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Rietdijk WJR, van der Kuy PHM, den Uil CA. Human resource management at the intensive care unit: A pragmatic review and future research agenda for building a learning health system. Learn Health Syst 2024; 8:e10395. [PMID: 38633021 PMCID: PMC11019382 DOI: 10.1002/lrh2.10395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/18/2023] [Accepted: 09/10/2023] [Indexed: 04/19/2024] Open
Abstract
Recently, the importance of efficient and effective health care has been recognized, especially during the acute phase of the Coronavirus Disease-2019 (COVID-19) pandemic. Intensive care units (ICUs) have faced an immense workload, with massive numbers of patients being treated in a very short period of time. In general, ICUs are required to deliver high-quality care at all times during the year. At the same time, high-quality organizational goals may not be aligned with the interests, motivation, and development of individual staff members (eg, nurses, and doctors). For management of the ICU, it is important to balance the organizational goals and development of the staff members ("their human capital"), usually referred to as human resource management. Although many studies have considered this area, no holistic view of the topic has been presented. Such a holistic view may help leadership and/or other stakeholders at the ICU to design a better learning health system. This pragmatic review aims to provide a conceptual model for the management of ICUs. Future research may also use this conceptual model for studying important factors for designing and understanding human resources in an ICU.
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Affiliation(s)
- Wim J. R. Rietdijk
- Department of Hospital PharmacyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Institutional AffairsVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - P. Hugo M. van der Kuy
- Department of Hospital PharmacyErasmus University Medical CenterRotterdamThe Netherlands
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Abstract
AIMS The study aims to test the Turkish validity and reliability of the Rushton Moral Resilience Scale (RMRS) and examine the effect of moral resilience on moral distress. BACKGROUND Moral distress is a phenomenon that negatively affects health workers, health institutions, and the person receiving care. In order to eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience involves developing systems that support a culture of ethical practice in healthcare and aim to increase an individual's capacity to cope with moral challenges. METHODS A methodological and descriptive-predictive study design was adopted. Sociodemographic Information Form, Measure of Moral Distress - Healthcare Professionals (MMD-HP), and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 255 clinical nurses were recruited. ETHICAL CONSIDERATIONS Hacettepe University's non-interventional ethics committee approved the study's protocol and informed consent was obtained from the participants. RESULTS The original four-factor structure of the scale was tested with confirmatory factor analysis, and the index values were evaluated and found at an acceptable level. The Cronbach Alpha coefficient of the scale was found to be 0.826. Moral resilience predicted moral distress total, intensity, and frequency levels. A moderate and weak relationship was found in the negative between all sub-dimensions of moral distress and moral resilience. CONCLUSIONS The Rushton Moral Resilience Scale Turkish version showed good psychometric properties. Moral resilience has a reducing effect on moral distress. Young nurses who have less experience are at risk because they have lower moral resilience levels, while nurses working in intensive care units are at risk because of their high moral distress levels. A healthy workplace can be created by developing specific approaches to improve moral resilience in reducing the impact of moral distress in the healthcare environment.
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Affiliation(s)
- Mustafa Sabri Kovanci
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
| | - Azize Atli Özbaş
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
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Asadi Y, Molazem Z, Mohebbi Z, Ghaemmaghami P. Investigating the relationship between resilience and professional ethics in nurses: a cross-sectional study in southern Iran. BMC Nurs 2023; 22:409. [PMID: 37904119 PMCID: PMC10614398 DOI: 10.1186/s12912-023-01578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/24/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION All businesses that deal directly with clients need to observe ethics, but in the nursing profession due to its nature, compliance with professional ethics becomes more necessary. On the other hand, nurses face tensions and difficult conditions in their daily work environment. Resilience is one of the most important abilities of human beings, which in difficult conditions causes effective adaptation to stress-causing factors. Therefore, the relationship between resilience and professional ethics becomes important. THE AIM OF THE STUDY The present study was conducted to investigate the relationship between resilience and professional ethics in nurses of Shahid Ganji Hospital, Borazjan 2022-2023. METHODS The current study is a cross-sectional descriptive-analytical study. The study environment was Shahid Ganji Hospital in Borazjan, Bushehr, Iran. The research method of the current study was census, so all 400 nurses of this hospital were invited to participate in the study. Finally, 340 of them were included in the study based on the inclusion criteria. Data collection tools included a demographic information form, Connor-Davidson questionnaire, and Cadozier professional ethics questionnaire. Data analysis was done using SPSS version 22 software. RESULTS Most of the participants were between 25 and 30 years old. The average overall score of resilience and professional ethics of nurses participating in the study was 64.1 ± 16.3 and 34.3 ± 9.4, respectively. No significant difference was observed between the demographic characteristics of nurses with resilience and professional ethics. The Spearman correlation coefficient indicated a statistically significant and inverse relationship between professional ethics and resilience levels (r = -0.265, P < 0.001). CONCLUSION The present study demonstrated a significant and inverse relationship between professional ethics and resilience among nurses. Furthermore, professional ethics were at a moderate level, while resilience was at a good level. Therefore, it is recommended that enhancing professional ethics skills through the organization of educational workshops for nurses should be considered by nursing managers.
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Affiliation(s)
- Yasaman Asadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Molazem
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zinat Mohebbi
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvin Ghaemmaghami
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Galanis P, Psomiadi ME, Karagkounis C, Liamopoulou P, Manomenidis G, Panayiotou G, Bellali T. Psychometric Properties of the Greek Version of the Connor-Davidson Resilience Scale (CD-RISC-10) in a Sample of Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6752. [PMID: 37754611 PMCID: PMC10531141 DOI: 10.3390/ijerph20186752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/24/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
Resilience has been defined as one's ability to maintain a mental health state and overall well-being when undergoing grave stress or facing significant adversity. Numerous resilience-investigating research tools have been developed over the years, with the Connor-Davidson Resilience Scale (CD-RISC), a self-rated tool presenting valuable psychometric properties, remaining one of the most prominent. We aimed to translate and validate the brief CD-RISC-10 in a convenience sample of 584 nurses in Greece's secondary and tertiary health care system. We conducted a confirmatory factor analysis and known-groups validity test and estimated the reliability of the CD-RISC-10. Our confirmatory factor analysis revealed that the scale had a unifactorial structure since all the model fit indices were very good. Moreover, the reliability of the CD-RISC-10 was very good since the acquired Cronbach's alpha and McDonald's omega were 0.924 and 0.925, respectively. Therefore, the Greek version of the CD-RISC-10 confirmed the factor structure of the original scale and had very good validity and reliability.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Elissavet Psomiadi
- Directorate of Operational Preparedness for Public Health Emergencies, Greek Ministry of Health, 10433 Athens, Greece
| | | | - Polyxeni Liamopoulou
- Department of Nursing, School of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece
| | - Georgios Manomenidis
- Nursing Department (Didimoteicho Branch), International Hellenic University, 57400 Thessaloniki, Greece
| | - Georgios Panayiotou
- Laboratory of Exercise, Health and Human Performance, Applied Sport Science Postgraduate Program, Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia P.O. Box 22006, Cyprus;
| | - Thalia Bellali
- Department of Nursing, School of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece
- Department of Health Sciences, School of Sciences, European University Cyprus, 6, Diogenes Str. Engomi, CY-2404, Nicosia P.O. Box 22006, Cyprus
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Zarrin L, Ghafourifard M, Sheikhalipour Z. Relationship between Nurses Reflection, Self-efficacy and Work Engagement: A Multicenter Study. J Caring Sci 2023; 12:155-162. [PMID: 38020737 PMCID: PMC10663437 DOI: 10.34172/jcs.2023.31920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Reflection is considered an essential element in nurses' practice with different positive outcomes, we decided to determine the level of nurses' reflection and then assess the relationship between nurses' reflection with their self-efficacy and work engagement. Methods In this cross-sectional study, a total of 240 nurses were selected from seven educational hospitals affiliated with Tabriz University of medical sciences (Iran). The stratified random sampling method was used to select the participants from hospitals. Data were collected through three questionnaires including Groningen Reflection Ability Scale (GRAS), Sherer's General Self-Efficacy Scale (SGSES), and Utrecht Work Engagement Scale (UWES). Data were analyzed using SPSS version 13. Results According to the results, the mean (SD) score of nurses' reflection was calculated as 86.51 (8.17) out of 115. The mean (SD) score of nurses' self-efficacy was 60.89 (11.11) out of 85. Moreover, the mean (SD) total score of nurses' work engagement in a possible range of 0 to 6 was 3.39 (1.36). There was a positive and significant relationship between the total reflection score with work engagement and self-efficacy scores. Conclusion According to the results, nurses working in different units showed different scores of reflection. Moreover, the results of the present study showed that nurses' reflection is associated with nurses' work engagement and self-efficacy. Therefore, nurse managers and nurse educators should improve nurses' skills in reflection and they should support the reflective practice in clinical settings.
