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Wibisono S, Mavandadi P, Wilkinson S, Amiot C, Forbat L, Thomas EF, Allen F, Decety J, Noonan K, Minto K, Breen LJ, Kho M, Crane M, Lizzio-Wilson M, Molenberghs P, Louis W. "More support, less distress?": Examining the role of social norms in alleviating practitioners' psychological distress in the context of assisted dying services. DEATH STUDIES 2024:1-12. [PMID: 38597737 DOI: 10.1080/07481187.2024.2337189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
This study explores how providing assisted dying services affects the psychological distress of practitioners. It investigates the influence of professional norms that endorse such services within their field. Study 1 included veterinarians (N = 137, 75.2% female, Mage = 43.1 years, SDage = 12.7 years), and Study 2 health practitioner students (N = 386, 71.0% female, Mage = 21.0 years, SDage = 14.4 years). In both studies, participants indicated their degree of psychological distress following exposure to scenarios depicting assisted dying services that were relevant to their respective situations. In Study 1, we found that higher willingness to perform animal euthanasia was associated with lower distress, as were supportive norms. In Study 2, a negative association between a greater willingness to perform euthanasia and lower psychological distress occurred only when the provision of such services was supported by professional norms. In conclusion, psychological distress is buffered by supportive professional norms.
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Affiliation(s)
- Susilo Wibisono
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Payam Mavandadi
- Institute for Social Neuroscience, ISN Psychology, Ivanhoe, Australia
| | - Stuart Wilkinson
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Catherine Amiot
- Department of Psychology, The Université du Quebec à Montreal, Montreal, Canada
| | - Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia
| | - Felicity Allen
- Department of Psychology, Charles Darwin University, Darwin, Australia
| | - Jean Decety
- Department of Psychology, and Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Kerrie Noonan
- School of Psychology, Western Sydney University, Penrith, Australia
- Western NSW Local Health District, Dubbo, Australia
| | - Kiara Minto
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Lauren J Breen
- Curtin School of Population Health and Enable Institute, Curtin University, Perth, Australia
| | - Madison Kho
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | | | | | - Winnifred Louis
- School of Psychology, University of Queensland, Brisbane, Australia
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Girela-Lopez E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, Lopez-Valero M, Romero-Saldaña M. Measuring moral distress in health professionals using the MMD-HP-SPA scale. BMC Med Ethics 2024; 25:41. [PMID: 38570759 PMCID: PMC10993501 DOI: 10.1186/s12910-024-01041-z] [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: 04/13/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.
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Affiliation(s)
- Eloy Girela-Lopez
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Lopez-Valero
- Dispositivo de Cuidados Críticos y Urgencias, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy. Faculty of Medicine and Nursing, University of Cordoba, Córdoba, Spain
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Palmer JA, Mccullough M, Wormwood J, Soylemez Wiener R, Mesfin N, Still M, Xu CS, Linsky AM. Addressing clinician moral distress: Implications from a mixed methods evaluation during Covid-19. PLoS One 2023; 18:e0291542. [PMID: 37713379 PMCID: PMC10503769 DOI: 10.1371/journal.pone.0291542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
Clinician moral distress has been documented over the past several decades as occurring within numerous healthcare disciplines, often in relation to clinicians' involvement in patients' end-of-life decision-making. The resulting harms impact clinician well-being, patient well-being, and healthcare system functioning. Given Covid-19's catastrophic death toll and associated demands on end-of-life decision-making processes, the pandemic represents a particularly important context within which to understand clinician moral distress. Thus, we conducted a convergent mixed methods study to examine its prevalence, associations with clinicians' demographic and professional characteristics, and contributing circumstances among Veterans Health Administration (VA) clinicians. The study, conducted in April 2021, consisted of a cross-sectional on-line survey of VA clinicians at 20 VA Medical Centers with professional jurisdiction to place life-sustaining treatment orders working who were from a number of select specialties. The survey collected quantitative data on respondents' demographics, clinical practice characteristics, attitudes and behaviors related to goals of care conversations, intensity of moral distress during "peak-Covid," and qualitative data via an open-ended item asking for respondents to describe contributing circumstances if they had indicated any moral distress. To understand factors associated with heightened moral distress, we analyzed quantitative data using bivariate and multivariable regression analyses and qualitative data using a hybrid deductive/inductive thematic approach. Mixed methods analysis followed, whereby we compared the quantitative and qualitative datasets and integrated findings at the analytic level. Out of 3,396 eligible VA clinicians, 323 responded to the survey (9.5% adjusted response rate). Most respondents (81%) reported at least some moral distress during peak-Covid. In a multivariable logistic regression, female gender (OR 3.35; 95% CI 1.53-7.37) was associated with greater odds of moral distress, and practicing in geriatrics/palliative care (OR 0.40; 95% CI 0.18-0.87) and internal medicine/family medicine/primary care (OR 0.46; 95% CI 0.22-0.98) were associated with reduced odds of moral distress compared to medical subspecialties. From the 191 respondents who completed the open-ended item, five qualitative themes emerged as moral distress contributors: 1) patient visitation restrictions, 2) anticipatory actions, 3) clinical uncertainty related to Covid, 4) resource shortages, and 5) personal risk of contracting Covid. Mixed methods analysis found that quantitative results were consistent with these last two qualitative themes. In sum, clinician moral distress was prevalent early in the pandemic. This moral distress was associated with individual-, system-, and situation-level contributors. These identified contributors represent leverage points for future intervention to mitigate clinician moral distress and its negative outcomes during future healthcare crises and even during everyday clinical care.
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Affiliation(s)
- Jennifer A. Palmer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Megan Mccullough
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Medical Center, Bedford, Massachusetts, United States of America
- University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Jolie Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Medical Center, Bedford, Massachusetts, United States of America
- University of New Hampshire, Durham, New Hampshire, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Nathan Mesfin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Michael Still
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Chris S. Xu
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Amy M. Linsky
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, United States of America
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Tan AK, Samuels WE, Backhaus R, Capezuti E. Moral distress in long-term care questionnaire modification and psychometric evaluation. Nurs Ethics 2023; 30:789-802. [PMID: 36975048 DOI: 10.1177/09697330231151349] [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] [Indexed: 03/29/2023]
Abstract
BACKGROUND Licensed nurses working in long-term care facilities experience ethical challenges if not resolved can lead to moral distress. There is a lack of an English-language validated tool to adequately measure moral distress in the long-term care setting. AIMS To describe the modification and psychometric evaluation of the Moral Distress Questionnaire. METHODS Instrument development and psychometric evaluation. Internal consistency using Cronbach's α to establish reliability was conducted using SPSS version 27.0 while SPSS Amos version 27.0 was used to perform a confirmatory factor analysis of the Moral Distress Questionnaire. PARTICIPANTS A national sample of US-licensed nurses who provided direct resident care in long-term care settings were recruited via a targeted sampling method using Facebook from 7 December 2020 to 7 March 2021. ETHICAL CONSIDERATION The study was approved by the university's human research protection program. Informed consent was provided to all participants. RESULTS A total of 215 participants completed the surveys. Confirmatory analysis indicated that the 21-item scale with a 4-factor structure for the Moral Distress Questionnaire model met the established criteria and demonstrates an acceptable model fit (CMIN/DF = 2.0, CFI = 0.82, TLI = 0.77, RMSEA = 0.07). Factor loadings for each item depict a moderate to a strong relationship (range 0.36-0.70) with the given underlying construct. Cronbach's α coefficient was 0.87 for the overall scale and 0.60-0.74 for its subscales which demonstrate good reliabilities. DISCUSSION This is the first English-language validated tool to adequately measure moral distress in the long-term care setting experienced by US long-term care nurses. This reliable and well-validated tool will help identify moral distress situations experienced by US long-term care nurses. CONCLUSION The modified 21-item English version of the Moral Distress Questionnaire is reliable tool that demonstrates good psychometric properties to validly measure sources of moral distress among direct resident care nurses.
