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Tao H, Anderson G, Harris S, Sawyer A, Bailey A, Robinson P. Development and validation of the Moral Injury Symptom Scale - Clinician Version - Short Form (MISS-CV-SF). Contemp Nurse 2024; 60:438-451. [PMID: 38885130 DOI: 10.1080/10376178.2024.2366915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy. OBJECTIVE To develop the Moral Injury Symptom Scale - Clinician-Short Form and validate it among United States based acute care nurses. . METHODS The Moral Injury Symptom Scale - Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve. RESULTS Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. . CONCLUSIONS The Moral Injury Symptom Scale - Clinician Version - Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations. .
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van Schaik M, Pasman HRR, Widdershoven GA, De Snoo-Trimp J, Metselaar S. Effectiveness of CURA: Healthcare professionals' moral resilience and moral competences. Nurs Ethics 2024; 31:1140-1155. [PMID: 38031920 DOI: 10.1177/09697330231218344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences.Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences.Design: Single group pre-/post-test design with two questionnaires.Methods: Questionnaires used were the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist.Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents.Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales.Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice.
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Affiliation(s)
- Malene van Schaik
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Roeline Rw Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guy Am Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Janine De Snoo-Trimp
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Sexton JR, Truog AW, Kelly-Weeder S, Loftin C. The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses. J Emerg Nurs 2024; 50:626-634. [PMID: 38300203 DOI: 10.1016/j.jen.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. METHODS A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. RESULTS Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DISCUSSION Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.
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Kovanci MS, Atli Özbaş A. Moral resilience and intention to leave: Mediating effect of moral distress. Nurs Ethics 2024:9697330241272882. [PMID: 39133181 DOI: 10.1177/09697330241272882] [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: 08/13/2024]
Abstract
AIMS This study aims to examine the mediating effect of moral distress on the relationship between moral resilience and the intention to leave. BACKGROUND Moral distress is a phenomenon that negatively impacts healthcare workers, healthcare institutions, and recipients. To eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience is important in protecting against the negative effects of moral distress, such as burnout and turnover intention. In this direction, it is necessary to increase the moral resilience of nurses to reduce negative situations such as turnover intention in nurses. METHODS It is a descriptive-predictive study. Sociodemographic Information Form, Measure of Moral Distress - Healthcare Professionals, and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 220 clinical nurses were recruited. ETHICAL CONSIDERATIONS Approval was obtained from the university's non-interventional ethics committee, and informed consent was obtained from the participants. RESULTS The study found a total moral distress score of 6.39 ± 0.3.12 and moral resilience score of 2.69 ± 0.48. A moderate and weak negative correlation was found between moral distress and moral resilience. Moral distress has a moderating effect on the intention to leave nursing (β = -0.158, p = .010) and the intention to leave the current position (β = -0.174, p = .000). Individual's moral resilience directly affects the intention to leave. The presence of moral distress eliminates the direct effect of moral resilience and affects the intention to leave together with moral resilience. CONCLUSIONS Moral resilience leads to decreased intention to leave, and moral distress mediates this situation. An increase in moral distress decreases moral resilience and increases intention to leave. It can be assumed that if moral distress is not controlled, increasing moral resilience will not affect the intention to leave the job.
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Brewer K, Ziegler H, Kurdian S, Nguyen J. Relationships of individual and workplace characteristics With nurses' moral resilience. Nurs Ethics 2024; 31:432-442. [PMID: 37243604 DOI: 10.1177/09697330231161692] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Moral resilience is the integrity and emotional strength to remain buoyant and achieve moral growth amid distressing situations. Evidence is still emerging on how to best cultivate moral resilience. Few studies have examined the predictive relationship of workplace well-being and of organizational factors with moral resilience. RESEARCH AIMS The aims are to examine associations of workplace well-being (i.e., compassion satisfaction, burnout, and secondary traumatic stress) and moral resilience, and to examine associations of workplace factors (i.e., authentic leadership and perceived congruence of organizational mission and behaviors) and moral resilience. RESEARCH DESIGN This study uses a cross-sectional design. PARTICIPANTS AND RESEARCH CONTEXT Nurses practicing in a hospital in the United States were surveyed using validated instruments (N = 147). Individual factors were measured using demographics and the Professional Quality of Life Scale. Organizational factors were measured using the Authentic Leadership Questionnaire and a single item measuring organizational mission/behavior congruence. Moral resilience was measured using the Rushton Moral Resilience Scale. ETHICAL CONSIDERATIONS The study was approved by an institutional review board. FINDINGS Resilience was noted to have significant small correlations with burnout, secondary traumatic stress, compassion satisfaction, and organizational mission/behavior congruence. Burnout and secondary traumatic stress predicted less resilience, whereas compassion satisfaction and perceived congruence between organizational mission and behaviors predicted higher resilience. DISCUSSION Burnout and secondary traumatic stress, increasingly experienced by nurses and other health professionals, have negative effects on moral resilience. Compassion satisfaction can increase resilience, which is especially important in nursing. Organizational practices promoting integrity and confidence can have positive effects on resilience. CONCLUSIONS Continued work to confront workplace well-being issues, especially burnout, is needed as a way of increasing moral resilience. Studies of organizational and work environment factors to bolster resilience are likewise needed to assist organizational leaders in devising the best strategies.