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Affiliation(s)
| | - Mansour Ghafourifard
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Nordin A, Engström Å, Fredholm A, Persenius M, Andersson M. Measuring moral distress in Swedish intensive care: Psychometric and descriptive results. Intensive Crit Care Nurs 2023; 76:103376. [PMID: 36706495 DOI: 10.1016/j.iccn.2022.103376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To investigate the construct validity and psychometric properties of the Swedish version of the Moral Distress Scale-Revised and to describe moral distress in an intensive care context. RESEARCH METHODOLOGY/DESIGN The Italian Moral Distress Scale-Revised was translated and semantically adjusted to the Swedish intensive care context. A web survey with 14 moral distress items, as well as three additional and eight background questions was answered by critical care nurses (N = 71) working in intensive care units during the second year of the coronavirus disease pandemic. Inferential and descriptive statistics were used to investigate the Italian four-factor model and to examine critical care nurses' moral distress. RESULTS The result shows a factor model of four components differing from the previous model. Critical care nurses demonstrated significant differences in moral distress regarding priorities compared to before the pandemic, type of household; experience as critical care nurses and whether they had supervised students during the pandemic. CONCLUSION The component structure might have originated from the specific situation critical care nurses perceived during the pandemic. The health care organisations' role in preventing and healing the effects of moral distress is important for managers to understand. IMPLICATIONS FOR CLINICAL PRACTICE Moral distress is common in intensive care and it is necessary to use valid instrument when measuring it. A psychometrical investigation of the Swedish version of the Moral Distress Scale-Revised, adapted for intensive care shows need for further semantic and cultural adaptation. Perceived priorities during the pandemic, household type, supervising during the pandemic and working experience were related to critical care nurses' experience of moral distress and managers need to be aware of conditions that may trigger such a response.
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Affiliation(s)
- Anna Nordin
- Karlstad University, The Faculty of Health, Science and Technology, Department of Health Sciences, 651 88 Karlstad, Sweden; Luleå University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden.
| | - Åsa Engström
- Luleå University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden.
| | - Angelica Fredholm
- Karlstad University, The Faculty of Health, Science and Technology, Department of Health Sciences, 651 88 Karlstad, Sweden; County Council of Värmland, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
| | - Mona Persenius
- Karlstad University, The Faculty of Health, Science and Technology, Department of Health Sciences, 651 88 Karlstad, Sweden.
| | - Maria Andersson
- Luleå University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden; The Swedish Red Cross University College, Stockholm, Sweden.
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Wang R, Song Y, He Y, Long S, Feng L. Status of knowledge, attitude and practice of poststroke dysphagia in neurological nurses in China: A cross-sectional study. PLoS One 2023; 18:e0284657. [PMID: 37083919 PMCID: PMC10121028 DOI: 10.1371/journal.pone.0284657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES To explore the status and related factors of knowledge, attitude, and practice (KAP) of poststroke dysphagia among neurological nurses in China. METHODS Neurological nurses from 40 tertiary hospitals in Southwest China were invited to complete a survey on the knowledge, attitude, and practice of the nursing of poststroke dysphagia. We used a questionnaire to collect the participants' information including the basic characteristics and the KAP Questionnaire on poststroke dysphagia in the neurological ward. A sample of 707 participants completed the survey. RESULTS The knowledge, attitude, and practice scores for the nursing of poststroke dysphagia were 12.00±4.09, 71.99±11.00, 52.22±9.08, respectively. The total score of knowledge towards the nursing of poststroke dysphagia was significantly different among nurses with different ages, working time of nursing, working time of nursing in neurology, the highest level of education, professional title, position, the method of training, the number of dysphagia-related nursing trainings, the total length of dysphagia nursing training, and the nursing basis of patients with dysphagia. The total score of attitudes towards the nursing of poststroke dysphagia was significantly different among nurses with the way they were trained, and the nursing basis for patients with dysphagia. The total score of practice towards poststroke dysphagia was significantly different among nurses with the number of dysphagia-related nursing trainings, the total length of dysphagia nursing training, the training method, and the basis of nursing patients with dysphagia. CONCLUSION Neurological nurses' knowledge score in poststroke dysphagia is relatively low, and the knowledge level needs improvement. The attitude and practice score of neurological nurses in dysphagia after stroke was much better than the knowledge score. Managers and nursing researchers should develop and offer effective training for neurological nurses to improve their knowledge, attitude and practice towards poststroke dysphagia, and then improve patients' health outcomes.
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Affiliation(s)
- Rui Wang
- Department of Neurology, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Yuqing Song
- West China School of Nursing/ West China Hospital, Sichuan University, Chengdu, PR China
| | - Yueyue He
- Department of Neurology, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Shiyan Long
- Department of Neurology, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Ling Feng
- Department of Neurology, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, PR China
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Prentice TM, Imbulana DI, Gillam L, Davis PG, Janvier A. Addressing Moral Distress: lessons Learnt from a Non-Interventional Longitudinal Study on Moral Distress. AJOB Empir Bioeth 2022; 13:226-236. [PMID: 35856901 DOI: 10.1080/23294515.2022.2093422] [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: 01/29/2023]
Abstract
BACKGROUND Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate its harmful effects. However, the effects of participating in moral distress studies have not been evaluated. OBJECTIVE To evaluate the impact of participation in a longitudinal, non-intervention research project on moral distress in the NICU. DESIGN Clinicians who previously participated in an 18-month longitudinal research study on moral distress at two NICUs were invited to complete a questionnaire on the impact of participation. The original study required regular completion of surveys that sought predictions of death, disability and the intensity/nature of moral distress experienced by clinicians caring for extremely preterm babies. Individual and unit-wide effects were explored. Free-text responses to open-ended questions were analyzed using inductive content analysis. RESULTS A total of 249/463 (53%) eligible clinicians participated. Participation in the original 18-month study was perceived as having a positive impact by 58% of respondents. Clinicians found articulating their views therapeutic (76%) and useful in clarifying personal opinions about the babies (85%). Free-text responses revealed the research stimulated increased reflection, validated feelings and increased dialogue amongst clinicians. Respondents generally did not find participation distressing (70%). However, a small number of physicians felt the focus of discussion shifted from the baby to the clinicians. Intensity and prevalence of moral distress did not significantly change over the 18-month period. CONCLUSIONS Participating in moral distress research prompted regular reflection regarding attitudes toward fragile patients, improving ethical awareness. This is useful in clarifying personal views that may influence patient care. Participation also enhanced communication around difficult clinical scenarios and improved provider satisfaction. These factors are insufficient to significantly reduce moral distress in isolation.