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Affiliation(s)
- Amil Kusain Tan
- The Graduate Center, City University of New York, New York, NY, USA
- Hunter-Bellevue School of Nursing, Hunter College of CUNY, New York, USA
| | - William Ellery Samuels
- The Graduate Center, City University of New York, New York, NY, USA
- Hunter-Bellevue School of Nursing, Hunter College of CUNY, New York, USA
| | - Ramona Backhaus
- Care and Public Health Research Institute, Maastricht University, Netherlands
- Living Lab in Ageing and Long-TermCare, Maastricht, Netherlands
| | - Elizabeth Capezuti
- Hunter-Bellevue School of Nursing, Hunter College of CUNY, New York, NY, USA
- The Graduate Center, City University of New York, New York, NY, USA
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Maunder RG, Heeney ND, Greenberg RA, Jeffs LP, Wiesenfeld LA, Johnstone J, Hunter JJ. The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey. BMC Nurs 2023; 22:243. [PMID: 37496000 PMCID: PMC10369708 DOI: 10.1186/s12912-023-01407-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Previous research suggests that moral distress contributes to burnout in nurses and other healthcare workers. We hypothesized that burnout both contributed to moral distress and was amplified by moral distress for hospital workers in the COVID-19 pandemic. This study also aimed to test if moral distress was related to considering leaving one's job. METHODS A cohort of 213 hospital workers completed quarterly surveys at six time-points over fifteen months that included validated measures of three dimensions of professional burnout and moral distress. Moral distress was categorized as minimal, medium, or high. Analyses using linear and ordinal regression models tested the association between burnout and other variables at Time 1 (T1), moral distress at Time 3 (T3), and burnout and considering leaving one's job at Time 6 (T6). RESULTS Moral distress was highest in nurses. Job type (nurse (co-efficient 1.99, p < .001); other healthcare professional (co-efficient 1.44, p < .001); non-professional staff with close patient contact (reference group)) and burnout-depersonalization (co-efficient 0.32, p < .001) measured at T1 accounted for an estimated 45% of the variance in moral distress at T3. Moral distress at T3 predicted burnout-depersonalization (Beta = 0.34, p < .001) and burnout-emotional exhaustion (Beta = 0.38, p < .008) at T6, and was significantly associated with considering leaving one's job or healthcare. CONCLUSION Aspects of burnout that were associated with experiencing greater moral distress occurred both prior to and following moral distress, consistent with the hypotheses that burnout both amplifies moral distress and is increased by moral distress. This potential vicious circle, in addition to an association between moral distress and considering leaving one's job, suggests that interventions for moral distress may help mitigate a workforce that is both depleted and burdened with burnout.
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van Zuylen ML, de Snoo-Trimp JC, Metselaar S, Dongelmans DA, Molewijk B. Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned. BMC Med Ethics 2023; 24:40. [PMID: 37291555 PMCID: PMC10249541 DOI: 10.1186/s12910-023-00919-8] [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: 03/30/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. METHODS A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. RESULTS All 178 respondents (response rate: 25-32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to 'team cooperation', 'team solidarity' and 'work ethic'. Lessons learned were mostly related to 'quality of care' and 'professional qualities'. CONCLUSIONS Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals' dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. TRIAL REGISTRATION The trial was registered on The Netherlands Trial Register, number NL9177.
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Affiliation(s)
- Mark L. van Zuylen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Janine C. de Snoo-Trimp
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care, Amsterdam, UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Bert Molewijk
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, Amsterdam, 1081 HV The Netherlands
- Center of Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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van Lummel EVTJ, Meijer Y, Tjan DHT, van Delden JJM. Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study. BMC Palliat Care 2023; 22:24. [PMID: 36922796 PMCID: PMC10015131 DOI: 10.1186/s12904-023-01139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Advance Care Planning (ACP) enables patients to define and discuss their goals and preferences for future medical treatment and care. However, the structural implementation of ACP interventions remains challenging. The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention has recently been developed which takes into account existing barriers and facilitators. We aimed to evaluate the MUTUAL intervention and identify the barriers and facilitators healthcare professionals experience in the implementation of the MUTUAL intervention and also to identify suggestions for improvement. METHODS We performed a sequential exploratory mixed-methods study at five outpatient clinics of one, 300-bed, non-academic hospital. Firstly, semi-structured interviews were performed with a purposive sample of healthcare professionals. The content of these interviews was used to specify the Measurement Instrument for Determinants of Innovations (MIDI). The MIDI was sent to all healthcare professionals. The interviews and questionnaires were used to clarify the results. RESULTS Eleven healthcare professionals participated in the interviews and 37 responded to the questionnaire. Eight barriers and 20 facilitators were identified. Healthcare professionals agreed that the elements of the MUTUAL intervention are clear, correct, complete, and simple - and the intervention is relevant for patients and their proxies. The main barriers are found within the user and the organisational domain. Barriers related to the organisation include: inadequate replacement of staff, insufficient staff, and insufficient time to introduce and invite patients. Several suggestions for improvement were made. CONCLUSION Our results show that healthcare professionals positively evaluate the MUTUAL intervention and are very receptive to implementing the MUTUAL intervention. Taking into account the suggestions for improvement may enhance further implementation.
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Affiliation(s)
- Eline V T J van Lummel
- Department of Intensive Care, Gelderse Vallei hospital, Ede, Netherlands. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Yoeki Meijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dave H T Tjan
- Department of Intensive Care, Gelderse Vallei hospital, Ede, Netherlands
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Lizzio-Wilson M, Thomas EF, Louis WR, Crane MF, Kho M, Molenberghs P, Wibisono S, Minto K, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Allen F. Using Latent Profile Analysis to Understand Health Practitioners' Attitudes Toward Voluntary Assisted Dying. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149453. [PMID: 36826344 DOI: 10.1177/00302228221149453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others' emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners' attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD.
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Affiliation(s)
- Morgana Lizzio-Wilson
- Department of Psychology, The University of Exeter, Exeter, UK
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Winnifred R Louis
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Monique F Crane
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Madison Kho
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Susilo Wibisono
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Catherine E Amiot
- Département de Psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- Death Literacy Institute, University of Western Sydney, Penrith South, NSW, Australia
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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Warmels G, Roberts A, Haddad J, Chomienne MH, Bush SH, Gratton V. Comparing Adherence with Best Practices in End-of-Life Care After Implementing the End-of-Life Order Set: A Quality Improvement Project in an Ottawa Academic Hospital. Palliat Med Rep 2023; 4:100-107. [PMID: 37095865 PMCID: PMC10122227 DOI: 10.1089/pmr.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/26/2023] Open
Abstract
Background Physicians in acute care require tools to assist them in transitioning patients from a "life prolonging" approach to "end-of-life care," and standardized order sets can be a useful strategy. The end-of-life order set (EOLOS) was developed and implemented in the medical wards of a community academic hospital. Objective To compare adherence with best practices in end-of-life care after implementing the EOLOS. Methods We conducted a retrospective chart review of admitted patients with expected deaths in the year preceding EOLOS implementation ("before EOLOS" group), and in the 12 to 24 months following EOLOS implementation ("after EOLOS" group). Results A total of 295 charts were included: 139 (47%) in the "before EOLOS" group and 156 (53%) in the "after EOLOS" group, of which 117/156 charts (75%) had a completed EOLOS. The "after EOLOS" group demonstrated more "do not resuscitate" orders and more written communication to team members about comfort goals of care. There was a decrease in nonbeneficial interventions in the last 24 hours of life in the "after EOLOS" group: high-flow oxygen, intravenous antibiotics, and deep vein thrombosis/venous thromboembolism prophylaxis. The "after EOLOS" group demonstrated increased prescription of all common end-of-life medications, except for opioids, which had a high preexisting rate of prescription. Patients in the "after EOLOS" group showed a higher rate of spiritual care and palliative care consult team consultation. Conclusion Findings support standardized order sets as a good framework allowing generalist hospital staff to improve adherence to established palliative care principles and improve end-of-life care of hospital inpatients.
