. Theoretical models in professions such as nursing attempt to explain the evolution of moral conflict into moral distress. In veterinary professionals, a model has been proposed to explain this pathway (the moral deliberation pathway). However, empirical data are still lacking on whether veterinary clinicians experience a moral deliberation pathway as hypothesised. METHODS Using thematic analysis, this qualitative study investigates veterinary clinicians' experiences with moral distress and aims to explain the moral deliberation pathway in these veterinarians. RESULTS The results suggest that veterinarians' experiences with moral distress follow a deliberation process that can be explained by the proposed moral deliberation pathway. Experiencing a moral conflict leads to moral stress, then either to moral distress or resolution into moral comfort. LIMITATIONS Self-selection of participants and possible recollection bias may have biased the findings. CONCLUSIONS The empirical data provided by this study can inform future research and intervention strategies to identify, measure and manage moral distress in the veterinary context.
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Affiliation(s)
- Alejandra I Arbe Montoya
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy, South Australia, Australia
| | - Susan M Matthew
- College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Aaron Jarden
- Centre for Wellbeing Science, Melbourne Graduate School of Education, University of Melbourne, Victoria, Australia
| | - Susan J Hazel
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy, South Australia, Australia
| | - Michelle L McArthur
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy, South Australia, Australia
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Bruggmann MS, Schneider DG, Ramos FRS, Dalmolin GDL, Rodrigues J, Bhering Á. Intensity and frequency of moral distress in mental health nurses in Brazil. Rev Esc Enferm USP 2023; 57:e20230122. [PMID: 37695606 PMCID: PMC10476911 DOI: 10.1590/1980-220x-reeusp-2023-0122en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/05/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To assess the intensity and frequency of moral distress in mental health nurses in Brazil. METHOD Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. RESULTS Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. CONCLUSION The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.
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Affiliation(s)
| | | | - Flávia Regina Souza Ramos
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
| | | | - Jeferson Rodrigues
- Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Ácmon Bhering
- Secretaria Municipal de Educação de Florianópolis, SC, Brazil
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12
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Watts T, Sydor A, Whybrow D, Temeng E, Hewitt R, Pattinson R, Bundy C, Kyle RG, Jones B. Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed-methods systematic review and thematic synthesis. Nurs Open 2023; 10:6014-6032. [PMID: 37458290 PMCID: PMC10416007 DOI: 10.1002/nop2.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
AIM To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and professional and career intentions. DESIGN Joanna Briggs Institute mixed-methods systematic review and thematic synthesis. Registered in Prospero (Redacted). METHODS Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction. RESULTS Searches yielded 2343 hits. Seventy-seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well-being. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to this systematic review.
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Affiliation(s)
- Tessa Watts
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Anna Sydor
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Dean Whybrow
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Eunice Temeng
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Rachael Hewitt
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | | | - Richard G. Kyle
- Public Health WalesCardiffUK
- Academy of NursingUniversity of ExeterExeterUK
| | - Bethan Jones
- School of Healthcare SciencesCardiff UniversityCardiffUK
- School of Health and Social WellbeingUniversity of West of EnglandBristolUK
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13
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Boxell L, Lanphier E. Measuring Moral Distress: Improving the Tools by Educating Clinicians. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:61-63. [PMID: 37011360 DOI: 10.1080/15265161.2023.2186517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
| | - Elizabeth Lanphier
- Cincinnati Children's Hospital Medical Center
- University of Cincinnati College of Medicine
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14
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Işık MT, Yıldırım G. Individualized care perceptions and moral distress of intensive care nurses. Nurs Crit Care 2023; 28:184-192. [PMID: 34532925 DOI: 10.1111/nicc.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive care settings are characterized by their structure, which constantly changes in parallel with scientific and technological developments, the uncertainty of the lifeline between birth and death, the challenges in the fair distribution of limited resources, the participation of individuals in medical decisions, and witnessing the pain experienced by individuals. These characteristics also affect the level of moral distress, which can make it difficult for ICU nurses to provide the most appropriate individualized care for their patients. AIMS The purpose of this study was to determine the moral distress levels and individualized care perceptions of intensive care nurses. STUDY DESIGN This study employed a cross-sectional descriptive survey design. METHODS This descriptive study was conducted with 128 nurses working in the intensive care units of a university hospital in Turkey. Data were collected using an 'Information Form', 'the Moral Distress Scale', and 'the Individualized Care Scale-Nurse Version'. RESULTS 78.9% of the nurses stated that there was staff shortage, and 36.0% stated that the physical conditions were not suitable for care in the intensive care units in which they worked. The mean score on the Moral Distress Scale was 79.2 ± 46.4. The mean total score on the Individualized Care Scale-Nurse Version was 3.5 ± 0.8. CONCLUSION This study revealed that the intensive care nurses had moderate levels of moral distress and good levels of individualized care perceptions although there was no significant relationship between their moral distress levels and individualized care perceptions. Also, the nurses adopted care behaviours supporting patients' feelings and autonomy. RELEVANCE TO CLINICAL PRACTICE In our study, the intensive care nurses did not reflect their moderate-level moral distress in the individualized care provided. It could be beneficial to measure intensive care nurses' moral distress and care levels at frequent intervals so that early precautions could be taken to prevent the accumulation of moral distress and care difficulties among intensive care nurses.
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Affiliation(s)
- Meryem Türkan Işık
- Fundamental Nursing Department, Faculty of Nursing, Mersin University, Ciftlikkoy Campus, Yenisehir/Mersin, Turkey
| | - Gülay Yıldırım
- Department of History of Medicine and Ethics, Cumhuriyet University Faculty of Medicine, Dean's Office, Sivas, Turkey
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15
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Turnover Intention and Organizational Commitment of Primary Healthcare Nurses. Healthcare (Basel) 2023; 11:healthcare11040521. [PMID: 36833055 PMCID: PMC9957010 DOI: 10.3390/healthcare11040521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Turnover intention is a predictor of the decision to leave an organization, which, if carried out, affects the quality of care provided. There is an association between turnover intention and organizational commitment. The more committed nurses are to the unit in which they work, the more committed they become to the unit's organizational goals; thus, they tend to continue working for the organization. Aiming to assess the turnover intention and the organizational commitment of nurses in primary healthcare, we conducted a quantitative, observational, descriptive, and cross-sectional study. The Intention of Turnover Scale and the Organizational Commitment Scale were applied in a sample of 297 nurses. Data were analyzed based on descriptive statistics. About 92.8% of the nurses intend to stay at their current workplace and only 7.3% plan to leave soon, suggesting low turnover intention; 84.5% of the nurses are willing to make an effort beyond what is normal to help their organization succeed, and 88.7% feel really interested in the destiny of the organization, which shows high organizational commitment. Pearson's Coefficient revealed the existence of a significant negative correlation between the factors "Intention to leave" and "Committed to the organization" (r = -0.51, p < 0.01). These findings suggest that, when nurses are more committed to their work and to the organization, they display less intention to leave, keeping the teams committed and motivated towards the organizational goals Our findings may guide nurse managers and policy-makers to develop strategies that retain nurses in organizations, keeping them motivated and engaged, and focusing on higher organizational commitment due to the influence it may have on the turnover intention.