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Affiliation(s)
- Trisha M Prentice
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Dilini I Imbulana
- Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lynn Gillam
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Annie Janvier
- Departement of Pediatrics, Division of Neonatology, Clinical Ethics Unit, Palliative Care Unit, Unité de Recherche en Éthique Clinique et Partenariat Famille, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
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The Effect of Psychosocial Safety Climate on Engagement and Psychological Distress: A Multilevel Study on the Healthcare Sector. SAFETY 2022. [DOI: 10.3390/safety8030062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
All work sectors have been affected by the impact of the COVID-19 pandemic. The perception of risk combined with the lack of safety and fear for their own safety have caused severe psychological discomfort in workers. Of all the work sectors, the most affected was certainly the healthcare sector. In hospitals, medical staff were at the forefront of the battle against COVID-19, providing care in close physical proximity to patients and had a direct risk of being exposed to the virus. The main objective of the study was to investigate the perception of a psychosocial safety climate and the effect on engagement and psychological stress in a sample of 606 healthcare workers (physicians 39.6%, nurses 41.3%, healthcare assistant 19.1%), belonging to six organisations and organised into 11 working groups. Furthermore, we wanted to investigate the mediating effect of workaholism at both individual and group level. The results partially confirmed our hypotheses and the mediating effect at the individual level of working compulsively. A psychosocial safety climate in healthcare workers led to a decrease in engagement through the mediation of working compulsively. The mediating effect of working compulsively might be due to a climate that did not guarantee or preserve the psychological health and safety of healthcare workers. In this research, the most important limit concerns the number of organisations and the number of groups.
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Linking Transformational and Despotic Leadership to Employee Engagement: Unfolding the Role of Psychological Distress as a Mediator. SUSTAINABILITY 2022. [DOI: 10.3390/su14148851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This research investigates the antecedents of employee engagement in Pakistan’s banks to conceptualize the idea of employee engagement. For this, the study examines the relationship between transformational leadership (TL), despotic leadership (DL), and the mediation of psychological distress (PD) with an outcome variable, employee engagement (EE). The study focused on first-line bank managers based in Punjab province using a cluster sampling technique. A questionnaire survey was used, and 341 respondents were selected for analysis using PLS-SEM. The study’s findings confirmed that all seven hypotheses tested were statistically significant. The results revealed that the transforming role of transformational leadership is more effective than despotic leadership in promoting employee engagement. The indirect link of psychological distress between transformational leadership, despotic leadership, and employee engagement also acts vice versa. The current study findings have implications for advancing our understanding of the effects of transformational leadership because of their positivity, which can reduce psychological distress and increase employee engagement in the service sector. In contrast, despotic leadership undermines employees’ abilities by increasing psychological distress and disengagement among employees. Our findings will help the banking industry understand how despotic and transformational leadership can negatively and positively affect employee outcomes.
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Fagerström C, Wickström H, Tuvesson H. Still engaged – healthcare staff’s engagement when introducing a new eHealth solution for wound management: a qualitative study. BMC Health Serv Res 2022; 22:103. [PMID: 35078483 PMCID: PMC8788143 DOI: 10.1186/s12913-022-07515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management. Methods A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis. Results Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others. Conclusions The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.
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Ruiz-Frutos C, Ortega-Moreno M, Soriano-Tarín G, Romero-Martín M, Allande-Cussó R, Cabanillas-Moruno JL, Gómez-Salgado J. Psychological Distress Among Occupational Health Professionals During Coronavirus Disease 2019 Pandemic in Spain: Description and Effect of Work Engagement and Work Environment. Front Psychol 2022; 12:765169. [PMID: 34975655 PMCID: PMC8716488 DOI: 10.3389/fpsyg.2021.765169] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/03/2021] [Indexed: 01/19/2023] Open
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of hospital health professionals has been widely described, but few studies have focused on occupational health professionals. Therefore, the objective of this study was to assess psychological distress (PD) of occupational health workers and its relationship with their work engagement (WE) and work environment characteristics. A cross-sectional survey was conducted. A sample of 499 nurses and physicians participated in the study. Variables included demographic data, work environment characteristics, work engagement Utrecht Work Engagement Scale (UWES-9) and psychological distress General Health Questionnaire (GHQ-12). The Chi-square Automatic Interaction Detection method was performed for data analysis. Data collection took place via the internet between April 23 and June 24, 2020. A total of 65.53% of the participants had PD, and the total mean score of the UWES-9 scale was 34.80 (SD = 10.69). Workload, conflicts, stressful situations, and less job satisfaction were significantly related to a higher percentage of PD (p < 0.05). Participants with low engagement showed higher levels of PD (76.7%; p < 0.001). The dedication was revealed as the most significant dimension. Interventions aimed at promoting resilience and coping strategies are suggested. WE should be fostered as a preventive measure against PD among occupational health workers. By protecting workers, occupational health departments have a shared responsibility with public health in containing the pandemic. Therefore, it is essential to prevent the psychological impact that this responsibility may have on occupational health workers by implementing prevention measures.
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Affiliation(s)
- Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labor Sciences, University of Huelva, Huelva, Spain.,Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Mónica Ortega-Moreno
- Department of Economy, Faculty of Labor Sciences, University of Huelva, Huelva, Spain
| | - Guillermo Soriano-Tarín
- Asociación Española de Medicina del Trabajo - Spanish Association of Specialists in Occupational Health Medicine, Valencia, Spain
| | | | | | - Juan Luis Cabanillas-Moruno
- Asociación Española de Medicina del Trabajo - Spanish Association of Specialists in Occupational Health Medicine, Valencia, Spain.,Department of Preventive Medicine and Public Health, Universidad de Sevilla, Seville, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labor Sciences, University of Huelva, Huelva, Spain.,Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil, Ecuador
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Moral Distress Among Interdisciplinary Critical Care Team Members at a Comprehensive Cancer Center. Dimens Crit Care Nurs 2021; 40:301-307. [PMID: 34398568 DOI: 10.1097/dcc.0000000000000490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Moral distress (MD) has been linked to health care professional burnout, intent to leave, and decreased quality of care. OBJECTIVES The aim of this study was to describe the perceptions of MD among critical care interdisciplinary team members and assess the association of MD with team member characteristics. METHODS A descriptive cross-sectional design was used with interdisciplinary team members in an intensive care unit setting at an NCI-designated Comprehensive Cancer Center in the southeastern United States. The Measure of Moral Distress for Healthcare Professionals was provided to registered nurses, oncology technicians, providers, respiratory therapists, and ancillary team members (social workers, pharmacists, dietitians). RESULTS A total of 67 team members completed the survey. Mean responses for 3 items were higher than 8 (halfway point of scale): "Follow family's insistence to continue aggressive treatment even though I believe it is not in the best interest of patient" (mean [SD], 11.4 [4.8]); "Continue to provide aggressive treatment for a patient most likely to die regardless of this treatment when no one will make a decision to withdraw it" (mean [SD], 10.5 [5.3]); and "Witness providers giving 'false hope' to patient/family" (mean [SD], 9.0 [5.3]). Higher responses on the "Continuing to provide aggressive treatment" item was associated with having "considered leaving due to MD" (P = .027) and "considering leaving now due to MD" (P = .016). Higher total scores were related to having left or considered leaving a job (P = .04). When examining education level, registered nurses with a master's degree (n = 5) exhibited the most MD (P = .04). CONCLUSION This study suggests that the Measure of Moral Distress for Healthcare Professionals is useful in identifying areas for focused efforts at reducing MD for interdisciplinary teams.