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Affiliation(s)
- Grace Warmels
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anne Roberts
- Department of Palliative Care, Montfort Hospital, Ottawa, Ontario, Canada
| | - John Haddad
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marie-Hélène Chomienne
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Shirley H. Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Valerie Gratton
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, Montfort Hospital, Ottawa, Ontario, Canada
- Address correspondence to: Valerie Gratton, MD, CCFP-PC, Department of Family Medicine, Montfort Hospital, 713 Montreal Road, Ottawa, Ontario K1K 0T2, Canada.
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10
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Wibisono S, Minto K, Lizzio-Wilson M, Thomas EF, Crane M, Molenberghs P, Kho M, Amiot CE, Decety J, Breen LJ, Noonan K, Forbat L, Louis W. Attitudes Toward and Experience With Assisted-Death Services and Psychological Implications for Health Practitioners: A Narrative Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221138997. [PMID: 36357863 DOI: 10.1177/00302228221138997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
A narrative systematic review was conducted to review studies that examine mental health implications of involvement in assisted-death services among health practitioners. Qualitative and quantitative studies were included to understand health practitioners' attitudes and experiences with assisted dying services, as well as to identify the mental health consequences. We identified 18 articles from 1591 articles drawn from seven major scientific databases (i.e., PubMed, MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Scopus). Two raters independently evaluated the exclusion and inclusion decisions of the articles and examined methodological flaws in the selected articles. We found that engagement in assisted death services were not reliably associated with mental health outcomes such as anxiety and moral distress. Both positive and negative outcomes were reported, and psychological outcomes for practitioners were shown to vary based on factors including social support for health practitioners' views; their perceived capacity to care for the patients; and legislation.
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Affiliation(s)
- Susilo Wibisono
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Department of Psychology, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Kiara Minto
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, QLD, Australia
| | - Morgana Lizzio-Wilson
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Emma F Thomas
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Madison Kho
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Catherine E Amiot
- Department of Psychology, The Universite du Quebec a Montreal, Montreal, QC, Canada
| | - Jean Decety
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Lauren J Breen
- Curtin School of Population Health and Enable Institute, Curtin University, Perth, WA, Australia
| | - Kerrie Noonan
- School of Social Sciences, Western Sydney University, Kingswood, Australia
| | - Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Winnifred Louis
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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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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Byrnes E, Ross AI, Murphy M. A Systematic Review of Barriers and Facilitators to Implementing Assisted Dying: A Qualitative Evidence Synthesis of Professionals' Perspectives. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221116697. [PMID: 35929771 DOI: 10.1177/00302228221116697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. This systematic review and qualitative evidence synthesis aims to identify the factors that healthcare professionals experience when working within assisted dying frameworks. PRISMA guidelines for systematic reviews were followed. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. Remaining papers were subjected to critical appraisal and a thematic synthesis. Eight themes fell under the domain of 'barrier' and represented different personal and professional factors that hinder professionals from delivering assisted dying healthcare. Five themes came under the domain of 'facilitators' and represent factors that contribute to the smooth implementation and delivery of assisted dying services. Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks.
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Affiliation(s)
- Eric Byrnes
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
- Cork Mental Health Services, Cork/Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Alasdair Iain Ross
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
- Cork Mental Health Services, Cork/Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Mike Murphy
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
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13
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Understanding Moral Distress among Eldercare Workers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159303. [PMID: 35954662 PMCID: PMC9368675 DOI: 10.3390/ijerph19159303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing moral distress, which is associated with poor work ability. The causes and consequences of moral distress among eldercare workers remain undiscovered. This scoping review investigates the existing studies of causes and consequences of moral distress among eldercare workers. Additionally, it seeks evidence of interventions designed to mitigate moral distress in eldercare workers. Fourteen studies were included in the final review. Most of the included studies were qualitative, aiming to increase understanding of morally challenging situations in eldercare. We also found quantitative studies with cross-sectional designs and small sample sizes. Thus, no reliable evidence of causal effects between moral distress and worker wellbeing in eldercare was found. We found no interventions undertaken to resolve moral distress among eldercare workers, either. More research is needed on the causes and consequences of moral distress and on interventions to mitigate moral distress among eldercare workers. This is of utmost importance to increase the attractiveness of eldercare as a workplace and to improve eldercare workers’ ability to work and sustain long working careers.
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14
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Arends SAM, Steenbergen M, Thodé M, Francke AL, Jongerden IP. Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: A qualitative interview study. PATIENT EDUCATION AND COUNSELING 2022; 105:2531-2536. [PMID: 35123835 DOI: 10.1016/j.pec.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/17/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore whether nurses in hospital settings experience moral distress when involved in potentially life-prolonging treatments in adults with a short life expectancy. METHODS A qualitative study using semi-structured interviews. RESULTS 23 Registered nurses working in inpatient or outpatient hospital settings participated. The nurses stated they were often not involved in decisions regarding life-prolonging treatments. They reported signs of moral distress such as feeling powerless when they when they were not being listened to in the decision-making process and when confronted with negative treatment outcomes. Nurses felt frustrated when their own values were not reflected in the decision-making or when physicians created unrealistic expectations. CONCLUSIONS Hospital nurses experience moral distress when they are involved in life-prolonging treatment because of the patient's advanced condition and their own lack of involvement in the decision-making process about the treatment. In these situations, moral distress is characterised by feelings of powerlessness and frustration. PRACTICE IMPLICATIONS Nurses need to be empowered by training programmes that focus on an active role in the decision-making process. Further research is needed to evaluate effective tools and training programmes that help nurses in shared decision-making processes.
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Affiliation(s)
- Susanne A M Arends
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | | | - Maureen Thodé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, Netherlands.
| | - Irene P Jongerden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
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15
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Gherman MA, Arhiri L, Holman AC. Ageism, moral sensitivity and nursing students' intentions to work with older people - A cross-sectional study. NURSE EDUCATION TODAY 2022; 113:105372. [PMID: 35526469 DOI: 10.1016/j.nedt.2022.105372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Nursing students' intentions to work with older people are low, despite a worldwide need for gerontological nursing, with ageism being the main culprit. Romania lacks legislation to prevent and combat elder abuse in healthcare, although it is alleged to be rampant among nursing staff. There is also a lack of research on nursing students' ageism toward older people and intentions to work with them. OBJECTIVES Since ageism conflicts with nursing ethics, we expect moral sensitivity to lower ageism and increase intention to work with older people, while also moderating other socio-psychological influences. Because ageism and intention to work with older people are largely predicted by the same variables, we hypothesize that ageism may function as a mediator. Finally, we explore ageism among Romanian nursing students and its predictors in a culturally sensitive manner. DESIGN This is a cross-sectional, descriptive survey study. SETTINGS The study was conducted in Romania. PARTICIPANTS AND METHODS 408 nursing students completed online-administered questionnaires measuring intention to work with older people, ageism, moral sensitivity, death and ageing anxiety, knowledge of ageing, attitudes toward own ageing and intergenerational contact. Data were analyzed with Pearson's correlations, regressions with simple slope analyses and bootstrapped mediation analyses. RESULTS Ageism mediated the relationships between students' intentions to work with older people and knowledge of ageing, ageing anxiety, intergenerational contact quality, attitudes toward own ageing and moral sensitivity. Moral sensitivity decreased ageism and increased intention, while moderating the influence of contact quality, death and ageing anxiety, attitudes toward own ageing and knowledge of ageing on ageism. Additionally, it moderated the influence of perceived behavioral control on intention. CONCLUSIONS Integrating moral sensitivity training in the nursing curricula could both decrease ageism in nursing students and increase their intention to work with older people, providing an efficient and low-cost strategy to aid students consider gerontological nursing for career advancement.
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Affiliation(s)
- Mihaela-Alexandra Gherman
- Al.I. Cuza, University of Iasi, Romania, Faculty of Psychology and Education Sciences, Str. Toma Cozma, nr. 3, Iasi 700554, Romania.
| | - Laura Arhiri
- Al.I. Cuza, University of Iasi, Romania, Faculty of Psychology and Education Sciences, Str. Toma Cozma, nr. 3, Iasi 700554, Romania.
| | - Andrei Corneliu Holman
- Al.I. Cuza, University of Iasi, Romania, Faculty of Psychology and Education Sciences, Str. Toma Cozma, nr. 3, Iasi 700554, Romania.