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Chen X, Zhang Y, Zheng R, Hong W, Zhang J. Latent profiles of nurses' moral resilience and compassion fatigue. Nurs Ethics 2024; 31:635-651. [PMID: 38148631 DOI: 10.1177/09697330231222594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Compassion fatigue is often associated with moral distress in the nursing practice among registered nurses. Moral resilience is an important ability to maintain, restore, or promote their physical and mental health in response to ethical dilemmas in nursing. Moral resilience can be utilized as a potential solution to aid registered nurses in effectively managing compassion fatigue. AIM To identify latent profiles of moral resilience among registered nurses and to explore the relationships of these profiles with compassion fatigue. RESEARCH DESIGN From August 2022 to December 2022, 569 nurses were recruited in two general hospitals, in China. A Rushton Moral Resilience Scale and the Chinese version of Compassion Fatigue-Short Scale were given to the participants. A latent profile analysis was conducted to explore moral resilience latent profiles. Predictors of profiles membership was evaluated using multinomial logistic regression analysis, and the compassion fatigue scores of each latent profile were compared using a one-way analysis of variance. ETHICAL CONSIDERATIONS We obtained ethical approval from the Institution Review Board of Xiangya School of Nursing, Central South University (IRB No. E202293, approved 15/July/2022). RESULTS A four-profile moral resilience model best fit the data. Different levels and shapes differentiated the four profiles: high moral resilience (28.7%), moderate moral resilience (52.3%), low responses and high efficacy (16.2%), and low moral resilience (2.8%). Nurses with bachelor's degrees were more likely to belong to the high moral resilience (OR = 0.118, p = .038) and moderate moral resilience (OR = 0.248, p = .045); Nurses who were divorced or separated (OR = 11.746, p = .025) and very dissatisfied with their work (OR = 0.001, p = .049) were more probably belonging to low moral resilience. Nurses who had received ethical training in the hospital were more likely involved in high moral resilience (OR = 5.129, p = .003) and low responses and high efficacy (OR = 5.129, p = .003). In each profile of moral resilience, compassion fatigue was experienced differently by the participants (F = 13.05, p < .001). CONCLUSIONS Developing and implementing interventions tailored to each nurse's moral resilience profile would maximize interventions' effectiveness and reduce nurses' compassion fatigue.