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16
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Ashida K, Kawashima T, Molewijk AC, de Snoo-Trimp JC, Kawakami A, Tanaka M. Moral distress reduction using moral case deliberation in Japan: A mixed-methods study. Jpn J Nurs Sci 2023:e12528. [PMID: 36758945 DOI: 10.1111/jjns.12528] [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: 09/12/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
AIMS This study aims to develop and examine the effectiveness of a support program for reducing moral distress of nurses, based on the moral case deliberation methodology, and to study the feasibility of its implementation. METHODS Study design was an intervention study with pre/post-comparison. The support program included a short lecture and three moral case deliberation sessions for nurses working in an acute care hospital. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) and the Euro-MCD (Moral Case Deliberation) 2.0 scale were used for pre/post-comparison, using the Wilcoxon's signed-rank test. Furthermore, post-intervention interviews were conducted with consenting participants to determine the reasons for changes in pre/post-intervention quantitative data. Of the 34 participants, 29 completed the post-questionnaire and were included in the quantitative data analysis, and 27 were included in the qualitative data analysis. RESULTS The mean MMD-HP total scores increased from 147.5 ± 61.0 to 159.3 ± 66.7, but not significantly (p = .375). The mean score of moral competence, a sub-scale of the Euro-MCD 2.0, increased significantly from 15.4 ± 2.4 to 16.4 ± 2.8 after the intervention (p = .036). A qualitative analysis revealed increased moral sensitivity to ethically difficult situations and improved analytical skills as the reasons for change in scores pre/post-intervention. CONCLUSION The results of the qualitative analysis suggested the effectiveness of the intervention. The moral distress score increased, although not significantly, and moral competence also increased, suggesting the participants' values changed after the intervention. It was found that the support program using MCD is expected to improve participants' moral competence.
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Affiliation(s)
- Kaoru Ashida
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Kanto Gakuin University, Yokohama, Japan
| | - Tetsuharu Kawashima
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Kanto Gakuin University, Yokohama, Japan
| | - Albert C Molewijk
- Department of Medical Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Aki Kawakami
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Makoto Tanaka
- Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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17
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Alimoradi Z, Jafari E, Lin CY, Rajabi R, Marznaki ZH, Soodmand M, Potenza MN, Pakpour AH. Estimation of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics 2023; 30:334-357. [PMID: 36704986 PMCID: PMC9902807 DOI: 10.1177/09697330221135212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. AIM To estimate moral distress among nurses. METHODS This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. ETHICAL CONSIDERATION The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. RESULTS Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. CONCLUSION The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.
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Affiliation(s)
| | - Elahe Jafari
- 113106Qazvin University of Medical Sciences, Qazvin, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | | | | | | | - Marc N Potenza
- Yale University, USA; Connecticut Council on Problem Gambling, USA; Connecticut Mental Health Center, USA; Wu Tsai Institute, Yale University, USA
| | - Amir H Pakpour
- Jönköping University, Sweden; Qazvin University of Medical Sciences, Iran
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18
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de Vries N, Boone A, Godderis L, Bouman J, Szemik S, Matranga D, de Winter P. The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231159318. [PMID: 36912131 PMCID: PMC10014988 DOI: 10.1177/00469580231159318] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.
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Affiliation(s)
- Neeltje de Vries
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands.,Department of Science, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Anke Boone
- Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, KU Leuven, Leuven, Belgium.,IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - José Bouman
- Department of Science, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Szymon Szemik
- Department of Epidemiology, School of Medinie in Kotawice, Medical University of Silesia, Katowice, Poland
| | - Domenica Matranga
- University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
| | - Peter de Winter
- Department of Science, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands.,Leuven Child and Health Institute, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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19
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Salari N, Shohaimi S, Khaledi-Paveh B, Kazeminia M, Bazrafshan MR, Mohammadi M. The severity of moral distress in nurses: a systematic review and meta-analysis. Philos Ethics Humanit Med 2022; 17:13. [PMID: 36348378 PMCID: PMC9644548 DOI: 10.1186/s13010-022-00126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/03/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral distress in nurses. However, to date, a comprehensive study that shows the results of these research across the world was not found, therefore due to the importance of this issue, its role in the health of nurses and patients, and the lack of general statistics about it worldwide, the present study was conducted to determine the frequency and severity of moral distress in nurses through a systematic review and meta-analysis. METHODS In this review study, searching national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Embase, ScienceDirect, Scopus, CINHAL, PubMed, and Web of Science (WoS) between 2005 and February 2020 were extracted. The random-effects model was used for analysis, and the heterogeneity of studies with the I2 index was investigated. Data were analyzed using Comprehensive Meta-Analysis (Version 2). RESULTS The frequency of moral distress in 9 articles with a sample size of 1576 persons was 1.7 ± 0.5 from (0-4), in 13 articles with a sample size of 1870 persons, 3.07 ± 0.1 from (0-5), in 6 articles with a sample size of 1316 persons, 3.2 ± 0.29 from (0-6), in 18 articles with a sample size of 1959 persons, 4.6 ± 0.518 from (1-7) and in 35 articles with a sample size of 3718 persons, 81.1 ± 4.6 from (216-30), and the severity of moral distress in 4 articles with a sample size of 1116 persons, 1.7 ± 0.37 from (0-4), in 5 articles with a sample size of 1282 persons, 2.6 ± 0.28 from (0-5), in 5 articles with a sample size of 944 persons, 3.9 ± 0.63 from (0-6) and in 8 articles with a sample size of 901 persons was 82.3 ± 5.4 (0-216). CONCLUSION The results of this study showed that the frequency and severity of moral distress in nurses are high and are a serious problem in nurses. Therefore, policymakers in this field should consider its role in the health of nurses and patients.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad-Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
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20
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Interventions to Reduce Nurses' Moral Distress in the Intensive Care Unit: An Integrative Review. Dimens Crit Care Nurs 2022; 41:274-280. [PMID: 35905430 DOI: 10.1097/dcc.0000000000000542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Critical care nurses experience moral distress, the phenomenon of knowing the "right" thing to do but being unable to do so, at high rates; this contributes to attrition and has severe mental health impacts on nurses. OBJECTIVE The purpose of this integrative review was to determine if interventions to reduce moral distress have an effect on intensive care unit (ICU) nurses' moral distress levels. METHODS Three databases were searched, PubMed, APA PsycNet, and CINAHL, using the keywords "moral distress" AND nurs* AND reduc* AND ("intensive care" OR "critical care" OR ICU). Only experimental studies involving adult ICU nurses were included for a total of 6 studies. RESULTS Interventions fell into 3 categories: (1) educational interventions, (2) interventions to enhance the ICU environment, and (3) interventions to help nurses cope. Two studies detailing educational interventions demonstrated some reduction in moral distress. One study aimed to improve the ICU environment and showed some statistically significant reduction in moral distress. All 6 studies included some focus on coping, and 2 showed statistically significant reductions in moral distress. DISCUSSION Only a few studies have been conducted examining this issue. These studies had severe limitations, such as small sample sizes, attrition, and inadequate control groups. There were also few statistically significant results. These interventions should be reexamined using larger sample sizes, and other interventions should also be trialed. COVID-19 may have had a significant impact on this issue, and interventions may need to be refocused in the wake of the pandemic.