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16
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Wilson CA, Metwally H, Heavner S, Kennedy AB, Britt TW. Chronicling moral distress among healthcare providers during the COVID-19 pandemic: A longitudinal analysis of mental health strain, burnout, and maladaptive coping behaviours. Int J Ment Health Nurs 2022; 31:111-127. [PMID: 34644443 PMCID: PMC8653372 DOI: 10.1111/inm.12942] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020-December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross-level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.
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Affiliation(s)
| | | | | | - Ann Blair Kennedy
- University of South Carolina School of Medicine Greenville Campus, Greenville, South Carolina, USA
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Kang J, Choi EK, Seo M, Ahn GS, Park HY, Hong J, Kim MS, Keam B, Park HY. Care for critically and terminally ill patients and moral distress of physicians and nurses in tertiary hospitals in South Korea: A qualitative study. PLoS One 2021; 16:e0260343. [PMID: 34914723 PMCID: PMC8675648 DOI: 10.1371/journal.pone.0260343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Physicians and nurses working in acute care settings, such as tertiary hospitals, are involved in various stages of critical and terminal care, ranging from diagnosis of life-threatening diseases to care for the dying. It is well known that critical and terminal care causes moral distress to healthcare professionals. This study aimed to explore moral distress in critical and terminal care in acute hospital settings by analyzing the experiences of physicians and nurses from various departments. Semi-structured in-depth interviews were conducted in two tertiary hospitals in South Korea. The collected data were analyzed using grounded theory. A total of 22 physicians and nurses who had experienced moral difficulties regarding critical and terminal care were recruited via purposive maximum variation sampling, and 21 reported moral distress. The following points were what participants believed to be right for the patients: minimizing meaningless interventions during the terminal stage, letting patients know of their poor prognosis, saving lives, offering palliative care, and providing care with compassion. However, family dominance, hierarchy, the clinical culture of avoiding the discussion of death, lack of support for the surviving patients, and intensive workload challenged what the participants were pursuing and frustrated them. As a result, the participants experienced stress, lack of enthusiasm, guilt, depression, and skepticism. This study revealed that healthcare professionals working in tertiary hospitals in South Korea experienced moral distress when taking care of critically and terminally ill patients, in similar ways to the medical staff working in other settings. On the other hand, the present study uniquely identified that the aspects of saving lives and the necessity of palliative care were reported as those valued by healthcare professionals. This study contributes to the literature by adding data collected from two tertiary hospitals in South Korea.
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Affiliation(s)
- Jiyeon Kang
- Department of Anthropology, Seoul National University, Gwanak-gu, Seoul, Republic of Korea
| | - Eun Kyung Choi
- Medical Education Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Minjeong Seo
- College of Nursing and Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Gyeongsangnamdo, Republic of Korea
| | - Grace S. Ahn
- School of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jinui Hong
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Min Sun Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hye Yoon Park
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University, College of Medicine, Jongno-gu, Seoul, Republic of Korea
- * E-mail:
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18
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Bayanzay K, Amoozgar B, Kaushal V, Holman A, Som V, Sen S. Impact of profession and wards on moral distress in a community hospital. Nurs Ethics 2021; 29:356-363. [PMID: 34727763 DOI: 10.1177/09697330211015349] [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: 11/17/2022]
Abstract
BACKGROUND Recently, a singular survey titled "Measure of Moral Distress-Healthcare Professionals," which addresses shortcomings of previous instruments, has been validated. AIM To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. PARTICIPANT AND RESEARCH CONTEXT We distributed a self-administered, validated survey titled "Measure of Moral Distress-Healthcare Professionals" to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. FINDINGS A total of 101 surveys were included in the study. The mean Measure of Moral Distress-Healthcare Professionals score for all respondents was 143.0 (standard deviation = 79.8). The mean Measure of Moral Distress-Healthcare Professionals score was 1.75 greater for nurses than for physicians (92.5 vs 161.5, p < .001), and nurses were 2.52 times more likely to consider leaving their position due to moral distress (68% vs 27%). The mean Measure of Moral Distress-Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward (92.5, SD = 38.2) and highest in the telemetry ward (197.7, SD = 83.6). The intensive care unit ward had a mean Measure of Moral Distress-Healthcare Professionals score mildly greater than the emergency room. ETHICAL CONSIDERATIONS No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center's Institutional Review Board. DISCUSSION This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. CONCLUSION In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress-Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians.
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The challenges of ethical deliberation in palliative care settings: A descriptive study. Palliat Support Care 2021; 20:212-220. [DOI: 10.1017/s1478951521000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveInadequate deliberation processes about ethical problems occurring in palliative care settings may negatively impact both patients and healthcare professionals. Better knowledge of the palliative care professionals’ practices regarding such processes could help identify specific education needs to improve the quality of palliative care in the context of complex ethical situations. Therefore, this descriptive study aimed to (1) examine ethical deliberation processes in interprofessional teams in five palliative care settings; (2) identify organizational factors that constrain such processes; and (3) based on this knowledge, identify priority education needs for future and current palliative care professionals.MethodThe study involved three data collection activities: (1) direct observation of simulated interprofessional ethical deliberations in various palliative care settings; (2) individual semi-structured interviews; and (3) deliberative dialogues.ResultsThirty-six healthcare professionals took part in the simulated ethical deliberations and in the deliberative dialogue activities, and 13 were met in an individual interview. The study results revealed suboptimal interprofessional collaboration and ethical deliberation competencies, particularly regarding awareness of the ethical issue under consideration, clarification of conflicting values, reasonable decision making, and implementation planning. Participants also reported facing serious organizational constraints that challenged ethical deliberation processes.Significance of resultsThis study confirmed the need for professional education in interprofessional collaboration and ethical deliberation so that palliative care professionals can adequately face current and future ethical challenges. It also enabled the identification of educational priorities in this regard. Future research should focus on identifying promising educational activities, assessing their effectiveness, and measuring their impact on patient and family experience and the quality of palliative care.
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20
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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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21
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Facilitating communication for critically ill patients and their family members: Study protocol for two randomized trials implemented in the U.S. and France. Contemp Clin Trials 2021; 107:106465. [PMID: 34091062 DOI: 10.1016/j.cct.2021.106465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Critically-ill patients and their families suffer a high burden of psychological symptoms due, in part, to many transitions among clinicians and settings during and after critical illness, resulting in fragmented care. Communication facilitators may help. DESIGN AND INTERVENTION We are conducting two cluster-randomized trials, one in the U.S. and one in France, with the goal of evaluating a nurse facilitator trained to support, model, and teach communication strategies enabling patients and families to secure care consistent with patients' goals, beginning in ICU and continuing for 3 months. PARTICIPANTS We will randomize 376 critically-ill patients in the US and 400 in France to intervention or usual care. Eligible patients have a risk of hospital mortality of greater than15% or a chronic illness with a median survival of approximately 2 years or less. OUTCOMES We assess effectiveness with patient- and family-centered outcomes, including symptoms of depression, anxiety, and post-traumatic stress, as well as assessments of goal-concordant care, at 1-, 3-, and 6-months post-randomization. The primary outcome is family symptoms of depression over 6 months. We also evaluate whether the intervention improves value by reducing utilization while improving outcomes. Finally, we use mixed methods to explore implementation factors associated with implementation outcomes (acceptability, fidelity, acceptability, penetration) to inform dissemination. Conducting the trial in U.S. and France will provide insights into differences and similarities between countries. CONCLUSIONS We describe the design of two randomized trials of a communication facilitator for improving outcomes for critically ill patients and their families in two countries.
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Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: "If You Can't Stand the Heat, Get Out of the Kitchen". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124442. [PMID: 32575765 PMCID: PMC7345032 DOI: 10.3390/ijerph17124442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
Ethical conflicts among nurses can undermine nurses’ psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.