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Imbulana DI, Davis PG, Prentice TM. Interventions to reduce moral distress in clinicians working in intensive care: A systematic review. Intensive Crit Care Nurs 2021; 66:103092. [PMID: 34147334 DOI: 10.1016/j.iccn.2021.103092] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/07/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of interventions to mitigate the harmful effects of moral distress experienced by nursing and medical clinicians working in the intensive care setting. DESIGN Eligible studies were identified from searches of PubMed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus. Included studies were published prior to 20 August 2020. RESULTS Twelve studies were included in this review comprising three randomised controlled trials, seven quasi-randomised trials and two observational studies. Nine studies reported interventions targeting only nurses while three included both nurses and doctors. The types of interventions identified included: moral empowerment programs, end-of-life educational programs, reflective exercises through individual narrative writing or group reflective debriefing, multidisciplinary case debriefing meetings integrated into clinical practice and moral resiliency training. Due to the overall low methodological quality and high risk of bias, no single intervention may be considered efficacious in managing moral distress. CONCLUSIONS There is weak evidence that some currently available interventions reduce the moral distress experienced by intensive care health care providers. Larger randomised trials involving all intensive healthcare clinicians are required to evaluate multifaceted interventions.
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Affiliation(s)
- Dilini I Imbulana
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia; School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia.
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia; Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Trisha M Prentice
- Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Gómez-Salgado J, Domínguez-Salas S, Romero-Martín M, Romero A, Coronado-Vázquez V, Ruiz-Frutos C. Work engagement and psychological distress of health professionals during the COVID-19 pandemic. J Nurs Manag 2021; 29:1016-1025. [PMID: 33400325 DOI: 10.1111/jonm.13239] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 01/18/2023]
Abstract
AIMS To describe the level of work engagement of active health care professionals during the COVID-19 pandemic, and its relationship with psychological distress according to the professional category. BACKGROUND Health care professionals working on the front line of the COVID-19 pandemic are at risk of psychological distress, and work engagement could be a positive attitude that could serve as a protective factor. METHODS Cross-sectional observational study of 1,459 health care professionals. Psychological distress was measured with the General Health Questionnaire and work engagement with the Utrecht Work Engagement Scale. Data were analysed with bivariate analyses and correlations. RESULTS Psychological distress was reported by 80.6% of health care professionals. Work engagement as high with a total mean score of 5.04 (SD = 1.14). The results showed that distressed professionals showed significantly lower levels of work engagement. CONCLUSIONS The present study identified psychological distress and work engagement experienced by health care professionals during the COVID-19 pandemic. Most of the variables included in the study revealed a significant relationship with psychological distress and work engagement. IMPLICATIONS FOR NURSING MANAGEMENT The relationship between the working conditions with psychological distress and work engagement suggests that improvements in the workplace are needed to promote protective measure for the mental health of health care professionals.
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Affiliation(s)
- Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health. Faculty of Labour Sciences, University of Huelva, Huelva, Spain.,Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Sara Domínguez-Salas
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | | | - Adolfo Romero
- Nursing and Podiatry Department, Health Sciences School, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Valle Coronado-Vázquez
- Department of Nursing, Catholic University of Ávila, Ávila, Spain.,Group B21-20R, Health Research Institute of Aragon (IIS), Zaragoza, Spain
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health. Faculty of Labour Sciences, University of Huelva, Huelva, Spain.,Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Abstract
BACKGROUND Occupational stress in neonatal nursing is a significant professional concern. Prolonged exposure to morally distressing patient care experiences and other healthcare issues may lead to worry among nurses. When worry becomes excessive, nurses and advanced practice registered nurses may lose joy that gives meaning to their work. Enhancing meaning in work may have a positive impact on nurse satisfaction, engagement, productivity, and burnout. PURPOSE To explore neonatal nurses' top professional satisfiers and top professional worries and concerns. METHODS A descriptive study was conducted in a convenience sample of neonatal nurses to identify the top professional satisfiers that get them up in the morning and the top professional worries and concerns that keep them awake at night. RESULTS Complete data were available for 29 neonatal nurses. The top professional satisfiers were caring for infants and families, making a difference, witnessing resilience, intellectual challenge of specialty, positive working relationships with colleagues, and educating parents and families. The top professional worries and concerns were staffing, missed care, workload, making a mistake, and failure to rescue. IMPLICATIONS FOR PRACTICE Healthcare and professional organizations must develop strategies to address occupational stress in today's complex healthcare environment. Identifying professional worries and concerns may help nurses navigate challenging and distressing situations. Furthermore, understanding nurses' professional satisfiers may promote personal and professional resiliency and help organizations create healthier workplace environments. IMPLICATIONS FOR RESEARCH Future studies are needed to test effective interventions that may promote professional satisfaction and help neonatal nurses cope with occupational stressors.
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Abstract
OBJECTIVE This study examines nurses' perceptions of communication and engagement in the workplace. BACKGROUND Work engagement and communication are both important concepts in the healthcare environment. METHODS Inferential analyses were conducted using the Utrecht Work Engagement Scale and Farley's Communication Assessment Questionnaire, along with descriptive and bivariate analyses. RESULTS Job vigor was negatively associated with the level of informed communication and indirect communication, whereas greater job dedication was found to be associated with more informed communication. Additionally, a statistically significant correlation between years of experience and vigor and absorption was noted, although age did not demonstrate the same relationship. Ultimately, nurse characteristics played an important role in the perception of communication in the work environment and in job enthusiasm. CONCLUSIONS Nurse administrators must create a culture that values communication and communicate skillfully using various methods to meet the needs of different employees.
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18
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Bakertzis E, Myloni B. Profession as a major drive of work engagement and its effects on job performance among healthcare employees in Greece: A comparative analysis among doctors, nurses and administrative staff. Health Serv Manage Res 2020; 34:80-91. [PMID: 32903094 DOI: 10.1177/0951484820943592] [Citation(s) in RCA: 6] [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
OBJECTIVES The current research explores how employees' work engagement in the Greek healthcare sector influences their job performance level in each profession. A secondary objective is to examine the correlation between work engagement and demographics. METHOD In order to achieve these objectives, a questionnaire containing Likert 5 point-scale questions was used to collect data from 269 participants. Our sample, drawn from the healthcare sector, consisted of 85 doctors, 139 nurses, and 45 administrative staff. Regression analysis was used to investigate the relationship between work engagement and job performance among the different professional groups. RESULTS Our findings showed that a strong correlation exists between work engagement and job performance among doctors, but this relationship is weak among administrative staff and nurses. Additionally, though doctors scored higher on engagement and lower on job performance as compared to administrative staff and nurses, a reverse trend was found among the last two employee categories. Engagement levels were also found to increase with age, though not necessarily with experience. CONCLUSIONS The most important conclusion is that although work engagement levels significantly affect employee job performance as hypothesised, the relationship is much stronger among doctors than among nurses or administrative staff. This implies profession has a major role in driving work engagement and, thereby, performance. Furthermore, age seems to be significantly linked to the level of work engagement, indicating that more mature employees are more likely to be engaged with their work as compared to less mature ones.