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Affiliation(s)
- Xuelei Chen
- Central South University
- Guilin Medical University
| | | | | | - Wei Hong
- The Second Affiliated Hospital of Guilin Medical University
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Mũrage A, Morgan R, Samji H, Smith J. Gendered and racial experiences of moral distress: A scoping review. J Adv Nurs 2024; 80:1283-1298. [PMID: 37849045 DOI: 10.1111/jan.15901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research. DESIGN Scoping review. METHODS The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted. DATA SOURCES Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022. RESULTS After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals. IMPACT This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings. CONCLUSION There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Alice Mũrage
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
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Tian X, He Q, Liu X, Gan X, Jiménez Herrera MF. Moral resilience in registered nurses: Cultural adaption and validation study. Nurs Ethics 2024; 31:355-370. [PMID: 37726157 DOI: 10.1177/09697330231196229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Healthcare professionals, especially professional nurses, experience various types of moral suffering due to inevitable ethical conflicts. Moral resilience is recently proposed as a resource to address moral suffering. However, there is no tool to measure moral resilience in Chinese professional nurses. AIM This study aimed to translate the Rushton Moral Resilience Scale (RMRS) into Chinese and evaluate the psychometric properties of the Chinese version of RMRS (Chi-RMRS). RESEARCH DESIGN A methodological and descriptive research design. PARTICIPANTS AND RESEARCH CONTEXT A convenience sample of 411 Chinese professional nurses was recruited through an online survey platform between February and March 2023. ETHICAL CONSIDERATIONS This study was approved by the Research Ethics Committees of the University and hospitals involved. RESULTS The RMRS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level content validity index (CVI) was 0.922 with the item-level CVIs ranging from 0.833 to 1.000. The explanatory factor analysis (EFA) generated a three-factor structure for the Chi-RMRS, and the confirmatory factor analysis (CFA) demonstrated the three-factor structure with factor loadings for each item ranging from 0.42 to 0.80. The scale-level Cronbach's α coefficient was 0.811 with each dimension ranging from 0.717 to 0.821, and composite reliability (CR) coefficient for the overall scale was 0.920, with each dimension varying from 0.739 to 0.824. The standard error of measurement (SEM) and smallest detectable change (SDC) were 3.522 and 9.763, respectively. DISCUSSION The Chi-RMRS is able to measure moral resilience of Chinese professional nurses, and has good validity and reliability. It can be used in research and practice to determine the level of moral resilience, thus helping nursing managers to monitor the status of Chinese professional nurses, then develop interventions to maintain the well-being of professional nurses and to ensure quality of care.
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Affiliation(s)
- Xu Tian
- Universitat Rovira I Virgili; Chongqing Traditional Chinese Medicine Hospital
| | | | | | - Xiuni Gan
- The Second Affiliated Hospital of Chongqing Medical University
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Rushton CH, Hanson GC, Boyce D, Holtz H, Nelson KE, Spilg EG, Robillard R. Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers. J Adv Nurs 2024; 80:1177-1187. [PMID: 37772644 DOI: 10.1111/jan.15873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023]
Abstract
AIM To refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity. BACKGROUND Healthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues. Moral resilience is a resource that may mitigate negative consequences. To better understand mechanisms for doing so, a valid and reliable measurement tool is necessary. DESIGN Cross-sectional survey. METHODS Participants (N = 1297) had completed ≥1 items on the RMRS as part of the baseline survey of a larger longitudinal study. Item analysis, confirmatory factor analyses, reliability analyses (Cronbach's alpha), and correlations were used to establish reliability and validity of the revised RMRS. RESULTS Item and confirmatory factor analysis were used to refine the RMRS from 21 to 16 items. The four-factor structure (responses to moral adversity, personal integrity, relational integrity and moral efficacy) demonstrated adequate fit in follow-up confirmatory analyses in the initial and hold-out sub-samples. All subscales and the total scale had adequate reliabilities (α ≥ 0.70). A higher-order factor analysis supports the computation of either subscale scores or a total scale score. Correlations of scores with stress, anxiety, depression and moral distress provide evidence of the scale's validity. Reliability of the personal integrity subscale improved. CONCLUSION AND IMPLICATIONS The RMRS-16 demonstrates adequate reliability and validity, particularly the personal integrity subscale. Moral resilience is an important lever for reducing consequences when confronted with ethical challenges in practice. Improved reliability of the four subscales and having a shorter overall scale allow for targeted application and will facilitate further research and intervention development. PATIENT/PUBLIC CONTRIBUTION Data came from a larger study of Canadian healthcare workers from multiple healthcare organizations who completed a survey about their experiences during COVID-19.