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Vincent H, Jones DJ, Engebretson J. Moral distress perspectives among interprofessional intensive care unit team members. Nurs Ethics 2020; 27:1450-1460. [PMID: 32406313 DOI: 10.1177/0969733020916747] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To examine interprofessional healthcare professionals' perceptions of triggers and root causes of moral distress. DESIGN Qualitative description of open-text comments written on the Moral Distress Scale-Revised survey. METHODS A subset of interprofessional providers from a parent study provided open-text comments that originated from four areas of the Moral Distress Scale-Revised, including the margins of the 21-item questionnaire, the designated open-text section, shared perceptions of team communication and dynamics affecting moral distress, and the section addressing an intent to leave a clinical position because of moral distress. Open-text comments were captured, coded, and divided into meaning units and themes using systematic text condensation. PARTICIPANTS Twenty-eight of the 223 parent study participants completing the Moral Distress Scale-Revised shared comments on situations contributing to moral distress. RESULTS All 28 participants working in the four medical center intensive care units reported feelings of moral distress. Feelings of moral distress were associated with professional anguish over patient care decisions, team, and system-level factors. Professional-level contributors reflected clinician concerns of continuing life support measures perceived not in the patient's best interest. Team and unit-level factors were related to poor communication, bullying, and a lack of collegial collaboration. System-level factors included clinicians feeling unsupported by senior administration and institutional culpability as a result of healthcare processes and system constraints impeding reliable patient care delivery. ETHICAL CONSIDERATIONS Approval was obtained from the Institutional Review Board (IRB) of the University of Texas Health IRB and the organization in which the study was conducted. CONCLUSION Moral distress was associated with feelings of anguish, professional intimidation, and organizational factors that impacted the delivery of ethically based patient care. Participants expressed a sense of awareness that they may experience ethical dilemmas as a consequence of the changing reality of providing healthcare within complex healthcare systems. Strategies to combat moral distress should target team and system interventions designed to improve interprofessional collaboration and support professional ethical values and moral commitments of all healthcare providers.
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Affiliation(s)
- Heather Vincent
- 6614University of Pittsburgh, USA; The University of Texas Health Science Center at Houston, USA
| | - Deborah J Jones
- 12338The University of Texas Medical Branch at Galveston, USA
| | - Joan Engebretson
- 12340The University of Texas Health Science Center at Houston, USA
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Jones-Bonofiglio K. Acute Care Contexts. HEALTH CARE ETHICS THROUGH THE LENS OF MORAL DISTRESS 2020. [DOI: 10.1007/978-3-030-56156-7_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Kada O, Lesnik T. [Facets of moral distress in nusing homes : A qualitative study with examined registered nurses]. Z Gerontol Geriatr 2019; 52:743-750. [PMID: 31696363 DOI: 10.1007/s00391-019-01645-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/15/2019] [Indexed: 12/01/2022]
Abstract
Although the nursing home setting has some characteristic features that are relevant with respect to the development of moral distress (MD), it has so far been studied primarily in the acute care setting. The underlying classical definition of MD is increasingly criticized and broadening of this definition is encouraged to include stress due to moral uncertainty. Hence, the present qualitative study explored how nursing personnel in nursing homes experience MD. Guided interviews were conducted with 21 nurses from 5 nursing homes. The fully transcribed interviews were analyzed using Mayring's qualitative content analysis, whereby deductive (scaling and content structuring) and inductive techniques were applied. The application of scaling structuring revealed that MD was experienced mainly in a moderately severe form. The respondents reported situations where they experienced moral stress because they were impeded by barrieres to take the morally correct action. These situations were inductively summarized in the categories "unnecessary/false treatment at the end of life", "incorrect management of challenging behavior", "poor care in general" and "unnecessary hospital transfers". Decisions made by relatives and physicians were the most frequently mentioned external barrier and a lack of courage was the most frequently named internal barrier; however, the respondents also mentioned stress reactions corresponding to the category "moral uncertainty", especially during end of life care and for hospital transfer decisions, most of all when the resident's wish was not clear or due to unavailability of physicians. The results underline the necessity of a broad conception of MD at the theoretical and interventional levels.
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Affiliation(s)
- Olivia Kada
- Studiengang Gesundheits- und Pflegemanagement, FH Kärnten, Hauptplatz 12, 9560, Feldkirchen i.K., Österreich.
| | - Tanja Lesnik
- Klinikum Klagenfurt am Wörthersee, Studiengang Gesundheits- und Pflegemanagement, FH Kärnten, Kärnten, Österreich
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Cleary M, West S, Saghafi F, Lees D, Kornhaber R. Finding Common Ground for the Common Good: Compromise in Health Care. Issues Ment Health Nurs 2019; 40:926-928. [PMID: 31381465 DOI: 10.1080/01612840.2019.1643630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Michelle Cleary
- School of Nursing, College of Health and Medicine, University of Tasmania , NSW , Australia
| | - Sancia West
- School of Nursing, College of Health and Medicine, University of Tasmania , NSW , Australia
| | - Farida Saghafi
- School of Nursing, College of Health and Medicine, University of Tasmania , NSW , Australia
| | | | - Rachel Kornhaber
- School of Nursing, College of Health and Medicine, University of Tasmania , NSW , Australia
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Affiliation(s)
- Mozhgan Moshtagh
- Social Welfare and Health, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Mohsenpour
- Assistant Professor, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Epstein EG, Whitehead PB, Prompahakul C, Thacker LR, Hamric AB. Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals. AJOB Empir Bioeth 2019; 10:113-124. [PMID: 31002584 DOI: 10.1080/23294515.2019.1586008] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND As ongoing research explores the impact of moral distress on health care professionals (HCPs) and organizations and seeks to develop effective interventions, valid and reliable instruments to measure moral distress are needed. This article describes the development and testing of a revision of the widely used Moral Distress Scale-Revised (MDS-R) to measure moral distress. METHODS We revised the MDS-R by evaluating the combined data from 22 previous studies, assessing 301 write-in items and 209 root causes identified through moral distress consultation, and reviewing 14 recent publications from various professions in which root causes were described. The revised 27-item scale, the Measure of Moral Distress for Healthcare Professionals (MMD-HP), is usable by all HCPs in adult and pediatric critical, acute, or long-term acute care settings. We then assessed the reliability of the MMD-HP and evaluated construct validity via hypothesis testing. The MMD-HP, Hospital Ethical Climate Survey (HECS), and a demographic survey were distributed electronically via Qualtrics to nurses, physicians, and other health care professionals at two academic medical centers over a 3-week period. RESULTS In total, 653 surveys were included in the final analysis. The MMD-HP demonstrated good reliability. The four hypotheses were supported: (1) MMD-HP scores were higher for nurses (M 112.3, SD 73.2) than for physicians (M 96.3, SD 54.7, p = 0.023). (2) MMD-HP scores were higher for those considering leaving their position (M 168.4, SD 75.8) than for those not considering leaving (M 94.3, SD 61.2, p < 0.001). (3) The MMD-HP was negatively correlated with the HECS (r = -0.55, p < 0.001). (4) An exploratory factor analysis revealed a four-factor structure, reflective of patient, unit, and system levels of moral distress. CONCLUSIONS The MMD-HP represents the most currently understood causes of moral distress. Because the instrument behaves as would be predicted, we recommend that the MMD-HP replace the MDS-R.