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21
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Giannetta N, Villa G, Bonetti L, Dionisi S, Pozza A, Rolandi S, Rosa D, Manara DF. Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10640. [PMID: 36078353 PMCID: PMC9517876 DOI: 10.3390/ijerph191710640] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No systematic review in the literature has analyzed the intensity and frequency of moral distress among ICU nurses. No study seems to have mapped the leading personal and professional characteristics associated with high levels of moral distress. This systematic review aimed to describe the intensity and frequency of moral distress experienced by nurses in ICUs, as assessed by Corley's instruments on moral distress (the Moral Distress Scale and the Moral Distress Scale-Revised). Additionally, this systematic review aimed to summarize the correlates of moral distress. METHODS A systematic search and review were performed using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Library of Medicine (MEDLINE/PubMed), and Psychological Abstracts Information Services (PsycINFO). The review methodology followed PRISMA guidelines. The quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. RESULTS Findings showed a moderate level of moral distress among nurses working in ICUs. The findings of this systematic review confirm that there are a lot of triggers of moral distress related to patient-level factors, unit/team-level factors, or system-level causes. Beyond the triggers of moral distress, this systematic review showed some correlates of moral distress: those nurses working in ICUs with less work experience and those who are younger, female, and intend to leave their jobs have higher levels of moral distress. This systematic review's findings show a positive correlation between professional autonomy, empowerment, and moral distress scores. Additionally, nurses who feel supported by head nurses report lower moral distress scores. CONCLUSIONS This review could help better identify which professionals are at a higher risk of experiencing moral distress, allowing the early detection of those at risk of moral distress, and giving the organization some tools to implement preventive strategies.
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Affiliation(s)
- Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Centre, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Debora Rosa
- Department of Cardiovascular, Neural, and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
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22
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Macintyre MR, Brown BWJ, Schults JA. Factors Influencing Pediatric Hematology/Oncology Nurse Retention: A Scoping Review. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:402-417. [PMID: 35815893 DOI: 10.1177/27527530221099899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Nursing staff retention is an ongoing concern within pediatric hematology/oncology settings globally. Work-related stressors cause emotional burden, psychological distress, and burnout to which nurses respond by leaving their workplace. Consequently, workplace culture and functionality are negatively impacted, quality of care reduces, and potential harm to patients increases. This paper aims to identify the "most" influencing factors for intention to leave among pediatric hematology/oncology nurses. Methods: A systematic search was undertaken on 29 July 2021 across five electronic databases, Cumulative Index to Nursing and Allied Health Literature, Joanna Briggs Institute, MEDLINE, PubMed, and Web of Science, using MeSH and keywords related to pediatric hematology/oncology nurse retention. Results: The initial search yielded 283 articles. Following abstract and full-text review, nine articles met inclusion criteria. Across all studies, strong links between health service organizational factors (e.g., unit acuity and time constraints), clinician demographics (e.g., age, education, experience, and coping mechanisms), and nursing retention within pediatric hematology/oncology settings were observed. Direct patient care and long-term relationships with pediatric hematology/oncology patients were identified as the most frequent and intense stressors, while also presenting the most rewarding aspect of the nurse's work. Discussion: Clinician burnout and retention were found to be complex and multifaceted organizational and individual issues, which most importantly evolved from accumulative exposure to specialty-specific stressors. Interventions to prevent clinician burnout and improve staff retention, therefore, need to comprise individual and organizational level strategies specific to the healthcare context.
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Affiliation(s)
| | - Brandon W J Brown
- College of Medicine and Public Health, 1065Flinders University, Bedford Park, SA, Australia
| | - Jessica A Schults
- School of Nursing and Midwifery, 5723Griffith University, Nathan, QLD, Australia.,157827Metro North Hospital and Health Service, Herston Infectious Disease Institute, Herston, QLD, Australia.,1974University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, QLD, Australia
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23
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The Association Between Factors Promoting Nonbeneficial Surgery and Moral Distress: A National Survey of Surgeons. Ann Surg 2022; 276:94-100. [PMID: 33214444 PMCID: PMC9635854 DOI: 10.1097/sla.0000000000004554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence of moral distress among surgeons and test the association between factors promoting non-beneficial surgery and surgeons' moral distress. SUMMARY BACKGROUND DATA Moral distress experienced by clinicians can lead to low-quality care and burnout. Older adults increasingly receive invasive treatments at the end of life that may contribute to surgeons' moral distress, particularly when external factors, such as pressure from colleagues, institutional norms, or social demands, push them to offer surgery they consider non-beneficial. METHODS We mailed surveys to 5200 surgeons randomly selected from the American College of Surgeons membership, which included questions adapted from the revised Moral Distress Scale. We then analyzed the association between factors influencing the decision to offer surgery to seriously ill older adults and surgeons' moral distress. RESULTS The weighted adjusted response rate was 53% (n = 2161). Respondents whose decision to offer surgery was influenced by their belief that pursuing surgery gives the patient or family time to cope with the patient's condition were more likely to have high moral distress (34% vs 22%, P < 0.001), and this persisted on multivariate analysis (odds ratio 1.44, 95% confidence interval 1.02-2.03). Time required to discuss nonoperative treatments or the consulting intensivists' endorsement of operative intervention, were not associated with high surgeon moral distress. CONCLUSIONS Surgeons experience moral distress when they feel pressured to perform surgery they believe provides no clear patient benefit. Strategies that empower surgeons to recommend nonsurgical treatments when they believe this is in the patient's best interest may reduce nonbeneficial surgery and surgeon moral distress.