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Affiliation(s)
- Cynda H Rushton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ginger C Hanson
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle Boyce
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heidi Holtz
- School of Nursing, Barnes College of Nursing, St. Louis, Missouri, USA
| | - Katie E Nelson
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edward G Spilg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Yu Q, Huang C, Yan J, Yue L, Tian Y, Yang J, Li X, Li Y, Qin Y. Ethical climate, moral resilience, and ethical competence of head nurses. Nurs Ethics 2024:9697330241230526. [PMID: 38317573 DOI: 10.1177/09697330241230526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual's ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them. OBJECTIVES To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses. DESIGN A quantitative, cross-sectional study. METHODS A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson's correlation and a structural equation model. ETHICAL CONSIDERATIONS This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146). RESULTS Head nurses' ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience. CONCLUSION This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuelan Qin
- The First Affiliated Hospital of Hunan Normal University
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Galanis P, Moisoglou I, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Kaitelidou D. Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era. NURSING REPORTS 2024; 14:254-266. [PMID: 38391065 PMCID: PMC10885038 DOI: 10.3390/nursrep14010020] [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: 12/17/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioannis Moisoglou
- Department of Nursing, University of Thessaly, 41500 Larissa, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children's Hospital, 11527 Athens, Greece
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Stanley MJ, Logan RI. Moral Resilience and Race, Ethnicity, and Culture Within Healthcare Workers During the COVID-19 Pandemic in the USA: a Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01911-7. [PMID: 38261163 DOI: 10.1007/s40615-024-01911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/15/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
The COVID-19 pandemic has and continues to impact the world affecting all aspects of life. Healthcare workers have been hit especially hard and, in many cases, experience negative impacts not only on their physical health but also on their mental and emotional well-being. Additionally, the COVID-19 pandemic has not affected populations equally and this is true in the USA, including healthcare workers. However, these workers have also persevered, drawing on moral resilience to push through challenging situations throughout this pandemic. In this scoping review, we analyzed studies to assess the role of race, ethnicity, and/or culture on the moral resilience of healthcare workers throughout the COVID-19 pandemic. Our aim was to understand the research that has assessed these potential connections and determine best practices for building moral resilience in the face of this global catastrophe. Fourteen articles met inclusion criteria and were analyzed in this review. Following a thematic analysis, several themes emerged including (1) moral resilience and the COVID-19 pandemic; (2) race, ethnicity, and culture among healthcare workers; and (3) building moral resilience. In sum, the findings from the literature indicate a paucity of studies that analyze the role played by race, ethnicity, and/or culture in connection to moral resilience during the COVID-19 pandemic.
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Affiliation(s)
- Mary Jo Stanley
- Department of Health Science, Colorado Mesa University, Grand Junction, CO, USA.
| | - Ryan I Logan
- Department of Anthropology and Geography & Environmental Resources, California State University, Stanislaus, Turlock, CA, USA
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Berdida DJE, Grande RAN. Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis. JOURNAL OF RELIGION AND HEALTH 2023; 62:3957-3978. [PMID: 37442900 DOI: 10.1007/s10943-023-01873-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.
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Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, St. Martin de Porres Bldg., España Boulevard, 1015, Manila, Philippines.
| | - Rizal Angelo N Grande
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il, 55473, Kingdom of Saudi Arabia
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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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Rink LC, Silva SG, Adair KC, Oyesanya TO, Humphreys JC, Sexton JB. Characterizing burnout and resilience among nurses: A latent profile analysis of emotional exhaustion, emotional thriving and emotional recovery. Nurs Open 2023; 10:7279-7291. [PMID: 37661657 PMCID: PMC10563410 DOI: 10.1002/nop2.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
AIMS To identify subgroups of nurses with distinct profiles of burnout (emotional exhaustion) and resilience (emotional thriving and emotional recovery) and describe nurse characteristics associated with each profile. DESIGN Cross-sectional, correlational design. METHODS Data were collected via electronic survey from 2018 to 2019. Latent profile analysis was used to identify subgroups of nurses with distinct profiles of emotional exhaustion, emotional thriving and emotional recovery, with each measured on a 0-100 scale. Bivariate statistics were used to determine profile differences in nurse sociodemographic, professional and psychological characteristics. RESULTS Four distinct profile subgroups were identified: (1) "exhausted" (14% with very high emotional exhaustion, low emotional thriving and moderate emotional recovery), (2) "exhausted with thriving" (6% with high emotional exhaustion, moderate-high emotional thriving and low emotional recovery), (3) "exhausted with thriving and recovery" (52% with moderate-high emotional exhaustion, emotional thriving and emotional recovery), and (4) "thriving and recovery" (27% with low emotional exhaustion and very high emotional thriving and emotional recovery). Nurses in the "exhausted" and "exhausted with thriving" profiles reported greater depression and poorer work-life integration. Nurses in "exhausted" profile were more likely to work in an inpatient setting. Nurses in the "exhausted with thriving and recovery" and "thriving and recovery" profiles reported more positive emotions, more well-being behaviours, and better work-life integration, with the "thriving and recovery" subgroup having the highest levels of these characteristics, lower depression scores and greater racial minority representation. CONCLUSION Approaches designed to improve nurse well-being should be tailored to the nurses' profile of emotional exhaustion, thriving and recovery to maximize effectiveness. IMPACT Given the growing shortage of nurses in healthcare systems, it is critical that multilevel strategies be investigated to retain nursing staff that consider the intersectionality and complexity of the different aspects of burnout and resilience experienced by the nurse. NO PATIENT OR PUBLIC CONTRIBUTION The aim was to assess burnout and resilience among nurses.