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Affiliation(s)
- Elizabeth G Epstein
- a University of Virginia School of Nursing , Charlottesville , Virginia , USA
| | - Phyllis B Whitehead
- b Carilion Roanoke Memorial Hospital, Palliative Medicine Clinical Nurse Specialist , Roanoke , Virginia , USA
| | - Chuleeporn Prompahakul
- c School of Nursing , University of Virginia School of Nursing, Senior Lecturer Faculty of Nursing, Prince of Songkla University, Hatyai , Songkhla , Thailand
| | - Leroy R Thacker
- d Department of Biostatistics, One Capital Square , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Ann B Hamric
- e School of Nursing , Virginia Commonwealth University , Richmond , Virginia , USA
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Lazzari T, Terzoni S, Destrebecq A, Meani L, Bonetti L, Ferrara P. Moral distress in correctional nurses: A national survey. Nurs Ethics 2019; 27:40-52. [DOI: 10.1177/0969733019834976] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Moral distress is an increasingly documented problem in nursing and might foster nurses’ intention to leave their workplace. It has been studied in different settings, but no specific research has been conducted in Italian correctional facilities. A recent Italian study produced a preliminary validation of the Moral Distress Scale for Correctional Nurses, which needs to be completed. Objectives: To investigate the level of moral distress of nurses working in the Italian correctional setting, by completing the validation process of the Moral Distress Scale for Correctional Nurses. Methodology: Multicenter questionnaire survey. All correctional nurses (461) affiliated with the Italian Society of Medicine and Penitentiary Health (also called “Simspe-onlus”) were invited to participate and 238 responded. The survey was conducted between April and November 2017 through SurveyMonkey®. Analysis of covariance was conducted to investigate the relationship between moral distress and the other variables under study. Exploratory factor analysis was conducted on the scale to confirm its dimensions. Ethical considerations: The study was approved by the Italian Society of Medicine and Penitentiary Health (Simspe-onlus). The questionnaire included informed consent, pursuant to the law in force. The software could not accept questionnaires without explicit consent. Data were analyzed anonymously. Findings: The median score was 46.5, indicating moderate moral distress. The only variable affecting moral distress was work experience in correctional facilities. Longer experience was correlated to higher levels of moral distress and intention to leave. Incompetent colleagues and short staffing were related to higher levels of moral distress. The scale confirmed the one-dimensional structure suggested by the original authors. Discussion: This is the first study investigating moral distress among Correctional Nurses. The prison context is a high-risk environment for nurses, increasing the intention to leave the workplace. Conclusion: Corrective and protective measures, such as specific education, are needed to prevent moral distress development and to reduce nurses’ shortage in this area.
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Forozeiya D, Vanderspank-Wright B, Bourbonnais FF, Moreau D, Wright DK. Coping with moral distress - The experiences of intensive care nurses: An interpretive descriptive study. Intensive Crit Care Nurs 2019; 53:23-29. [PMID: 30948283 DOI: 10.1016/j.iccn.2019.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/07/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Over the last three decades, there has been a growing body of literature that has described moral distress as a prominent issue that negatively affects intensive care nurses. Yet, little focus has been given to how intensive care nurses cope and continue in their practice despite being exposed to moral distress. OBJECTIVE To describe intensive care nurses' experiences of coping with moral distress. RESEARCH METHODS/SETTING A qualitative design using an interpretative descriptive approach. Semi-structured interviews were conducted with seven intensive care nurses. FINDINGS The shared experience of coping with moral distress was explicated through the overarching theme of being Like Grass in the Wind. Four major themes emerged: Going Against What I Think is Best, Moral Distress - It's Just Inherent in Our Job, It Just Felt Awful, and Dealing with It. The findings also reflected actions associated with turning towards or turning away from morally distressing situations. CONCLUSION By developing coping strategies such as seeking social support, nurses can move forward in their practice and meaningfully engage with patients and families experiencing critical illness. When successful coping is not attained, nurses are at risk of becoming morally disengaged within their practice.
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Interprofessional teamwork, quality of care and turnover intention in geriatric care: A cross-sectional study in 55 acute geriatric units. Int J Nurs Stud 2019; 91:94-100. [DOI: 10.1016/j.ijnurstu.2018.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/01/2018] [Accepted: 11/24/2018] [Indexed: 11/20/2022]
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Meziane D, Ramirez-Garcia MP, Fortin ML. A reflective practice intervention to act on the moral distress of nurses providing end-of-life care on acute care units. Int J Palliat Nurs 2018; 24:444-451. [DOI: 10.12968/ijpn.2018.24.9.444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dounia Meziane
- Pivot nurse in oncology Montreal-West Intergrated University Health and Social Services Center, Montréal, Canada
| | | | - Marie-Laurence Fortin
- Palliative care clinical nurse specialist Montreal-West-Central Integrated University Health and Social Services Centre, Montréal, Canada
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Awosoga O, Pijl EM, Hagen B, Hall B, Sajobi T, Spenceley S. Development and validation of the Moral Distress in Dementia Care Survey instrument. J Adv Nurs 2018; 74:2685-2700. [PMID: 30019353 DOI: 10.1111/jan.13803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/25/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
AIMS To report on the development and validation of the Moral Distress in Dementia Care Survey instrument. BACKGROUND Despite growing awareness of moral distress among nurses, little is known about the moral distress experiences of nursing staff in dementia care settings. To address this gap, our research team developed a tool for measuring the frequency, severity and effects of moral distress in nursing staff working in dementia care. DESIGN The research team employed an exploratory sequential mixed method design to generate items for the moral distress questionnaire. Data were collected between January 2013 - June 2014. In this paper, we report on the development and validation of the Moral Distress in Dementia Care Survey instrument. METHODS The Moral Distress in Dementia Care Survey instrument was piloted with a portion of the target population prior to a broader implementation. Appropriate statistical analyses and psychometric testing were completed. RESULTS The team collected 389 completed surveys from registered nurses, licensed practical nurses and healthcare aides, representing a 43.6% response rate across 23 sites. The Moral Distress in Dementia Care Survey emerged as a reliable and valid instrument to measure the frequency, severity and effects of moral distress for nursing staff in dementia care settings. The relative value of the Moral Distress in Dementia Care Survey as a measurement instrument was superseded by its clinical relevance for dementia care staff. CONCLUSION The Moral Distress in Dementia Care Survey is a potentially useful tool for estimating the frequency, severity and effects of moral distress in nursing staff working in dementia care settings and for the evaluation of measures taken to mitigate moral distress.
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Affiliation(s)
- Olu Awosoga
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Em M Pijl
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Brad Hagen
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Barry Hall
- Faculty of Social Work, University of Calgary, Lethbridge, AB, Canada
| | - Tolulope Sajobi
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannon Spenceley
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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Camp ME, Jeon-Slaughter H, Johnson AE, Sadler JZ. Medical student reflections on geriatrics: Moral distress, empathy, ethics and end of life. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:235-248. [PMID: 29028421 DOI: 10.1080/02701960.2017.1391804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medical students' early clinical encounters may influence their perceptions of geriatrics. This study examines reflective essays written by 3rd-year medical students on required clinical rotations. Using content analysis, the authors analyzed the essays' thematic content. The authors then used chi-squared analysis to compare themes with geriatric patients (age 60+) to themes with other age groups. One hundred twenty out of 802 essays described a geriatric patient. The most common geriatric themes were (1) death and dying, (2) decision making, (3) meaningful physician-patient interactions, (4) quality of care, and (5) professional development. Geriatric essays were more likely to discuss death/dying and risk-benefit themes and less likely to discuss abuse. Geriatric essays were more likely to describe students' moral distress. Geriatric essays with moral distress were more likely to include empathy themes compared to geriatric essays without moral distress. Geriatric patients may pose unique ethical challenges for early clinical students.
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Affiliation(s)
- Mary E Camp
- a Department of Psychiatry, Southwestern Medical Center , The University of Texas, Dallas, TX, USA
| | - Haekyung Jeon-Slaughter
- a Department of Psychiatry, Southwestern Medical Center , The University of Texas, Dallas, TX, USA
| | - Anne E Johnson
- a Department of Psychiatry, Southwestern Medical Center , The University of Texas, Dallas, TX, USA
| | - John Z Sadler
- a Department of Psychiatry, Southwestern Medical Center , The University of Texas, Dallas, TX, USA
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Korkmaz F, Mustafbaylı Ö, Yerlikaya I. Moral Problems Experienced by Nurses. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.408966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lokker ME, Swart SJ, Rietjens JAC, van Zuylen L, Perez RSGM, van der Heide A. Palliative sedation and moral distress: A qualitative study of nurses. Appl Nurs Res 2018; 40:157-161. [PMID: 29579492 DOI: 10.1016/j.apnr.2018.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/06/2018] [Accepted: 02/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical nursing practice may involve moral distress, which has been reported to occur frequently when nurses care for dying patients. Palliative sedation is a practice that is used to alleviate unbearable and refractory suffering in the last phase of life and has been linked to distress in nurses. AIM The aim of this study was to explore nurses' reports on the practice of palliative sedation focusing on their experiences with pressure, dilemmas and morally distressing situations. METHODS In-depth interviews with 36 nurses working in hospital, nursing home or primary care. RESULTS Several nurses described situations in which they felt that administration of palliative sedation was in the patient's best interest, but where they were constrained from taking action. Nurses also reported on situations where they experienced pressure to be actively involved in the provision of palliative sedation, while they felt this was not in the patient's best interest. The latter situation related to (1) starting palliative sedation when the nurse felt not all options to relieve suffering had been explored yet; (2) family requesting an increase of the sedation level where the nurse felt that this may involve unjustified hastening of death; (3) a decision by the physician to start palliative sedation where the patient had previously expressed an explicit wish for euthanasia. CONCLUSIONS Nurses experienced moral distress in situations where they were not able to act in what they believed is the patient's best interest. Situations involving moral distress require nurses to be well informed and able to adequately communicate with suffering patients, distressed family and physicians.
