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Reimer-Kirkham S, Sharma S. The social relations of prayer in healthcare: Adding to nursing's equity-oriented professional practice and disciplinary knowledge. Nurs Inq 2024; 31:e12608. [PMID: 37869907 DOI: 10.1111/nin.12608] [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: 03/05/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
Although spiritual practices such as prayer are engaged by many to support well-being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest-whether embraced, tolerated, or resisted-in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the "spirit" of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person-centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity-oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care.
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Affiliation(s)
| | - Sonya Sharma
- Social Research Institute, University College London, London, UK
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Miller PH, Epstein EG, Smith TB, Welch TD, Smith M, Bail JR. Critical care nurse leaders' moral distress: A qualitative descriptive study. Nurs Ethics 2024:9697330241238347. [PMID: 38476080 DOI: 10.1177/09697330241238347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. RESEARCH AIM The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. RESEARCH DESIGN A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. PARTICIPANT AND RESEARCH CONTEXT Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. ETHICAL CONSIDERATIONS This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. FINDINGS UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. CONCLUSIONS The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed.
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Affiliation(s)
- Preston H Miller
- University of Alabama in Huntsville College of Nursing; The University of Alabama Capstone College of Nursing
| | | | - Todd B Smith
- The University of Alabama Capstone College of Nursing
| | | | - Miranda Smith
- The University of Alabama in Huntsville College of Nursing
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Stanley MJ, Logan RI. Moral Resilience and Race, Ethnicity, and Culture Within Healthcare Workers During the COVID-19 Pandemic in the USA: a Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01911-7. [PMID: 38261163 DOI: 10.1007/s40615-024-01911-7] [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: 10/24/2023] [Revised: 12/15/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
The COVID-19 pandemic has and continues to impact the world affecting all aspects of life. Healthcare workers have been hit especially hard and, in many cases, experience negative impacts not only on their physical health but also on their mental and emotional well-being. Additionally, the COVID-19 pandemic has not affected populations equally and this is true in the USA, including healthcare workers. However, these workers have also persevered, drawing on moral resilience to push through challenging situations throughout this pandemic. In this scoping review, we analyzed studies to assess the role of race, ethnicity, and/or culture on the moral resilience of healthcare workers throughout the COVID-19 pandemic. Our aim was to understand the research that has assessed these potential connections and determine best practices for building moral resilience in the face of this global catastrophe. Fourteen articles met inclusion criteria and were analyzed in this review. Following a thematic analysis, several themes emerged including (1) moral resilience and the COVID-19 pandemic; (2) race, ethnicity, and culture among healthcare workers; and (3) building moral resilience. In sum, the findings from the literature indicate a paucity of studies that analyze the role played by race, ethnicity, and/or culture in connection to moral resilience during the COVID-19 pandemic.
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Affiliation(s)
- Mary Jo Stanley
- Department of Health Science, Colorado Mesa University, Grand Junction, CO, USA.
| | - Ryan I Logan
- Department of Anthropology and Geography & Environmental Resources, California State University, Stanislaus, Turlock, CA, USA
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Nowicki GJ, Schneider-Matyka D, Godlewska I, Tytuła A, Kotus M, Walec M, Grochans E, Ślusarska B. The relationship between the strength of religious faith and spirituality in relation to post-traumatic growth among nurses caring for COVID-19 patients in eastern Poland: a cross-sectional study. Front Psychiatry 2024; 14:1331033. [PMID: 38260777 PMCID: PMC10800582 DOI: 10.3389/fpsyt.2023.1331033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction The COVID-19 pandemic had forced intensive care unit (ICU) nurses to adapt to extreme conditions in a short period of time. This resulted in them experiencing extremely stressful situations. The aim of this study was to assess the relationship between post-traumatic growth (PTG) and religiosity and spirituality (R/S) among nurses caring for COVID-19 patients in intensive care during the pandemic. Materials and methods 120 nurses working in Lublin, eastern Poland, participated in the cross-sectional study. The questionnaire was made up of three standardised tools: The Post-Traumatic Growth Inventory, The Santa Clara Strength of Religious Faith Questionnaire, The Spiritual Attitude and Involvement List. Results In terms of spirituality, the study group of nurses achieved the highest score in the Connectedness with Nature subscale (4.37 ± 1.07), while the strength of religious beliefs had a positive correlation with post-traumatic growth only in the Spiritual changes subscale (r = 0.422, p < 0.001). The following dimensions of spirituality were significantly correlated with post-traumatic growth in the multi-factor model that included religiosity and spirituality: Transcendent experiences, Spiritual activities, Meaningfulness, Acceptance, and Trust. We saw that increase in the assessment of the Transcendent experiences, Meaningfulness and Trust subscales significantly mirrors increase in post-traumatic growth, while increase in the assessment of the Spiritual activities and Acceptance subscales significantly mirrors decrease in post-traumatic growth. The above variables explained up to 44% of the dependent variable. Conclusion Both religiosity and spirituality were significantly associated with post-traumatic growth in the group of ICU nurses, but spirituality appears to have played a larger role. Our findings support the value and significance of the development of spiritual and religious identity as a means of enhancing positive psychological changes in the face of traumatic events.