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Affiliation(s)
- Lesley C. Rink
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
| | - Susan G. Silva
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
| | - Kathryn C. Adair
- Duke Center for Healthcare Safety and QualityDuke University Health SystemDurhamNorth CarolinaUSA
- Duke University School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Tolu O. Oyesanya
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
| | | | - John Bryan Sexton
- Duke Center for Healthcare Safety and QualityDuke University Health SystemDurhamNorth CarolinaUSA
- Duke University School of MedicineDuke UniversityDurhamNorth CarolinaUSA
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16
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Whitehead IO, Moffatt S, Warwick S, Spiers GF, Kunonga TP, Tang E, Hanratty B. Systematic review of the relationship between burn-out and spiritual health in doctors. BMJ Open 2023; 13:e068402. [PMID: 37553194 PMCID: PMC10414094 DOI: 10.1136/bmjopen-2022-068402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To investigate the relationship between burn-out and spiritual health among medical doctors. DESIGN Systematic literature review and narrative synthesis of cross-sectional studies. SETTING Any setting, worldwide. DATA SOURCES Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science. ELIGIBILITY CRITERIA Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors. DATA EXTRACTION AND SYNTHESIS All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis. RESULTS Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias. CONCLUSIONS Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions. PROSPERO REGISTRATION NUMBER CRD42020200145.
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Affiliation(s)
| | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Warwick
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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17
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Metselaar S, Molewijk B. Fostering moral resilience through moral case deliberation. Nurs Ethics 2023; 30:730-745. [PMID: 37946387 DOI: 10.1177/09697330231183085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics consultation has been proposed as such an intervention. In this paper, we add to this proposition by discussing Moral Case Deliberation (MCD) as a specific form of clinical ethics support that promotes moral resilience. We argue that MCD in general may contribute to the moral resilience of healthcare professionals as it promotes moral agency. In addition, we focus on three specific MCD reflection methods: the Dilemma Method, the Aristotelian moral inquiry into emotions, and CURA, a method consisting of four main steps: Concentrate, Unrush, Reflect, and Act. In practice, all three methods are used by nurse ethicists or by nurses who received training to facilitate reflection sessions with these methods. We maintain that these methods also have specific elements that promote moral resilience. However, the Dilemma Method fosters dealing well with tragedy, the latter two promote moral resilience by including attention to emotions as part of the reflection process. We will end with discussing the importance of future empirical research on the impact of MCD on moral resilience, and of comparing MCD with other interventions that seek to mitigate moral distress and promote moral resilience.
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Affiliation(s)
- Suzanne Metselaar
- Department of Ethics, Law, and Humanities, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands
| | - Bert Molewijk
- Department of Ethics, Law, and Humanities, Amsterdam University Medical Centers Location VUmc, Amsterdam, The Netherlands
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18
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Berdida DJE. The mediating roles of moral courage and moral resilience between nurses' moral distress and moral injury: An online cross-sectional study. Nurse Educ Pract 2023; 71:103730. [PMID: 37499534 DOI: 10.1016/j.nepr.2023.103730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
AIMS To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury. BACKGROUND There is a preponderance of nursing literature about moral distress, moral resilience, moral courage and moral injury. However, examining moral resilience and moral courage as mediators remain underreported during the COVID-19 pandemic and in the context of a developing nation. DESIGN Correlational, cross-sectional design compliant with the STROBE guidelines. METHODS A convenience sample of nurses (n = 412) from the Philippines were recruited using social media platforms (e.g., Facebook, Messenger, Twitter). Four self-report and validated scales (8-item Moral-Distress Appraisal Scale, 21-item Nurses' Moral Courage Scale, 17-item Rushton Moral Resilience Scale and 10-item Moral Injury Symptom Scale: Healthcare Professionals Version) were used to collect data from January to July 2022. Pearson's r, bivariate analysis and multistage regression analyses were used for data analysis. RESULTS This study afforded a model that depicted the interrelationships of moral distress, moral resilience, moral courage and moral injury. Moral distress has a negative impact on moral resilience and moral courage while positively affecting moral injury. Moral resilience positively influences moral courage while having a negative impact on moral injury. Moral courage has an indirect impact on moral injury. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. CONCLUSIONS Healthcare organizations, policymakers and nurse managers should include policies and programs that include improving approaches to modifying workplace conditions and evaluating nurses' moral resilience and courage. Nurse managers need to advocate ethics education and professionalism. Nurses must practice self-care strategies to strengthen morally resilient and courageous therapeutic practices.