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Affiliation(s)
- M E Lokker
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands.
| | - S J Swart
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - J A C Rietjens
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - L van Zuylen
- Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - R S G M Perez
- Department of Anesthesiology, VUmc, Amsterdam, The Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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Lamiani G, Dordoni P, Argentero P. Value congruence and depressive symptoms among critical care clinicians: The mediating role of moral distress. Stress Health 2018; 34:135-142. [PMID: 28664611 DOI: 10.1002/smi.2769] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/21/2017] [Accepted: 05/29/2017] [Indexed: 11/07/2022]
Abstract
Clinicians working in intensive care units are often exposed to several job stressors that can negatively affect their mental health. Literature has acknowledged the role of value congruence and job control in determining clinicians' psychological well-being and depressive symptoms. However, potential mediators of this association have been scarcely examined. This study aimed to test the mediating role of moral distress in the relationship between value congruence and job control, on the one hand, and depression, on the other hand. A cross-sectional study involving physicians, nurses, and residents working in 7 intensive care units in the north of Italy was conducted. Clinicians were administered in the Italian Moral Distress Scale-Revised, the value and control subscales of the Areas of Worklife Scale, and the Beck Depression Inventory II. Structural equation modeling was used to test the mediation model. Analysis on 170 questionnaires (response rate 72%) found no relations between job control and moral distress. A total indirect effect of value congruence on depression through moral distress (β = -.12; p = .02) was found. Moral distress contributes to the development of depressive symptoms among critical care clinicians who perceive a value incongruence with their organization and therefore should be addressed.
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Affiliation(s)
- Giulia Lamiani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paola Dordoni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Young A, Froggatt K, Brearley SG. 'Powerlessness' or 'doing the right thing' - Moral distress among nursing home staff caring for residents at the end of life: An interpretive descriptive study. Palliat Med 2017; 31:853-860. [PMID: 28659023 DOI: 10.1177/0269216316682894] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caring for dying people can contribute to moral distress experienced by healthcare professionals. Moral distress can occur when this caring is restricted by organisational processes, resources or the provision of futile care. These factors apply to end of life care in nursing homes but research is lacking. AIM To describe how nursing home staff experience moral distress when caring for residents during and at the end of life. METHODS An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff. Data were analysed using a thematic analysis approach. SETTING Four nursing homes in one large metropolitan area. PARTICIPANTS A total of 16 staff: 2 nurse managers, 4 nurses and 10 care assistants. FINDINGS Participants described holding 'good dying' values which influenced their practice. The four practice-orientated themes of advocating, caring, communicating and relating with residents were found to influence interactions with residents, relatives, general practitioners, and colleagues. These led staff to be able to 'do the right thing' or to experience 'powerlessness', which could in turn lead to staff perceiving a 'bad death' for residents. CONCLUSION When there are incongruent values concerning care between staff and others involved in the care of residents, staff feel powerless to 'do the right thing' and unable to influence care decisions in order to avoid a 'bad death'. This powerlessness is the nature of their moral distress.
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Affiliation(s)
| | - Katherine Froggatt
- 2 International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sarah G Brearley
- 2 International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Kleinknecht‐Dolf M, Spichiger E, Müller M, Bartholomeyczik S, Spirig R. Advancement of the German version of the moral distress scale for acute care nurses-A mixed methods study. Nurs Open 2017; 4:251-266. [PMID: 29085651 PMCID: PMC5653387 DOI: 10.1002/nop2.91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
AIM Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German-speaking contexts. Hence, the aim of this study was to develop and psychometrically test a German-language version of the Moral Distress Scale. DESIGN We chose a sequential explanatory mixed methods design, followed by a second quantitative cross-sectional survey. METHODS An American moral distress scale was chosen, translated, culturally adapted, tested in a pilot study and subsequently used in 2011 to conduct an initial web-based quantitative cross-sectional survey of nurses in all inpatient units at five hospitals in Switzerland's German-speaking region. Data were analysed descriptively and via a Rasch analysis. In 2012, four focus group interviews were conducted with 26 nurses and then evaluated using knowledge maps. The results were used to improve the questionnaire. In 2015, using the revised German-language instrument, a second survey and Rasch analysis were conducted. RESULTS The descriptive results of the first survey's participants (n = 2153; response rate: 44%) indicated that moral distress is a salient phenomenon in Switzerland. The data from the focus group interviews and the Rasch analysis produced information valuable for the questionnaire's further development. Alongside the data from the second survey's participants (n = 1965; response rate: 40%), the Rasch analysis confirmed the elimination of previous deficiencies on its psychometrics. A Rasch-scaled German version of the Moral Distress Scale is now available for use.
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Affiliation(s)
- Michael Kleinknecht‐Dolf
- Department of Nursing and Allied Health Care ProfessionalsUniversity Hospital ZurichZurichSwitzerland
- Faculty for HealthSchool of Nursing ScienceUniversity Witten/HerdeckeWittenGermany
| | - Elisabeth Spichiger
- Directorate of NursingMedical‐Technical and Medical‐Therapeutic Areas, InselspitalBern University HospitalSwitzerland
- Nursing ScienceFaculty of MedicineDepartment Public HealthUniversity of BaselBaselSwitzerland
| | - Marianne Müller
- Institute of Data Analysis and Process DesignSchool of EngineeringZurich University of Applied SciencesWinterthurSwitzerland
| | | | - Rebecca Spirig
- Department of Nursing and Allied Health Care ProfessionalsUniversity Hospital ZurichZurichSwitzerland
- Faculty for HealthSchool of Nursing ScienceUniversity Witten/HerdeckeWittenGermany
- Nursing ScienceFaculty of MedicineDepartment Public HealthUniversity of BaselBaselSwitzerland
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Asgari S, Shafipour V, Taraghi Z, Yazdani-Charati J. Relationship between moral distress and ethical climate with job satisfaction in nurses. Nurs Ethics 2017; 26:346-356. [PMID: 28718349 DOI: 10.1177/0969733017712083] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Moral distress and ethical climate are important issues in the workplace that appear to affect people's quality of work life. OBJECTIVES: This study was conducted to determine the relationship of moral distress and ethical climate to job satisfaction in critical care nurses. MATERIALS AND METHODS: This descriptive-correlation study was conducted on 142 critical care nurses, selected from five social security hospitals in north Iran through census sampling. Data were collected using a demographic questionnaire, the Moral Distress Scale-Revised, the Olson's Hospital Ethical Climate Survey, and the Brayfield and Rothe Job Satisfaction index. ETHICAL CONSIDERATIONS: The research project was approved by the Ethics Committee of Mazandaran University of Medical Sciences and the Medical Deputy of the Social Security Organization. FINDINGS: The mean scores obtained by the critical care nurses for moral distress, ethical climate, and job satisfaction were 87.02 ± 44.56, 3.51 ± 0.53, and 62.64 ± 9.39, respectively. Although no significant relationships were observed between moral distress and job satisfaction, the relationship between ethical climate and job satisfaction was statistically significant (p < 0.05). CONCLUSION: Identifying ethical stressors in the workplace and giving proper feedback to the authorities to eliminate these factors and improve the ethical climate in these workplaces can help enhance job satisfaction in nurses and lead to higher quality care.