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24
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Mohd Kamaruzaman AZ, Ibrahim MI, Mokhtar AM, Mohd Zain M, Satiman SN, Yaacob NM. The Effect of Second-Victim-Related Distress and Support on Work-Related Outcomes in Tertiary Care Hospitals in Kelantan, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6454. [PMID: 35682042 PMCID: PMC9180130 DOI: 10.3390/ijerph19116454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
After a patient safety incident, the involved healthcare providers may experience sustained second-victim distress and reduced professional efficacy, with subsequent negative work-related outcomes and the cultivation of resilience. This study aims to investigate the factors affecting negative work-related outcomes and resilience with a hypothetical triad of support as the mediators: colleague, supervisor, and institutional support. This cross-sectional study recruited 733 healthcare providers from three tertiary care hospitals in Kelantan, Malaysia. Three steps of hierarchical linear regression were developed for both outcomes (negative work-related outcomes and resilience). Four multiple mediator models of the support triad were analyzed. Second-victim distress, professional efficacy, and the support triad contributed significantly in all the regression models. Colleague support partially mediated the relationship defining the effects of professional efficacy on negative work-related outcomes and resilience, whereas colleague and supervisor support partially mediated the effects of second-victim distress on negative work-related outcomes. Similar results were found regarding resilience, with all support triads producing similar results. As mediators, the support triads ameliorated the effect of second-victim distress on negative work-related outcomes and resilience, suggesting an important role of having good support, especially after encountering patient safety incidents.
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Affiliation(s)
- Ahmad Zulfahmi Mohd Kamaruzaman
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Ariffin Marzuki Mokhtar
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Maizun Mohd Zain
- Public Health Unit, Hospital Raja Perempuan Zainab II, Kota Bharu 16150, Kelantan, Malaysia;
| | - Saiful Nazri Satiman
- Medical Division, Kelantan State Health Department, Kota Bharu 16150, Kelantan, Malaysia;
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
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Maximiano Faraco M, Lima Gelbcke F, Brehmer LCDF, Ramos FRS, Ghizoni Schneider D. Moral distress-associated sociodemographic and occupational aspects in nursing managers at federal university hospitals. Rev Esc Enferm USP 2022; 56:e20210447. [PMID: 35604285 PMCID: PMC10081633 DOI: 10.1590/1980-220x-reeusp-2021-0447en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the association between sociodemographic and occupational characteristics and the predictors of Moral Distress in nursing managers of Federal University Hospitals. METHOD Cross-sectional study carried out with 126 nurses. Data were collected online between September 2019 and May 2020 applying the Brazilian Scale of Moral Distress in Nurses. The variables were analyzed using descriptive and bivariate statistics to compare the instrument mean responses in relation to sociodemographic and occupational characteristics (hospital size, region, age, gender, training and experience variables, employment relationships, and workload). RESULTS The highest levels of Moral Distress were experienced by nurses in large hospitals, with statistical significance among civil servants with job stability who have no management training, with less time of professional experience and with the highest weekly workload, with emphasis on predictive factors of "safe and qualified care", "work conditions" and "work team". CONCLUSION Based on the above, it is understood that studies of this nature allow the generation of adaptive strategies to reduce the impacts of Moral Distress.
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Affiliation(s)
- Michel Maximiano Faraco
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Francine Lima Gelbcke
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil.,Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Gestão do Cuidado em Enfermagem, Modalidade Profissional, Florianópolis, SC, Brazil
| | | | - Flávia Regina Souza Ramos
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
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Wang CC, Lo J, Saunders R, Adama E, Bulsara C, Etherton-Beer C, Yang AWH. Light acupuncture and five-element music therapy for nurses' mental health and well-being during and post-COVID-19: protocol for a randomised cross-over feasibility study. BMJ Open 2022; 12:e057106. [PMID: 35487736 PMCID: PMC9058290 DOI: 10.1136/bmjopen-2021-057106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Australian nurses have experienced higher levels of anxiety during the COVID-19 pandemic compared with the prepandemic. This may have affected their long-term mental health and intention to stay in the profession resulting in a workforce shortage, which further impacts the health of the public. Management is urgently required to improve nurses' well-being. However, there is limited evidence available. The proposed clinical trial aims to evaluate the feasibility and therapeutic effects of using a combination of light acupuncture and five-element music therapy to improve nurses' mental health and well-being during and post-COVID-19. METHODS AND ANALYSIS This randomised, single blinding, two-arm cross-over feasibility study involves a 1-week run-in period, 2-week intervention and 1-week run-in period in between interventions. Thirty-six eligible nurses will be recruited from the community and randomised into either a combination of light acupuncture treatment and five-element music therapy group or no treatment group for 2 weeks. After a 1-week run in period, they will be swapped to the different group. The primary outcome of this study is to evaluate the feasibility of a combination of light acupuncture treatment and five-element music therapy to improve nurses' mental health and well-being. The secondary outcomes will include anxiety and depression, work productivity and activity, and quality of life assessments. Participants will be asked to complete a set of online questionnaires throughout the trial period. All analyses will be performed in R Studio V.1.1.463. ETHICS AND DISSEMINATION Ethical approval was attained from Edith Cowan University's Human Research Ethics Committee (No. 2021-02728-WANG). Research findings will be shared with hospitals and in various forms to engage broader audiences, including national and international conferences, presentations, open-access peer-reviewed journal publications, and local community workshop dissemination with healthcare professionals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12621000957897p https://www.anzctr.org.au/ACTRN12621000957897p.aspx.
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Affiliation(s)
- Carol Chunfeng Wang
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame, Fremantle, Western Australia, Australia
| | | | - Angela Wei Hong Yang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families. Cancer Nurs 2022:00002820-990000000-00021. [PMID: 35439199 DOI: 10.1097/ncc.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families. OBJECTIVE The aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals. METHOD This qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis. RESULTS Two themes emerged: (1) living with conflicts intrinsic to the relationships, which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience, which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful. CONCLUSIONS The results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts. IMPLICATIONS FOR PRACTICE This study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.
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Morley G, Sankary LR, Horsburgh CC. Mitigating Moral Distress through Ethics Consultation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:61-63. [PMID: 35420516 DOI: 10.1080/15265161.2022.2044555] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Zeydi AE, Ghazanfari MJ, Suhonen R, Adib-Hajbaghery M, Karkhah S. Effective interventions for reducing moral distress in critical care nurses. Nurs Ethics 2022; 29:1047-1065. [PMID: 35081833 DOI: 10.1177/09697330211062982] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Moral distress (MD) has received considerable attention in the nursing literature over the past few decades. It has been found that high levels of MD can negatively impact nurses, patients, and their family and reduce the quality of patient care. This study aimed to investigate the potentially effective interventions to alleviate MD in critical care nurses. In this systematic review, a broad search of the literature was conducted in the international databases including PubMed/MEDLINE, Web of Science, and Scopus, as well as Google Scholar search engine using keywords such as moral distress, intensive care unit, ICU, nurses, and critical care nurses from 1984, when the concept of MD was first introduced in the nursing literature, up to 29 October 2020. Studies focusing on the interventions for managing MD in critical care nurse were evaluated. The quality of eligible papers was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 8 studies fulfilled the eligibility criteria. Three studies had RCT design and five studies had quasi-experimental design. All studies were conducted in the United States or Iran. Educational workshop, moral empowerment program, social work intervention, nursing ethics huddles, and multifaceted resiliency bundle intervention were effective interventions for managing of MD among critical care nurses. There is limited but promising research evidence evaluating the efficacy of educational interventions for managing of MD among critical care nurses. Although some positive results have been reported, there is limited generalizable evidence due to the variability of interventions. These findings highlight the need for further studies to validate the efficacy of these interventions or develop more potent and efficient interventions for reducing MD in critical care nurses.