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Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, Manila 1015, Philippines; College of Graduate Studies and Teacher Education Research (CGSTER), Philippine Normal University, Taft Ave., Manila 1000, Philippines.
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19
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Rushton CH. Transforming Moral Suffering by Cultivating Moral Resilience and Ethical Practice. Am J Crit Care 2023; 32:238-248. [PMID: 37391375 DOI: 10.4037/ajcc2023207] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Ethical challenges are inherent in nursing practice. They affect patients, families, teams, organizations, and nurses themselves. These challenges arise when there are competing core values or commitments and diverse views on how to balance or reconcile them. When ethical conflict, confusion, or uncertainty cannot be resolved, moral suffering ensues. The consequences of moral suffering in its many forms undermine safe, high-quality patient care, erode teamwork, and undermine well-being and integrity. My experience as a nurse in the pediatric intensive care unit and later as a clinical nurse specialist in confronting these moral and ethical challenges has been the foundation of my program of research. Together we will explore the evolution of our understanding of moral suffering-its expressions, meanings, and consequences and attempts to measure it. Moral distress, the most described form of moral suffering, took hold within nursing and slowly within other disciplines. After 3 decades of research documenting the existence of moral distress, there were few solutions. It was at this juncture that my work pivoted toward exploring the concept of moral resilience as a means for transforming but not eliminating moral suffering. The evolution of the concept, its components, a scale to measure it, and research findings will be explored. Throughout this journey, the interplay of moral resilience and a culture of ethical practice were highlighted and examined. Moral resilience is continuing to evolve in its application and relevance. Many vital lessons have been learned that can inform future research and guide interventions to harness the inherent capabilities of clinicians to restore or preserve their integrity and to engage in large-scale system transformation.
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Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics, Berman Institute of Bioethics, and a professor of nursing and pediatrics, Johns Hopkins University School of Nursing, Baltimore, Maryland
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20
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Nejat N, Rahbarian A, Shykhan R, Ebrahimpour S, Moslemi A, Khosravani M. Assessment of spiritual needs in cancer patients: A cross-sectional study. J Family Med Prim Care 2023; 12:894-901. [PMID: 37448916 PMCID: PMC10336942 DOI: 10.4103/jfmpc.jfmpc_989_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 08/27/2022] [Indexed: 07/18/2023] Open
Abstract
Introduction Addressing the spiritual needs of patients is an essential component of holistic care in nursing. Acknowledging the spiritual needs of cancer patients enhances the performance of clinical caregivers in providing quality services to such patients. Therefore, caregivers successfully fulfill or decrease the patients' needs and thus increase their adaptation to crises. Methods The present cross-sectional study was conducted to determine the spiritual needs of cancer patients. In this study, 96 cancer patients were selected from Ayatollah Khansari Hospital in Arak, Iran. The required data were collected through a demographic information form and the Persian version of the Spiritual Needs Questionnaire. Ethical Considerations Participants' verbal consent to participate in the study was obtained, and they were assured of anonymity and confidentiality. Results In the present study, the mean age of the participants was 47.82 ± 14.34 years. The frequency distribution of respondents by gender was 36 males (37.5%) and 60 females (62.5%). The mean scores of spiritual needs in the domains of religious needs, need for inner peace, existential needs, and need for giving/generativity were 12.03 ± 3.18, 7.26 ± 3.26, 4.61 ± 2.96, and 4.06 ± 2.32, respectively. The highest and lowest mean values were associated with religious needs and need for giving/generativity, respectively. Religious needs showed a significantly positive relationship with gender, occupation, and the type of treatment (P < 0.05). Moreover, a significant relationship was observed between the need for peace and level of education (P < 0.05). Conclusion The recognition of the spiritual needs of cancer patients is the first step in prioritizing and planning to provide spiritual care to these patients and supporting them in adapting to and coping with the disease. Therefore, nurses need to acquire the fundamental knowledge and skills required to identify these needs.