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41
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Kandelman N, Mazars T, Levy A. Risk factors for burnout among caregivers working in nursing homes. J Clin Nurs 2017; 27:e147-e153. [PMID: 28543882 DOI: 10.1111/jocn.13891] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES (i) To assess the level of burnout in nursing home caregivers within a unique healthcare network in France and (ii) to evaluate potential risk factors in this population. BACKGROUND Burnout syndrome occurs frequently among nursing home caregivers and has strong detrimental effects on the quality of health care for residents. DESIGN We used an observational survey to study burnout in nursing home caregivers. The survey was used to quantify burnout level (Maslach Burnout Inventory) and potential risk factors and was implemented from October 2013-April 2014. METHODS A logistic regression was used to explore the association between burnout and its risk factors. RESULTS Three hundred and sixty questionnaires were delivered to caregivers in 14 nursing homes within a unique healthcare network. The response rate was 37% (132/360), and 124/132 (94%) surveys were analysed. Caregiver burnout rate was 40% (49/124). Median age was 41 years (range, 20-70) and most caregivers were female. The most common profession (n = 54; 44%) was nurse caregiver and 90% (n = 112) had an antecedent of bullying by a resident. Risk factors identified were as follows: the presence of institutional protocols (death announcement [OR: 3.7] and pain assessment [OR: 2.8]), working in a profit-making establishment (OR: 2.6) and the antecedent of bullying by a resident (OR: 6.2). Factors most negatively associated with burnout included: practising pastimes (OR: 0.4) and working as a nurse (OR: 0.3). The only significant risk factor in the multivariate analysis was the antecedent of bullying by a resident (OR: 5.3). CONCLUSION Several specific risk factors for burnout in nursing home caregivers were identified. RELEVANCE TO CLINICAL PRACTICE In high-risk populations of healthcare professionals, screening and management of risk factors is crucial for preventing burnout.
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Affiliation(s)
- Nadia Kandelman
- Réseau de santé 92 Nord, Gennevilliers, France.,Department of General Practice, University Paris Diderot, Paris, France
| | - Thierry Mazars
- Réseau de santé 92 Nord, Gennevilliers, France.,Department of General Practice, University Paris Diderot, Paris, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Paris-Sud University, Villejuif, France
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42
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Andersson S, Lindqvist O, Fürst CJ, Brännström M. Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes. Scand J Caring Sci 2017; 32:299-308. [DOI: 10.1111/scs.12462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/05/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Olav Lindqvist
- Department of Nursing; Umeå University; Umeå Sweden
- Department of Learning, Informatics, Management and Ethics/MMC; Karolinska Institutet; Stockholm Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care; Lund University and Region Skåne; Lund Sweden
| | - Margareta Brännström
- Department of Nursing; Umeå University; Skellefteå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
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43
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Piers RD, Versluys KJJ, Devoghel J, Lambrecht S, Vyt A, Van Den Noortgate NJ. A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium. J Am Geriatr Soc 2017. [PMID: 28631275 DOI: 10.1111/jgs.14958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. DESIGN Cross-sectional multicenter study. SETTING Acute geriatric units in Belgium. PARTICIPANTS Team members of different professional backgrounds. MEASUREMENTS Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. RESULTS The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P < .001). Using the mean score on each of the six areas, four clusters that differed significantly in all areas were identified using hierarchical cluster analysis and scree plot analysis (P < .001). CONCLUSION Interprofessional teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams.
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Affiliation(s)
- Ruth D Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karen J J Versluys
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Devoghel
- Department of Geriatric Medicine, St. Jan Hospital Bruges, Bruges, Belgium
| | - Sophie Lambrecht
- Department of Geriatric Medicine, St. Maria Hospital Halle, Halle, Belgium
| | - André Vyt
- Artevelde University College and University of Ghent, Ghent, Belgium
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44
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Braedley S, Owusu P, Przednowek A, Armstrong P. We’re told, ‘Suck it up’: Long-Term Care Workers’ Psychological Health and Safety. AGEING INTERNATIONAL 2017. [DOI: 10.1007/s12126-017-9288-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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End-of-life care in critical care: moving forward to enhance patient and family experiences. Intensive Crit Care Nurs 2017; 33:1-2. [PMID: 26949159 DOI: 10.1016/j.iccn.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Schaefer R, Zoboli ELCP, Vieira M. Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool. Nurs Inq 2016; 23:346-357. [DOI: 10.1111/nin.12156] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rafaela Schaefer
- Department of Nursing; The Institute of Health Sciences of the Catholic University of Portugal - Porto (UCP); Porto Portugal
- Centre of Interdisciplinary Investigation in Health (CIIS); Porto Portugal
| | | | - Margarida Vieira
- Department of Nursing; The Institute of Health Sciences of the Catholic University of Portugal - Porto (UCP); Porto Portugal
- Centre of Interdisciplinary Investigation in Health (CIIS); Porto Portugal
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47
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Abstract
BACKGROUND Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by nurses nor a study conducted on the issue. AIM/OBJECTIVE The study aims to (a) validate the Turkish version of the Moral Distress Scale-Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses' moral distress level. METHOD The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale-Revised. Ethical considerations: The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality. RESULTS In parallel with the original scale, Turkish version of Moral Distress Scale-Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively. CONCLUSION Turkish version of Moral Distress Scale-Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care.
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48
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Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol 2016. [PMID: 26220460 DOI: 10.1177/1359105315595120] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians' wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.
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Affiliation(s)
- Giulia Lamiani
- 1 University of Milan, Italy.,2 University of Pavia, Italy
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49
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Pijl-Zieber EM, Awosoga O, Spenceley S, Hagen B, Hall B, Lapins J. Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia. DEMENTIA 2016; 17:315-336. [DOI: 10.1177/1471301216645214] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Em M Pijl-Zieber
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive Lethbridge, AB T1K 3M4, Canada
| | - Olu Awosoga
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive Lethbridge, AB T1K 3M4, Canada
| | - Shannon Spenceley
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive Lethbridge, AB T1K 3M4, Canada
| | - Brad Hagen
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive Lethbridge, AB T1K 3M4, Canada
| | - Barry Hall
- Faculty of Social Work, University of Calgary, Southern Alberta Region University of Lethbridge, 4401 University Drive Lethbridge, AB T1K 3M4, Canada
| | - Janet Lapins
- Nursing Instructor, Nursing Education in Southwestern Alberta (NESA) Program, Lethbridge College, 3000 College Drive Lethbridge, AB T1K 1L6, Canada
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50
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Spenceley S, Witcher CSG, Hagen B, Hall B, Kardolus-Wilson A. Sources of moral distress for nursing staff providing care to residents with dementia. DEMENTIA 2015; 16:815-834. [DOI: 10.1177/1471301215618108] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Health Organization estimates the number of people living with dementia at approximately 35.6 million; they project a doubling of this number by 2030 and tripling by 2050. Although the majority of people living with a dementia live in the community, residential facility care by nursing care providers is a significant component of the dementia journey in most countries. Research has also shown that caring for persons with dementia can be emotionally, physically, and ethically challenging, and that turnover in nursing staff in residential care settings tends to be high. Moral distress has been explored in a variety of settings where nurses provide acute or intensive care. The concept, however, has not previously been explored in residential facility care settings, particularly as related to the care of persons with dementia. In this paper, we explore moral distress in these settings, using Nathaniel’s definition of moral distress: the pain or anguish affecting the mind, body, or relationships in response to a situation in which the person is aware of a moral problem, acknowledges moral responsibility, makes a moral judgment about the correct action and yet, as a result of real or perceived constraints, cannot do what is thought to be right. We report findings from a qualitative study of moral distress in a single health region in a Canadian province. Our aim in this paper is to share findings that elucidate the sources of moral distress experienced by nursing care providers in the residential care of people living with dementia.
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Affiliation(s)
| | - Chad SG Witcher
- Faculty of Health Sciences, University of Lethbridge, Canada
| | - Brad Hagen
- Faculty of Health Sciences, University of Lethbridge, Canada
| | - Barry Hall
- Faculty of Social Work, University of Calgary, Canada
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