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Affiliation(s)
- Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, 108890Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Javad Ghazanfari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, 48462Kashan University of Medical Sciences, Kashan, Iran
| | - Riitta Suhonen
- Department of Nursing Science, 8058University of Turku, Turku, Finland.,Welfare Services Division, 8058Turku University Hospital and City of Turku, Turku, Finland
| | - Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, 48462Kashan University of Medical Sciences, Kashan, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, 37554Guilan University of Medical Sciences, Rasht, Iran.,Social Determinants of Health Research Center (SDHRC), 37554Guilan University of Medical Sciences, Rasht, Iran.,Burn and Regenerative Medicine Research Center, 37554Guilan University of Medical Sciences, Rasht, Iran
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Maximiano Faraco M, Lima Gelbcke F, Brehmer LCDF, Ramos FRS, Ghizoni Schneider D. Aspectos sociodemográficos e laborais associados ao distresse moral em gestores de enfermagem de hospitais universitários federais. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0447pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: Analisar a associação entre as características sociodemográficas e laborais e os fatores preditores de Distresse Moral em gestores de enfermagem de Hospitais Universitários Federais. Método: Estudo transversal realizado com 126 enfermeiros. Os dados foram coletados entre os meses de setembro de 2019 e maio de 2020, via online, aplicando-se a Escala Brasileira de Distresse Moral em Enfermeiros. As variáveis foram analisadas por estatística descritiva e bivariada para comparar as médias de respostas do instrumento em relação às características sociodemográficas e laborais (porte do hospital, região, idade, sexo, variáveis de formação e experiências, vínculos e carga horária). Resultados: Os níveis mais elevados de Distresse Moral foram vivenciados por enfermeiros em hospitais de grande porte, com significância estatística entre os estatutários, sem formação em gestão, com menor tempo de experiência profissional e com a maior carga horária de trabalho semanal, com ênfase nos fatores preditores de “cuidado seguro e qualificado”, “condições de trabalho” e “equipe de trabalho”. Conclusão: A partir do exposto, entende-se que estudos dessa natureza permitem gerar estratégias adaptativas para reduzir os impactos do Distresse Moral.
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Affiliation(s)
| | - Francine Lima Gelbcke
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil
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Romero-García M, Delgado-Hito P, Gálvez-Herrer M, Antonio Ángel-Sesmero J, Raquel Velasco-Sanz T, Benito-Aracil L, Heras-La Calle G. Moral distress, emotional impact and coping in intensive care units staff during the outbreack of COVID-19. Intensive Crit Care Nurs 2022; 70:103206. [PMID: 35120794 PMCID: PMC8776502 DOI: 10.1016/j.iccn.2022.103206] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/27/2022]
Abstract
Background From the beginning, the COVID-19 pandemic increased ICU workloads and created exceptionally difficult ethical dilemmas. ICU staff around the world have been subject to high levels of moral stress, potentially leading to mental health problems. There is only limited evidence on moral distress levels and coping styles among Spanish ICU staff, and how they influenced health professionals’ mental health during the pandemic. Objectives To assess moral distress, related mental health problems (anxiety and depression), and coping styles among ICU staff during the first wave of the COVID-19 pandemic in Spain. Design Cross-sectional. Settings and participants The study setting consisted of intensive care unit and areas converted into intensive care units in public and private hospitals. A total of 434 permanent and temporary intensive care staff (reassigned due to the pandemic from other departments to units) answered an online questionnaire between March and June 2020. Methods Sociodemographic and job variables, moral distress, anxiety, depression, and coping mechanisms were anonymously evaluated through a self-reported questionnaire. Descriptive and correlation analyses were conducted and multivariate linear regression models were developed to explore the predictive ability of moral distress and coping on anxiety and depression. Results Moral distress during the pandemic is determined by situations related to the patient and family, the intensive care unit, and resource management of the organisations themselves. intensive care unit staff already reached moderate levels of moral distress, anxiety, and depression during the first wave of the pandemic. Temporary staff (redeployed from other units) obtained higher scores in these variables (p = 0.04, p = 0.038, and p = 0.009, respectively) than permanent staff, as well as in greater intention to leave their current position (p = 0.03). This intention was also stronger in health staff working in areas converted into intensive care units (45.2%) than in normal intensive care units (40.2%) (p = 0.02). Moral distress, coupled with primarily avoidance-oriented coping styles, explains 37% (AdR2) of the variance in anxiety and 38% (AdR2) of the variance in depression. Conclusions Our study reveals that the emotional well-being of intensive care unit staff was already at risk during the first wave of the pandemic. The moral distress they experienced was related to anxiety and depression issues, as well as the desire to leave the profession, and should be addressed, not only in permanent staff, but also in temporary staff, redeployed to these units as reinforcement workers.
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Choi MH, Lee M. Psychosocial and psychological interventions' effectiveness among nurses in intensive care units caring for pediatric patients: A systematic review and meta-analysis. Front Pediatr 2022; 10:883230. [PMID: 36299695 PMCID: PMC9589089 DOI: 10.3389/fped.2022.883230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This review aimed to evaluate the effectiveness of psychosocial and psychological interventions in nurses among intensive care units caring for pediatric patients. METHODS A literature search was performed in PubMed, EMBASE, CINAHL databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Study design, population characteristics, contents of the programs, measured outcomes, and results were systematically reviewed from 8 selected studies. To estimate the effect size, a meta-analysis of the studies was performed using the RevMan 5.3 program. The effect size used was the standardized mean difference. RESULTS Of 1,630 studies identified, 4 met the inclusion criteria, and 3 studies were used to estimate the effect size of psychosocial and psychological interventions. The primary outcome variable of these studies was stress. The effect of the intervention program on stress was also found to have no effect in individual studies, and the overall effect size was not statistically significant (standardized mean difference = -0.06; 95% confidence interval: -0.33, 0.20; Z = 0.48, p = 0.630). However, according to the individual literature included in this study, after the stress management program was applied as a group, a significant stress reduction was shown in the experimental group (p = 0.021). CONCLUSIONS These results show that psychosocial and psychological interventions were effective in stress management by a group approach. Therefore, it is necessary to develop psychosocial support interventions for stress management of nurses among intensive care units caring for pediatric patients more diversely.