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Affiliation(s)
- Efstathios Bakertzis
- Department of Business Administration, 37795University of Patras, Patras, Greece
| | - Barbara Myloni
- Department of Business Administration, 37795University of Patras, Patras, Greece
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Relationships Among Character Strengths, Self-efficacy, Social Support, Depression, and Psychological Well-being of Hospital Nurses. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:150-157. [DOI: 10.1016/j.anr.2020.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
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Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes: An Integrative Review. J Hosp Palliat Nurs 2020; 21:250-256. [PMID: 31268970 DOI: 10.1097/njh.0000000000000561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
End-of-life care in the neonatal intensive care unit (NICU) is one of the most challenging practices for nurses. Negative emotions associated with moral distress often cause care to be incomplete or nurse disengagement. Emotional intelligence in nurses holds potential to address this issue, while improving patient outcomes. The purpose of this study was to critically appraise the evidence about emotional intelligence in nursing and to explore the relationship between emotional intelligence, moral distress in NICU nurses, end-of-life care, and other priority nurse and patient outcomes. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-structured integrative review was conducted, and CINAHL, Ovid, PubMed, and other databases were searched. Twelve studies were identified as relevant to this review after exclusion criteria were applied. Evidence supports the efficacy of emotional intelligence in bedside nurses as a method of improving key nurse and patient outcomes. Additionally, research suggests that emotional intelligence can be improved by training interventions. Clinical educators should integrate emotional intelligence concepts and strategies into staff training. Further research is recommended to validate previous findings in the NICU setting. Exploration of the relationship between emotional intelligence and moral distress in NICU nurses would provide a foundation for experimental designs to evaluate the effectiveness of emotional intelligence training interventions.
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Kitajima M, Miyata C, Tamura K, Kinoshita A, Arai H. Factors associated with the job satisfaction of certified nurses and nurse specialists in cancer care in Japan: Analysis based on the Basic Plan to Promote Cancer Control Programs. PLoS One 2020; 15:e0232336. [PMID: 32421704 PMCID: PMC7233545 DOI: 10.1371/journal.pone.0232336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background As the Japanese population ages, the number of cancer patients will likely increase. Therefore, qualified cancer health care providers should be recruited and retained. Nurse job satisfaction is influenced by numerous factors and may affect staff turnover and patient outcomes. Objectives To evaluate the job satisfaction of certified nurses and nurse specialists in Japanese cancer care and elucidate factors associated with job satisfaction. Methods Participants in this cross-sectional study comprised 200 certified nurse specialists and 1,472 certified nurses working in Japanese cancer care. A chi-square test and logistic regression analysis were conducted to identify job satisfaction factors. Results Job satisfaction was present in 38.45% and 49.00% of certified nurses and nurse specialists, respectively. Certified nurses associated job satisfaction with cross-departmental activities (OR 2.24, p<0.001), positive evaluation from senior stuff (OR 4.58, p<0.001), appropriate staff allocation (OR 1.75, p<0.001), more than five years certified nurse experience (OR 1.91, p<0.001), and positive evaluation of the development of certified nurses (OR 2.13, p<0.01) and nurse specialists (OR 1.37, p<0.05). Low job satisfaction was associated with working on a ward (OR 0.51, p<0.001) and a capacity of more than 200 beds (OR 0.33, p = 0.00). Certified nurse specialists associated job satisfaction with palliative care team participation (OR 2.64, p<0.05), cross–sectional activities (OR 7.06, p<0.01), positive evaluation from senior stuff (OR 13.15, p<0.001), presence of certified nurses in radiation therapy (OR 2.91, p<0.05), positive certified nurse specialist development evaluation (OR 7.35, p<0.001), medical service fees (OR 3.78, p<0.01), and independent activities (OR 11.34, p<0.01). Conclusions We identified factors related to activities, facilities, and the cancer care team associated with job satisfaction of certified nurses and nurse specialists in Japanese cancer care. Suggestions are provided to enhance job satisfaction through Japan’s Basic Plan to Promote Cancer Control, which may help hospital administrators retain nursing staff.
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Affiliation(s)
- Masaki Kitajima
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chiharu Miyata
- Nursing, Mie University Graduate School of Medicine, Mie, Japan
| | - Keiko Tamura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayae Kinoshita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
- * E-mail:
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22
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Abstract
BACKGROUND Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. OBJECTIVES We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. RESEARCH DESIGN An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. PARTICIPANTS Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. RESEARCH CONTEXT This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. ETHICAL CONSIDERATIONS The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. FINDINGS Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. DISCUSSION Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. CONCLUSION This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice.
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23
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Abstract
The best policies are evidence-based, providing feasible solutions to healthcare issues to prevent unintended consequences. Nurse researchers need to generate evidence with which to create policy. The obligation to monitor the impact of policies and standards rests on nurse leaders who have the duty to advocate when policies fail. Nurses providing direct care are beholden to report failed policies. Advocacy in the situation of a failed policy often requires moral courage to prevent moral distress amongst the ranks of nurses who enact policies at the intersect of care. In this article, the impact of three healthcare policy issues on nursing end-users will be evaluated: aid in dying, titration of vasoactive medications, and the Center for Medicare and Medicaid Services 30-minute rule.
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Affiliation(s)
- Judy E Davidson
- Department of Psychiatry, University of California San Diego School of Medicine, University of California San Diego Health, La Jolla, California
| | - Mary Faith Marshall
- Center for Biomedical Ethics and Humanities, School of Medicine, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Jonathan H Watanabe
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
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Mills M, Cortezzo DE. Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It. Front Pediatr 2020; 8:581. [PMID: 33014949 PMCID: PMC7511509 DOI: 10.3389/fped.2020.00581] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
Moral distress is prevalent in the neonatal intensive care unit (NICU), where decisions regarding end-of-life care, periviable resuscitation, and medical futility are common. Due to its origins in the nursing literature, moral distress has primarily been reported among bedside nurses in relation to the hierarchy of the medical team. However, it is increasingly recognized that moral distress may exist in different forms than initially described and that healthcare professions outside of nursing experience it. Advances in medical technology have allowed the smallest, sickest neonates to survive. The treatment for critically ill infants is no longer simply limited by the capability of medical technology but also by moral and ethical boundaries of what is right for a given child and family. Shared decision-making and the zone of parental discretion can inform and challenge the medical team to balance the complexities of patient autonomy against harm and suffering. Limited ability to prognosticate and uncertainty in outcomes add to the challenges faced with ethical dilemmas. While this does not necessarily equate to moral distress, subjective views of quality of life and personal values in these situations can lead to moral distress if the plans of care and the validity of each path are not fully explored. Differences in opinions and approaches between members of the medical team can strain relationships and affect each individual differently. It is unclear how the various types of moral distress uniquely impact each profession and their role in the distinctively challenging decisions made in the NICU environment. The purpose of this review is to describe moral distress and the situations that give rise to it in the NICU, ways in which various members of the medical team experience it, how it impacts care delivery, and approaches to address it.
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Affiliation(s)
- Manisha Mills
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Knowledge, attitude and practice regarding nursing interruptions among Chinese nurses: A nationwide cross-sectional survey. Int J Nurs Sci 2019; 7:66-73. [PMID: 32099862 PMCID: PMC7031111 DOI: 10.1016/j.ijnss.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives To explore the knowledge, attitude and practice of Chinese nurses regarding nursing interruptions and related factors. Methods A total of 6,400 nurses from 31 hospitals in China were investigated by using the Knowledge, Attitude and Practice (KAP) Questionnaire of Nursing Interruptions. The questionnaire consists of three dimensions, knowledge, attitude and practice, containing 10, 9 and 7 items, with full score of 50, 45 and 28, respectively. Results The mean overall KAP score regarding nursing interruptions of Chinese nurses was 74.05 ± 16.65 (range: 26–123), with scores for the knowledge, attitude, and practice component being 21.74 ± 9.80, 34.83 ± 6.98, and 17.49 ± 4.97, respectively. Among the nurses, 70.8% of them experienced an average level of KAP toward nursing interruptions while 15.5% were at a poor level. The knowledge, attitude, and practice of nursing interruptions were better in chief nurses, managers, nurses with a master degree or above, nurses ever received training, and nurses with a strong agreement to leadership compared to nurses in other groups (P < 0.05). In addition, employment type, professional title, position, standardized training and leaders’ attention were predictors of KAP in nurses. Conclusion Chinese nurses have a moderate level of KAP regarding nursing interruptions. Leaders’ attention, standardized training, position, professional title and employment type could predict nurses’ KAP state of nursing interruptions. Thus, a targeted training program should be implemented for clinical nurses by nursing leaders, with a particular focus on feasibility and professionalism.