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Affiliation(s)
- Grzegorz Józef Nowicki
- Department of Family and Geriatric Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Daria Schneider-Matyka
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Iwona Godlewska
- Second Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Andrzej Tytuła
- Head Chamber of Nurses and Midwives, Warszawa, Poland
- Faculty of Human Sciences, University of Economics and Innovation, Lublin, Poland
| | - Marzena Kotus
- Department of Anaesthesiological and Intensive Care Nursing, Medical University of Lublin, Lublin, Poland
| | - Monika Walec
- Department of Family and Geriatric Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Barbara Ślusarska
- Department of Family and Geriatric Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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Berdida DJE, Grande RAN. Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis. JOURNAL OF RELIGION AND HEALTH 2023; 62:3957-3978. [PMID: 37442900 DOI: 10.1007/s10943-023-01873-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.
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Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, St. Martin de Porres Bldg., España Boulevard, 1015, Manila, Philippines.
| | - Rizal Angelo N Grande
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il, 55473, Kingdom of Saudi Arabia
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Berdida DJE. The mediating roles of moral courage and moral resilience between nurses' moral distress and moral injury: An online cross-sectional study. Nurse Educ Pract 2023; 71:103730. [PMID: 37499534 DOI: 10.1016/j.nepr.2023.103730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
AIMS To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury. BACKGROUND There is a preponderance of nursing literature about moral distress, moral resilience, moral courage and moral injury. However, examining moral resilience and moral courage as mediators remain underreported during the COVID-19 pandemic and in the context of a developing nation. DESIGN Correlational, cross-sectional design compliant with the STROBE guidelines. METHODS A convenience sample of nurses (n = 412) from the Philippines were recruited using social media platforms (e.g., Facebook, Messenger, Twitter). Four self-report and validated scales (8-item Moral-Distress Appraisal Scale, 21-item Nurses' Moral Courage Scale, 17-item Rushton Moral Resilience Scale and 10-item Moral Injury Symptom Scale: Healthcare Professionals Version) were used to collect data from January to July 2022. Pearson's r, bivariate analysis and multistage regression analyses were used for data analysis. RESULTS This study afforded a model that depicted the interrelationships of moral distress, moral resilience, moral courage and moral injury. Moral distress has a negative impact on moral resilience and moral courage while positively affecting moral injury. Moral resilience positively influences moral courage while having a negative impact on moral injury. Moral courage has an indirect impact on moral injury. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. CONCLUSIONS Healthcare organizations, policymakers and nurse managers should include policies and programs that include improving approaches to modifying workplace conditions and evaluating nurses' moral resilience and courage. Nurse managers need to advocate ethics education and professionalism. Nurses must practice self-care strategies to strengthen morally resilient and courageous therapeutic practices.
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Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, Manila 1015, Philippines; College of Graduate Studies and Teacher Education Research (CGSTER), Philippine Normal University, Taft Ave., Manila 1000, Philippines.
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Hinzmann D, Schütte-Nütgen K, Büssing A, Boenisch O, Busch HJ, Dodt C, Friederich P, Kochanek M, Michels G, Frick E. Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:333. [PMID: 36612657 PMCID: PMC9819312 DOI: 10.3390/ijerph20010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.
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Affiliation(s)
- Dominik Hinzmann
- Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 München, Germany
| | | | - Arndt Büssing
- Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Boenisch
- Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Christoph Dodt
- Emergency Department, München Klinik, 81925 Munich, Germany
| | | | - Matthias Kochanek
- Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
| | - Guido Michels
- Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
| | - Eckhard Frick
- School of Medicine, Technical University of Munich, 80333 München, Germany
- Spiritual Care and Psychosomatic Health, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, 80539 Munich, Germany
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