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Affiliation(s)
- Mi Hyang Choi
- College of Nursing, Changshin University, Changwon, South Korea
| | - Misoon Lee
- Department of Nursing, Youngsan University, Yangsan, South Korea
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Nemati R, Moradi A, Marzban M, Farhadi A. The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic. Work 2021; 70:1039-1046. [PMID: 34842218 DOI: 10.3233/wor-210558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance. OBJECTIVE This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis. RESULTS The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014). CONCLUSION The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.
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Affiliation(s)
- Reza Nemati
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ainaz Moradi
- Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Marzban
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
| | - Akram Farhadi
- Department of Health Education and Promotion, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran
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Cantu R, Carter L, Elkins J. Burnout and intent-to-leave in physical therapists: a preliminary analysis of factors under organizational control. Physiother Theory Pract 2021; 38:2988-2997. [PMID: 34429016 DOI: 10.1080/09593985.2021.1967540] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
METHODS Twelve hundred PTs were sent a survey packet including the 20-item Ethics Environment Questionnaire (EEQ) and additional items inquiring about contemporary practice factors. Returned packets (n = 340) were analyzed utilizing correlational and regression analyses to determine relationships between ethical environment, burnout, intent-to-leave, productivity standards, billing and coding requirements and ability to provide pro-bono services. RESULTS There was a strong correlation between PTs' view of organizational ethics and burnout (Tb = -0.55), and a moderate correlation between organizational ethics and intent-to-leave (Tb = -0.43). There was also a strong relationship between burnout/intent-to-leave and practice factors such as productivity standards, billing/coding policy, and organizational provision of pro-bono services (p ≤ 0.01). Finally, there was a moderate correlation between PTs' view of organizational ethics and practice factors such as productivity standards (Tb = 0.46) and billing and coding policy (Tb = -0.45). CONCLUSIONS Contemporary practice factors such as productivity standards and billing/coding practices are related PT's perception of ethical workplace environment and both are related to PT burnout and intent-to-leave. Factors identified in this study related to burnout are all under organizational control.
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Affiliation(s)
- Roberto Cantu
- Ivester College of Health Sciences, Department of Physical Therapy, Brenau University, Gainesville, GA, USA
| | - Laura Carter
- Department of Physical Therapy, Piedmont Walton Hospital, Monroe, GA, USA
| | - Jeananne Elkins
- Ivester College of Health Sciences, Department of Physical Therapy, Brenau University, Gainesville, GA, USA
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Baele CA, Fontaine JRJ. The Moral Distress-Appraisal Scale: Scale development and validation study. J Adv Nurs 2021; 77:4120-4130. [PMID: 34171142 DOI: 10.1111/jan.14923] [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] [Received: 06/02/2020] [Revised: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
AIMS Moral distress-arising when one is constrained from moral action-has been receiving increased attention in nursing research. The phenomenon is associated with negative outcomes and is shown to impact a broad range of healthcare professions. The context-specific nature of existing measures, however, makes it difficult, if not impossible, to compare the prevalence and impact of moral distress across nursing settings and healthcare professions. This study presents an appraisal approach to the assessment of moral distress. The aims of this study were to develop and to investigate the reliability and validity of the Moral Distress-Appraisal Scale as a context-independent assessment instrument for moral distress. DESIGN This is a cross-sectional correlational validation study. METHODS Between September 2018 and June 2019, a total of 406 healthcare employees (mainly nurses) completed a quantitative survey consisting of a standard moral distress measure (Moral Distress Scale-Revised) and the Moral Distress-Appraisal Scale. A subsample (n = 164) received extra questions on work characteristics, well-being and attitudinal outcomes. Confirmatory factor analysis, Pearson correlations and regression analyses were conducted in order to evaluate the psychometric properties of the newly developed scale. RESULTS Confirmatory factor analysis provided evidence for the predicted structure of the 8-item Moral Distress-Appraisal Scale. As expected, the scale is positively correlated with the Moral Distress Scale-Revised and with job demands, burnout, depressive symptoms, and turnover intentions and negatively with job resources and job satisfaction. Furthermore, the scale showed incremental validity in predicting wellbeing and attitudinal outcomes above and beyond both known predictive work characteristics and the Moral Distress Scale-Revised. CONCLUSION This study provides first empirical evidence for the reliability and validity of the Moral Distress-Appraisal Scale. IMPACT The Moral Distress-Appraisal Scale can be used across healthcare professions and contexts. The proposed appraisal approach may facilitate integration of the scale into occupational health research and practice.
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Affiliation(s)
- Céline A Baele
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Johnny R J Fontaine
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Ashida K, Kawakami A, Kawashima T, Tanaka M. Values and self-perception of behaviour among critical care nurses. Nurs Ethics 2021; 28:1348-1358. [PMID: 34075832 DOI: 10.1177/0969733021999738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress. RESEARCH AIMS The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others. RESEARCH DESIGN A nationwide, cross-sectional study was conducted. PARTICIPANTS AND RESEARCH CONTEXT We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item. ETHICAL CONSIDERATIONS The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045). RESULTS The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients. DISCUSSION Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse's priorities might diverge from those of other team members, which can lead to conflict within the team. CONCLUSION This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress.
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Affiliation(s)
- Kaoru Ashida
- Tokyo Medical and Dental University (TMDU), Japan
| | - Aki Kawakami
- Tokyo Medical and Dental University (TMDU), Japan
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Factors associated with stress of conscience in caring for older people with delirium in a hospital setting: An exploratory cross-sectional study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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An Ethics Early Action Protocol to Promote Teamwork and Ethics Efficacy. Dimens Crit Care Nurs 2021; 40:226-236. [PMID: 34033444 DOI: 10.1097/dcc.0000000000000482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Moral dilemmas and ethical conflicts occur in critical care. Negative consequences include misunderstandings, mistrust, patient and family suffering, clinician moral distress, and patient safety concerns. Providing an opportunity for team-based ethics assessments and planning could improve communication and reduce moral distress. OBJECTIVES The aims of this study were to explore whether an early action ethics intervention affects intensive care unit (ICU) clinicians' moral distress, ethics self-efficacy, and perceptions of hospital climate and to compare nurses' and physicians' scores on moral distress, ethics self-efficacy, and ethical climate at 3 time points. METHODS Intensive care unit nurses and physicians were asked to complete surveys on moral distress, ethics self-efficacy, and ethical climate before implementing the ethics protocol in 6 ICUs. We measured responses to the same 3 surveys at 3 and 6 months after the protocol was used. RESULTS At baseline, nurses scored significantly higher than physicians in moral distress and significantly lower in ethics self-efficacy. Plot graphs revealed that nurses' and physicians' outcome scores trended toward one another. At 3 and 6 months post intervention, nurse and physician scores changed differently in moral distress and ethics self-efficacy. When examining nurse and physician scores separately over time, we found nurses' scores in moral distress and moral distress frequency decreased significantly over time and ethics self-efficacy and ethics climate increased significantly over time. Physicians' scores did not change significantly. DISCUSSION This study indicates that routine, team-based ethics assessment and planning opens a space for sharing information, which could decrease nurses' moral distress and increase their ethics self-efficacy. This, in turn, can potentially promote teamwork and reduce burnout.