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Arbe Montoya AI, Hazel S, Matthew SM, McArthur ML. Moral distress in veterinarians. Vet Rec 2019; 185:631. [PMID: 31427407 DOI: 10.1136/vr.105289] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/12/2019] [Accepted: 07/18/2019] [Indexed: 11/03/2022]
Abstract
Moral distress is a psychological state of anguish that has been widely studied in healthcare professionals. Experiencing moral distress can lead to problems including avoidance of patients and increased staff turnover. Moral distress in veterinarians has not yet been explored to the extent seen in the human medical field, and there is limited data regarding moral distress in veterinarians. However, it is expected to be prevalent in these professionals. So far, it has been reported that veterinarians commonly experience moral conflict, ethical challenges and ethical dilemmas during their career. These conflicts in association with other modifying factors such as personality traits can lead to the experience of moral distress. In a profession with known levels of occupational stress and reported mental health problems, exploring the area of moral distress and its effects on the professional wellbeing of veterinarians is important. Further studies such as developing a moral distress scale to measure this issue are needed in order to evaluate the incidence of this problem in veterinary professionals. Furthermore, assessing a possible relationship between moral distress, mental illness and attrition in veterinarians would be useful in developing intervention strategies to minimise the experience of moral distress and its associated negative consequences in veterinarians.
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Affiliation(s)
- Alejandra I Arbe Montoya
- Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Susan Hazel
- Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Susan M Matthew
- College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Michelle L McArthur
- Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
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Chen FF, Chen SY, Pai HC. Self-reflection and critical thinking: the influence of professional qualifications on registered nurses. Contemp Nurse 2019; 55:59-70. [PMID: 30830839 DOI: 10.1080/10376178.2019.1590154] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p < .001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p > .05) and critical thinking (β = 0.18, t = 3.143, p < .001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight.
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Affiliation(s)
- Fen-Fang Chen
- a Taichung Veterans General Hospital , Taichung City , Taiwan
| | - Shu-Yueh Chen
- b Department of Nursing , Central Taiwan University of Science and Technology (Adjunct Associate Professor) , Taiwan
| | - Hsiang-Chu Pai
- c Department of Nursing , Chung-Shan Medical University; Chung-Shan Medical University Hospital , No.110,Sec.1,Jianguo N.Rd., Taichung City 40201 , Taiwan, R.O.C
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Song EJ, Kim MJ, Koh MS. Moderating Effects of Career Commitment in the Relationship between Work Engagement and Organizational Citizenship Behaviors of the Clinical Nurses. ACTA ACUST UNITED AC 2019. [DOI: 10.11111/jkana.2019.25.3.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Case Study Investigation Decreases Burnout While Improving Interprofessional Teamwork, Nurse Satisfaction, and Patient Safety. Crit Care Nurs Q 2019; 42:96-105. [DOI: 10.1097/cnq.0000000000000243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saeedi S, Jouybari L, Sanagoo A, Vakili MA. The effectiveness of narrative writing on the moral distress of intensive care nurses. Nurs Ethics 2018; 26:2195-2203. [PMID: 30394850 DOI: 10.1177/0969733018806342] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nursing is a profession that has always been accompanied with common ethical concerns. There are some evidences which indicate that narrative writing on traumatic experiences may improve an individual's emotional health. OBJECTIVE This study aimed to determine the effectiveness of narrative writing on moral distress of nurses working in intensive care unit. RESEARCH DESIGN This study was a clinical trial with pre- and post-test design. The frequency and intensity of moral distress was measured by a valid and reliable questionnaire (Corely) at baseline and after 8 weeks. The intervention group was asked to write about their deepest emotions and stressful experiences in the intensive care unit for 8 weeks. PARTICIPANTS AND RESEARCH CONTEXT Using consensus sampling, 120 nurses of intensive care unit and neonatal intensive care unit of the teaching hospitals (in Iran) were invited to and were randomly allocated into the intervention and control groups. ETHICAL CONSIDERATIONS Participation was voluntary, data were anonymized, and the confidentiality of the participating nurses and their institutions maintained. The ethical approval was obtained from an IRB or research ethics committee. FINDINGS In total, 106 nurses completed the trial consisting of 87.75% females. The mean work experience of nurses in the intervention and control groups was 7.21 ± 4.96 and 8.28 ± 5.45 years, respectively. Independent t-test showed no statistical difference neither in the intensity of moral distress (P = 0.8), nor in its frequency (P = 0.5) between the two groups. DISCUSSION As nurses constantly face ethical tensions, moral distress is a phenomenon that results from the different situations of critical care units. Their concern about receiving negative feedback from the managerial level may have influenced the outcome of the intervention. CONCLUSION Narratives writing by the nurses showed no effect on reducing the intensity and frequency of moral distress. It seems that due to the intensity of moral distress in clinical settings, we need to test variety solutions to reduce the problem.
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Affiliation(s)
- Smat Saeedi
- Golestan University of Medical Sciences, Iran
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Hartley H, Wright DK, Vanderspank-Wright B, Grassau P, Murray MA. Dead on the table: A theoretical expansion of the vicarious trauma that operating room clinicians experience when their patients die. DEATH STUDIES 2018; 43:301-310. [PMID: 29757122 DOI: 10.1080/07481187.2018.1461711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 12/04/2017] [Accepted: 02/18/2018] [Indexed: 06/08/2023]
Abstract
The practice of operating room (OR) clinicians - nurses, surgeons, and anesthetists - is fundamentally about preserving life. Some patients, however, die in the OR. Clinicians are therefore vulnerable to moral and emotional trauma. In this paper, we discuss three forces that shape clinicians' moral and emotional experiences in OR care: biomedical values, normative death discourse, and socially (un)sanctioned grief. We suggest how each of these forces increases clinicians' vulnerability to feel traumatized when their patients die. We hope this discussion will stimulate clinicians and researchers to engage with social and cultural determinants of clinicians' experiences when patients die.
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Affiliation(s)
- Heather Hartley
- a School of Nursing, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
| | - David Kenneth Wright
- a School of Nursing, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
| | | | - Pamela Grassau
- b Bruyère Research Institute , Ottawa , Ontario , Canada
| | - Mary Ann Murray
- a School of Nursing, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
- c The Ottawa Hospital , Ottawa , Ontario , Canada
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Manomenidis G, Panagopoulou E, Montgomery A. Resilience in nursing: The role of internal and external factors. J Nurs Manag 2018; 27:172-178. [DOI: 10.1111/jonm.12662] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/21/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Georgios Manomenidis
- Primary Health Care Lab, General Practice and Health Research, Department of Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Efharis Panagopoulou
- Primary Health Care Lab, General Practice and Health Research, Department of Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Anthony Montgomery
- Department of Educational and Social Policy; University of Macedonia; Thessaloniki Greece
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Sherwood G, Koshy Cherian U, Horton-Deutsch S, Kitzmiller R, Smith-Miller C. Reflective practices: meaningful recognition for healthy work environments. Nurs Manag (Harrow) 2018; 24:30-34. [PMID: 29469246 DOI: 10.7748/nm.2018.e1684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/09/2022]
Abstract
Nurses' decisions about their intent to remain in the workforce are based on various factors. A healthy work environment in which work done well is recognised and appreciated contributes to nurses' satisfaction and better patient outcomes. This article examines the American Association of Critical-Care Nurses framework for a healthy work environment, focusing on standards for meaningful recognition. Reflective practice, which provides a self-analytical approach to appreciate and value one's work, is viewed as self-recognition. Neither boastful nor arrogant, reflective self-recognition is part of progression to professional maturity. It involves examining events at work continuously and systematically to learn, appreciate and move to higher levels of contribution in the workplace.