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Prompahakul C, Keim-Malpass J, LeBaron V, Yan G, Epstein EG. Moral distress among nurses: A mixed-methods study. Nurs Ethics 2021; 28:1165-1182. [PMID: 33888021 DOI: 10.1177/0969733021996028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. OBJECTIVE This study aims to describe the experience of moral distress and related factors among Thai nurses. DESIGN A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated. PARTICIPANTS Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand. ETHICAL CONSIDERATIONS This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151. RESULTS A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress. DISCUSSION Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient's and family's religious perspective that ties into the concept of moral distress needs to be explored. CONCLUSIONS Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context.
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Zandian H, Alipouri Sakha M, Nasiri E, Zahirian Moghadam T. Nursing work intention, stress, and professionalism in response to the COVID-19 outbreak in Iran: A cross-sectional study. Work 2021; 68:969-979. [PMID: 33867365 DOI: 10.3233/wor-205099] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Professionalism, stress and demographic factors are the three key influences in nurses' intention to provide care. OBJECTIVES This study examined the levels of work intention, stress and professionalism of nurses and determine the relationship between nursing work intention and factors in response to COVID-19. METHODS This cross-sectional study was conducted on 362 nurses from COVID-19-devoted hospitals in Iran. A self-administered electronic-based questionnaire was developed and used to determine levels of stress, professionalism, and nursing intention. Multiple regression analysis was carried out to analyze the correlation between nursing intention with respect to stress and professionalism. RESULTS The overall stress, professionalism, and nursing intention scores were 48.56, 21.46, and 17.83 respectively. There were significant differences in nursing intention scores between gender, marital status, and having training groups (p < 0.05). The regression analysis revealed that nursing intention had a significant relationship with older age (p < 0.001,S.E = 1.11,B = 17.02), higher income level (p < 0.001,S.E = 1.81,B = 6.98), having previous training (p = 0.008,S.E = 1.22,B = 3.27), higher stress level (p < 0.001,S.E = 2.37,B = -21.39), and high professionalism level (p < 0.001,S.E = 1.16,B = 11.99). CONCLUSION Having an adequate staff requirement plan, planning appropriate training for nurses, and proactive psychological support are crucial to prevent burnout and continue to provide nursing services.
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Affiliation(s)
- Hamed Zandian
- Ardabil University of Medical Sciences, Ardabil, Iran
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Khatatbeh H, Pakai A, Pusztai D, Szunomár S, Fullér N, Kovács Szebeni G, Siket A, Zrínyi M, Oláh A. Burnout and patient safety: A discriminant analysis of paediatric nurses by low to high managerial support. Nurs Open 2021; 8:982-989. [PMID: 33570274 PMCID: PMC7877129 DOI: 10.1002/nop2.708] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/03/2020] [Indexed: 11/11/2022] Open
Abstract
AIM To explore how levels of managerial support discriminate paediatric nurses' burnout, quality of life, intent to leave and adverse patient events. DESIGN A quantitative correlational study. METHODS A total of 225 paediatric nurses were selected from nine major hospitals across Jordan. The main measures used were the Copenhagen Burnout Inventory and the brief version of World Health Organization-Quality of Life Instrument. The study methods were compliant with the STROBE checklist. RESULTS Nurse manager support was negatively associated with adverse patient events, work-related burnout, client-related burnout, and intent to leave; and positively with physical and psychological quality of life. Frequency of nosocomial infections characterized low manager support, whereas medication errors described high support. Greater nurse manager support decreased the likelihood of adverse patient outcomes.
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Affiliation(s)
| | | | | | | | - Noémi Fullér
- Faculty of Health SciencesUniversity of PécsPécsHungary
| | | | - Adrienn Siket
- Faculty of Health SciencesUniversity of DebrecenNyiregyhazaHungary
| | - Miklós Zrínyi
- Faculty of Health SciencesUniversity of PécsPécsHungary
| | - András Oláh
- Faculty of Health SciencesUniversity of PécsPécsHungary
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Arbe Montoya AI, Hazel SJ, Matthew SM, McArthur ML. Why do veterinarians leave clinical practice? A qualitative study using thematic analysis. Vet Rec 2021; 188:e2. [DOI: 10.1002/vetr.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Alejandra I. Arbe Montoya
- School of Animal and Veterinary Science The University of Adelaide Roseworthy South Australia Australia
| | - Susan J. Hazel
- School of Animal and Veterinary Science The University of Adelaide Roseworthy South Australia Australia
| | - Susan M. Matthew
- College of Veterinary Medicine Washington State University Pullman Washington USA
| | - Michelle L. McArthur
- School of Animal and Veterinary Science The University of Adelaide Roseworthy South Australia Australia
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KOVANCI MS, HİÇDURMAZ D. Ahlaki Cesaret: Tanımı, Ahlaki Sıkıntı ve Ahlaki Duyarlılık İle İlişkisi ve Geliştirilmesi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.683548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Frechette J, Frati FYE, Octeau D, Bitzas V, Lavoie-Tremblay M. Impact of unit design on intensive care unit clinicians: a scoping review protocol. ACTA ACUST UNITED AC 2020; 17:2541-2550. [PMID: 31290792 DOI: 10.11124/jbisrir-2017-004007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aims to identify the known impact of unit design on intensive care unit clinicians, and more specifically, to explore similarities and differences across critical care settings. INTRODUCTION Construction and infrastructure renewal represent great opportunities for designing units that enhance patient care, as well as support the work of clinicians. A growing body of evidence is showing how unit design can impact clinical staff, but no reviews have been found that focus exclusively on clinicians within intensive care units. INCLUSION CRITERIA The review will consider studies that include healthcare staff who offer direct patient care in adult or pediatric intensive care units. Studies that focus on the impact of design (related to physical environment features) on clinicians will be included. METHODS The proposed systematic review will be conducted in accordance with JBI methodology for scoping reviews. The search strategy aims to find published and unpublished studies. The databases to be searched will include Embase MEDLINE, PsycINFO, Healthstar and CINAHL. Retrieved studies will be assessed against the inclusion criteria by two independent reviewers. For the papers included in the scoping review, data will be extracted and quality assessed by two independent reviewers. The extracted data will be presented in tabular form, and a narrative summary will describe how the results relate to the review objective.