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Affiliation(s)
- Gwen Sherwood
- University of North Carolina at Chapel Hill, Chapel Hill NC, United States
| | - Usha Koshy Cherian
- Medicine intensive care unit/step down unit/cardiac care unit, Dorn VA Medical Center, Columbia SC, United States
| | | | - Rebecca Kitzmiller
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill NC, United States
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Vaclavik E, Staffileno B, Carlson E. Moral Distress: Using Mindfulness-Based Stress Reduction Interventions to Decrease Nurse Perceptions of Distress. Clin J Oncol Nurs 2018; 22:326-332. [DOI: 10.1188/18.cjon.326-332] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wan Q, Zhou W, Li Z, Shang S, Yu F. Work engagement and its predictors in registered nurses: A cross-sectional design. Nurs Health Sci 2018; 20:415-421. [PMID: 29682890 DOI: 10.1111/nhs.12424] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/05/2018] [Accepted: 02/20/2018] [Indexed: 11/27/2022]
Abstract
Nurses are key staff members of health-care organizations. Nurse engagement directly influences quality of care and organizational performance. The purpose of the present study was to understand the state of work engagement and explore its predictors among registered nurses in China by using a descriptive, cross-sectional survey design (n = 1065). Work engagement was measured with the Chinese version of the Utrecht Work Engagement Scale. The results showed that the average work engagement of Chinese nurses was 3.54 (standard deviation = 1.49), and that nurses' age (β = .16, t = 5.32), job characteristics (β = .33, t = 9.43), and practice environment (β = .23, t = 6.59) were significant predictors of work engagement. Thus, nurse leaders should be encouraged to shape motivational job characteristics and create supportive practice environment so as to increase nurses' work engagement.
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Affiliation(s)
- Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| | - Weijiao Zhou
- School of Nursing, Peking University, Beijing, China
| | - Zhaoyang Li
- School of Nursing, Peking University, Beijing, China
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China
| | - Fang Yu
- School of Nursing, University of Minnesota, St Paul, Minnesota, USA
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Simmons AM, Rivers FM, Gordon S, Yoder LH. The Role of Spirituality Among Military En Route Care Nurses: Source of Strength or Moral Injury? Crit Care Nurse 2018; 38:61-67. [DOI: 10.4037/ccn2018674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND
Military nurses provide care to seriously injured service members in flight, on the ground, or at sea during transport from the point of injury to a facility capable of providing higher levels of care. From this experience nurses are at increased risk of developing negative behavioral health symptoms. Spirituality, a belief in someone or something greater than oneself, could provide behavioral health support for military nurses who serve in this role.
OBJECTIVE
To determine the impact of spirituality on the behavioral health of nurses who provided en route care while deployed to Iraq or Afghanistan.
METHODS
This exploratory mixed-methods study used 5 instruments to determine levels of anxiety, depression, posttraumatic stress, posttraumatic growth, and resilience among 119 military nurses. Interviews provided rich data about the experiences of these nurses and extended quantitative outcomes.
RESULTS
Posttraumatic Growth Inventory findings showed no significant change in spirituality based on deployment experiences (mean, 3.07; SD, 3.26). However, interviews revealed that spirituality served as a buffer against developing behavioral health issues. Many relied on spirituality to get them through difficult experiences. There was also a sense of moral injury as a few expressed regrets for things they witnessed or experienced.
CONCLUSIONS
Spirituality can insulate military nurses from negative behavioral health symptoms. Nurses included in the study relied on their spirituality to stay mentally fit. For nurses who experienced moral injury, supervisory recognition of this and appropriate referral may decrease the long-term effects of deployment on their behavioral health.
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Affiliation(s)
- Angela M. Simmons
- COL Angela M. Simmons, ANC, USA, serves at Madigan Army Medical Center. She is the chief of the Center for Nursing Science and Clinical Inquiry
| | - Felecia M. Rivers
- LTC (Ret) Felecia M. Rivers, ANC, USA, is chief of the Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center
| | - Sandi Gordon
- Sandi Gordon is a senior leadership consultant at Gordon Executive Coaching Group, LLC, in Austin, Texas
| | - Linda H. Yoder
- COL (Ret) Linda H. Yoder, ANC, USA, serves as an associate professor at the University of Texas at Austin School of Nursing, Austin Texas
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Loss of Magnet® Designation and Changes in RN Work Engagement: A Report on How 1 Hospital's Culture Changed Over Time. J Nurs Adm 2017; 47:491-496. [PMID: 28957866 DOI: 10.1097/nna.0000000000000520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the loss of Magnet® designation and how RNs' work engagement changed at 1 community hospital. BACKGROUND The importance of RN work engagement to promote quality and safety is widely recognized in healthcare. Ongoing consistent research is critical to determine what organizational structures are needed to support RN work engagement. METHODS This was a comparative, descriptive, correlational study of RN cohorts at 2 time points: time 1 (T1), in 2011 during Magnet designation (n = 119), and time 2 (T2), in 2016, approximately 2 years after the loss of Magnet designation (n = 140). RESULTS The cohort of RNs at T2 reported significantly lower work engagement in the time period after the loss of Magnet designation when compared with the RN cohort at T1 during Magnet designation (P ≤ .0002). CONCLUSION These results provide insights for clinical leaders striving to support a culture of RN work engagement and quality care.
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Abstract
BACKGROUND The survival rate for infants born with life-threatening problems has improved greatly over the last few decades. Nevertheless, infants still die in neonatal intensive care units (NICUs) every day. Despite existing standards of care, some aspects of end-of-life care (EOLC) are still not delivered consistently. Little is known about how NICU nurses' individual experiences affect EOLC. PURPOSE The purpose of this study was to explore, through lived and told stories, the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Coping strategies and changes in practice were also explored. METHODS Thirty-six members of the National Association of Neonatal Nurses submitted written narratives about an EOLC experience during which the nurse experienced strong emotions. FINDINGS Narrative analysis revealed many affective responses, but 3 were the most frequent: responsibility, moral distress, and identification. Coping methods included healthy and less healthy strategies, such as colleague support, informal and formal debriefing, practicing intentional gratefulness, avoidance, and compartmentalization. Changes in practice identified were universally described as professional growth through the use of reflective practice. IMPLICATIONS FOR PRACTICE & RESEARCH Educators should discuss the range of emotions experienced by caregivers related to EOLC and healthy coping strategies and encourage the use of reflective practice as a facilitator of professional growth. Nurse leaders should promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Future research should focus on formulating interventions to utilize debriefing with NICU nurses and perhaps the development of EOLC mentors.
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Abstract
: Moral distress is a pervasive problem in the nursing profession. An inability to act in alignment with one's moral values is detrimental not only to the nurse's well-being but also to patient care and clinical practice as a whole. Moral distress has typically been seen as characterized by powerlessness and victimization; we offer an alternate view. Ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience. This article outlines the concept and prevalence of moral distress, describes its impact and precipitating factors, and discusses promising practices and interventions.