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Affiliation(s)
- Julie Frechette
- Ingram School of Nursing, McGill University, Montreal, Canada
| | | | - Daphné Octeau
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, Canada.,Nursing Directorate, Integrated Health and Social Services University Network for West-Central Montreal, Montreal, Canada
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Marturano E, Hermann R, Giordano N, Trotta R. Moral Distress: Identification Among Inpatient Oncology Nurses in an Academic Health System. Clin J Oncol Nurs 2020; 24:500-508. [DOI: 10.1188/20.cjon.500-508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int J Nurs Stud 2020; 111:103767. [PMID: 32956930 DOI: 10.1016/j.ijnurstu.2020.103767] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND An increasing number of professionals are challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distress in different studies. Yet, there has not been, so far, a systematic assessment of the qualitative properties of the various instruments measuring moral distress in healthcare workers based on a universally accepted standardized framework. OBJECTIVE (1) To identify all instruments for the measurement of moral distress available in recent literature; (2) to evaluate the evidence regarding their measurement properties; (3) to facilitate the selection of the most appropriate instrument to be adopted in practice and research. DESIGN Systematic literature review. DATA SOURCES PubMed, CINAHL, and PyscINFO. REVIEW METHODS The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of the identified studies. The quality of measurement properties of each instrument was evaluated using Terwee's quality criteria. RESULTS Among the 1268 studies found, 88 full-text articles evaluated moral distress adopting different tools. Thirty two of them had a methodological design. The measurement instruments assessed in this review are different in terms of targeted population and items. The instruments were then divided into two main categories: (1) Corley's instruments on moral distress (Moral distress scale and Moral Distress Scale - Revised) and (2) instruments not directly derived from Corley's moral distress theory (Moral Distress thermometer, Moral Distress Risk Scale, Ethical Stress Scale or Moral Distress in Dementia Care Survey). The first set is the most frequently studied and used in different clinical settings and healthcare populations. A variety of psychometric properties have been evaluated for each instrument, revealing different qualities in the methodology used. CONCLUSIONS Several instruments assessing moral distress in healthcare workers have been identified and evaluated in this systematic review. Based on the criteria used here, Corley's instruments on moral distress seems to be the most useful and most appropriate to the clinical setting for practice and research purposes. TWEETABLE ABSTRACT The aim of this systematic review was to identify the instruments measuring moral distress now available in the literature, in order to (1) assess the evidence about their measurement properties, (2) support the selection of the most appropriate instrument to be used in practice and research.
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Affiliation(s)
- Noemi Giannetta
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Giulia Villa
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pennestrì
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Sala
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Mordacci
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
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Ramos FRS, Barth PO, Brehmer LCDF, Dalmolin GDL, Vargas MA, Schneider DG. Intensity and frequency of moral distress in Brazilian nurses. Rev Esc Enferm USP 2020; 54:e035578. [PMID: 32813799 DOI: 10.1590/s1980-220x2018020703578] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the frequency and intensity of moral distress in Brazilian nurses. METHOD Cross-sectional study performed with nurses from 27 Brazilian states through application of the Brazilian Moral Distress Scale in Nurses (Portuguese acronym: EDME-Br) and descriptive statistical analysis. RESULTS Participation of 1,226 Brazilian nurses in the study. The intensity and frequency of overall moral distress were rated as moderate level, with averages of 3.08 (± 1.45) and 2.94 (± 1.37), respectively. Specifically, the highest intensity and frequency was related to the factors Acknowledgement, power and professional identity and Work teams, while the lowest was related to the factor Defense of values and rights. CONCLUSION Moral distress occurs in precarious work environments, with little expressiveness of the nurses' role. One highlights the importance of the problem in terms of its amplitude and multicausality, reaching professionals acting in different work contexts.
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Affiliation(s)
- Flavia Regina Souza Ramos
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Priscila Orlandi Barth
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | - Mara Ambrosina Vargas
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Dulcinéia Ghizoni Schneider
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Frechette J, Bitzas V, Kilpatrick K, Aubry M, Lavoie-Tremblay M. A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers. J Nurs Manag 2020; 28:872-880. [PMID: 32219900 DOI: 10.1111/jonm.13012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 11/27/2022]
Abstract
AIM To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. BACKGROUND While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. METHOD The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital. RESULTS Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. CONCLUSION Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. IMPLICATIONS FOR NURSING MANAGEMENT The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.
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Affiliation(s)
- Julie Frechette
- McGill University Ingram School of Nursing, Montreal, QC, Canada
| | - Vasiliki Bitzas
- McGill University Ingram School of Nursing, Montreal, QC, Canada.,Quebec Integrated University Centre for Health and Social Services of Western Central Montreal Island, Montreal, QC, Canada
| | | | - Monique Aubry
- School of Business and Management, Université du Québec à Montréal, Montreal, QC, Canada
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Perni S, Pollack LR, Gonzalez WC, Dzeng E, Baldwin MR. Moral distress and burnout in caring for older adults during medical school training. BMC MEDICAL EDUCATION 2020; 20:84. [PMID: 32293416 PMCID: PMC7092500 DOI: 10.1186/s12909-020-1980-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/24/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Moral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics. METHODS A cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1-10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale. RESULTS Two-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4-7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers and faculty on the inpatient clerkships on medicine, neurology, and surgery, where students most often reported experiencing moral distress. CONCLUSIONS Moral distress is highly prevalent among medical students while caring for older patients, and associated with burnout. Incorporating geriatrics education and debriefing sessions into inpatient clerkships could alleviate medical student moral distress and burnout.
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Affiliation(s)
- Subha Perni
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - Lauren R Pollack
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Wendy C Gonzalez
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Dzeng
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Matthew R Baldwin
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Af Sandeberg M, Bartholdson C, Pergert P. Important situations that capture moral distress in paediatric oncology. BMC Med Ethics 2020; 21:6. [PMID: 31931787 PMCID: PMC6958740 DOI: 10.1186/s12910-020-0447-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology. METHODS In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. RESULTS Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21. CONCLUSION In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.
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Affiliation(s)
- Margareta Af Sandeberg
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden. .,Paediatric Haematology and Oncology, Children's and Women's Health Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Cecilia Bartholdson
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden.,Paediatric Neurology and Muscular Skeletal Disorders and Homecare, Children's and Women's Health Care, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Pergert
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden.,Paediatric Haematology and Oncology, Children's and Women's Health Care, Karolinska University Hospital, Stockholm, Sweden
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