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Guo YF, Cross W, Plummer V, Lam L, Luo YH, Zhang JP. Exploring resilience in Chinese nurses: a cross-sectional study. J Nurs Manag 2017; 25:223-230. [DOI: 10.1111/jonm.12457] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Yu-Fang Guo
- Nursing Psychology Research Center of Xiangya Nursing School; Central South University; Changsha Hunan China
| | - Wendy Cross
- School of Nursing and Midwifery; Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Virginia Plummer
- School of Nursing and Midwifery; Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Louisa Lam
- School of Nursing and Midwifery; Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Yuan-Hui Luo
- Nursing Psychology Research Center of Xiangya Nursing School; Central South University; Changsha Hunan China
| | - Jing-Ping Zhang
- Nursing Psychology Research Center of Xiangya Nursing School; Central South University; Changsha Hunan China
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Wheeler PL, Butell SS, Epeneter BJ, Langford CA, Taylor JD. Storytelling: A Guided Reflection Activity. J Nurs Educ 2017; 55:172-6. [PMID: 26926220 DOI: 10.3928/01484834-20160216-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/05/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reflective practice is a mode of inquiry in the authors' baccalaureate nursing program. To increase students' ability to "think like a nurse," the Reflective Practice Storytelling Guide was developed to facilitate discussion during weekly clinical seminars in the students' final clinical course. METHOD To evaluate the effectiveness of this guided activity, students were asked to provide feedback to specific questions following each seminar when the reflective presence activity was utilized. RESULTS Common themes emerged from the storytellers and the members of the group. Themes identified in the responses of the storytellers included role development and formation and the value of team support. Learning themes that emerged from the participants included communication, teamwork, clinical judgment, patient-centered care, use of resources, ethical and legal parameters in practice, and patient safety. CONCLUSION Utilizing a guided reflection activity resulted in the students experiencing a broader, deeper understanding of reflective professional practice.
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Bøgeskov BO, Rasmussen LD, Weinreich E. Between meaning and duty - leaders’ uses and misuses of ethical arguments in generating engagement. J Nurs Manag 2016; 25:129-138. [DOI: 10.1111/jonm.12449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Elvi Weinreich
- Department of Nursing Education; University College UCC; Denmark
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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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Abstract
Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.
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Keyko K, Cummings GG, Yonge O, Wong CA. Work engagement in professional nursing practice: A systematic review. Int J Nurs Stud 2016; 61:142-64. [DOI: 10.1016/j.ijnurstu.2016.06.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
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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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Prentice T, Janvier A, Gillam L, Davis PG. Moral distress within neonatal and paediatric intensive care units: a systematic review. Arch Dis Child 2016; 101:701-8. [PMID: 26801075 DOI: 10.1136/archdischild-2015-309410] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/09/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs). DESIGN Pubmed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus were searched using the terms neonat*, infant*, pediatric*, prematur* or preterm AND (moral distress OR moral responsibility OR moral dilemma OR conscience OR ethical confrontation) AND intensive care. RESULTS 13 studies on moral distress published between January 1985 and March 2015 met our inclusion criteria. Fewer than half of those studies (6) were multidisciplinary, with a predominance of nursing staff responses across all studies. The most common themes identified were overly 'burdensome' and disproportionate use of technology perceived not to be in a patient's best interest, and powerlessness to act. Concepts of moral distress are expressed differently within nursing and medical literature. In nursing literature, nurses are often portrayed as victims, with physicians seen as the perpetrators instigating 'aggressive care'. Within medical literature moral distress is described in terms of dilemmas or ethical confrontations. CONCLUSIONS Moral distress affects the care of patients in the NICU and PICU. Empirical data on multidisciplinary populations remain sparse, with inconsistent definitions and predominantly small sample sizes limiting generalisability of studies. Longitudinal data reflecting the views of all stakeholders, including parents, are required.
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Affiliation(s)
- Trisha Prentice
- Neonatal Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Annie Janvier
- Division of Neonatology and Clinical Ethics, University of Montreal, Montreal, Quebec, Canada
| | - Lynn Gillam
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter G Davis
- Department of Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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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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Dyo M, Kalowes P, Devries J. Moral distress and intention to leave: A comparison of adult and paediatric nurses by hospital setting. Intensive Crit Care Nurs 2016; 36:42-8. [PMID: 27209561 DOI: 10.1016/j.iccn.2016.04.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess moral distress intensity and frequency in adult/paediatric nurses in critical care and non-critical care units; and explore relationships of nurse characteristics and moral distress with intention to leave. METHODS/SETTING A descriptive, correlational design was used to administer an online survey using the Moral Distress Scale to nurses across multiple settings. MAIN OUTCOME MEASURES Intensity and frequency of moral distress and intention to leave current position. RESULTS The survey response rate was 43% (n=426/1000). Critical care nurses had the highest levels of moral distress intensity and frequency, compared to non-critical care specialties (M=2.5±0.19, p=0.005 for intensity and M=1.6±0.11, p<0.001 for frequency). Moral distress frequency showed a positive relationship with intention to leave a position of employment. Each unit increase in moral distress frequency doubled the odds of intention to leave when adjusting for age, gender, ethnicity and specialty area (p=0.003). Hispanic nurses had significantly higher levels of moral distress intensity (p=0.01). CONCLUSION Moral distress is a complex phenomenon requiring further study, particularly with regard to the role of ethnic and cultural differences on perceptions of moral distress.
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Affiliation(s)
- Melissa Dyo
- School of Nursing, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, United States.
| | - Peggy Kalowes
- Long Beach Memorial, 2801 Atlantic Avenue, Long Beach, CA 90806, United States
| | - Jessica Devries
- Long Beach Memorial, 2801 Atlantic Avenue, Long Beach, CA 90806, United States
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Goulet MH, Larue C, Alderson M. Reflective Practice: A Comparative Dimensional Analysis of the Concept in Nursing and Education Studies. Nurs Forum 2016; 51:139-150. [PMID: 25639655 DOI: 10.1111/nuf.12129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM This paper reports on an analysis of the concept of reflective practice. BACKGROUND Reflective practice, a concept borrowed from the field of education, is widely used in nursing. However, to date, no study has explored whether this appropriation has resulted in a definition of the concept specific to the nursing discipline. DATA SOURCES A sample comprised of 42 articles in the field of nursing drawn from the CINAHL database and 35 articles in education from the ERIC database (1989-2013) was analyzed. REVIEW METHOD A concept analysis using the method proposed by Bowers and Schatzman was conducted to explore the differing meanings of reflective practice in nursing and education. RESULTS In nursing, the dimensions of the concept differ depending on context. In the clinical context, the dimensions may be summarized as theory-practice gap, development, and caring; in training, as learning, guided process, and development; and in research, as knowledge, method, and social change. In education, the concept is also used in the contexts of training (the dimensions being development, deliberate review, emotions, and evaluation) and research (knowledge, temporal distance, and method). The humanist dimension in nursing thus reflects a use of the concept more specific to the discipline. CONCLUSION The concept analysis helped clarify the meaning of reflective practice in nursing and its specific use in the discipline. This observation leads to a consideration of how the concept has developed since its appropriation by nursing; the adoption of a terminology particular to nursing may well be worth contemplating.
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Affiliation(s)
- Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, Centre de Recherche de l'Institut Universitaire de Santé Mentale de Montréal (CRIUSMM), Montreal, Quebec, Canada
| | - Caroline Larue
- Faculty of Nursing, Université de Montréal, CRIUSMM, Montreal, Quebec, Canada
| | - Marie Alderson
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
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