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Affiliation(s)
- Nazi Nejat
- PhD in Nursing, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Amir Rahbarian
- MSc of Medical-Surgical Nursing, Students of Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhane Shykhan
- PhD in Psychology, Department of Psychology, Faculty of Humanities, Arak Islamic Azad University, Arak, Iran
| | - Sobhan Ebrahimpour
- Master of Nursing Student, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Azam Moslemi
- PhD of Biostatistics, Department of Biostatistic, Faculty of Medical Sciences, Arak University of Medical Sciences, Arak, Iran
| | - Mahboobeh Khosravani
- MSc of Medical-Surgical Nursing, MSc of Social Sciences, Department of Surgical Technology, School of Allied Medical Sciences, Arak University of Medical, Arak, Iran
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21
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Jantara RD, Barlem JGT, Jantara A, Rocha LP, Rocha SSD, Stigger DADS. Analysis of moral courage and related factors among undergraduate nursing students: a scoping review. Rev Bras Enferm 2023; 76Suppl 3:e20220225. [PMID: 37042930 PMCID: PMC10084776 DOI: 10.1590/0034-7167-2022-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/10/2022] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE to analyze scientific evidence on moral courage and related factors among nursing undergraduate students. METHOD the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist. RESULTS a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field. FINAL CONSIDERATIONS few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.
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Affiliation(s)
| | | | - Adrieli Jantara
- Universidade Federal do Rio Grande. Rio Grande, Rio Grande do Sul, Brazil
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22
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Sgarlata S, Dłużewicz A, Napiwodzka K. Ars Moriendi. Ethical Challenges of the Ultimate Realities of Life. ETHICS IN PROGRESS 2022. [DOI: 10.14746/eip.2022.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The aim of this issue of Ethics in Progress is to provide a provisional, open-ended view on the ultimate realities of life and the ethical challenges they pose in medical, sociological, and existential contexts. The issue explores axiologies and meta-ethical narratives related to the art of dying, or in other words the moral domain encompassing the quest for a good life and a good death. Two problematic aspects emerge from the latest body of research: (1) the difficulty involved in tackling ethical challenges in medical and sociological contexts; and (2) the marginal role of the patient’s agency and narrative-ownership of end-of-life decision-making. A direction is pointed out that suggests that interventions across interdisciplinary groups involved in medical aid to dying should focus on promoting ethical behaviour on the side of healthcare personnel. Finally, attention to language, discourse, communication, and the narratives of death and dying call this edition of Ethics in Progress to examine the ontological and epistemological categories that underlie the study of lifeworlds and ‘discourse communities’, which are those associated with moral agents interlacing historical motives, language, communication, normative beliefs, social norms and roles, power relations, hard clinical evidence, and contested values in the context of medical practices and, broadly speaking, practices surrounding death.
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23
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Whitehead IO, Moffatt S, Jagger C, Hanratty B. A national study of burnout and spiritual health in UK general practitioners during the COVID-19 pandemic. PLoS One 2022; 17:e0276739. [PMID: 36322555 PMCID: PMC9629610 DOI: 10.1371/journal.pone.0276739] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To quantify the burnout and spiritual health of general practitioners (GPs) in the United Kingdom (UK) who worked during the Covid-19 Pandemic. DESIGN Online survey, April/May 2021, distributed via emails to general practices, Clinical Commissioning Groups (CCGs), Health boards, Clinical Research Networks, professional groups, social media GP groups and networks. SETTING United Kingdom. PARTICIPANTS 1318 GPs who had worked in the National Health Service (NHS) during the COVID-19 pandemic (March 2020 -May 2021). MAIN OUTCOME MEASURES Burnout scores, measured by the Maslach Burnout Inventory (MBI) for Medical Personnel; spiritual health, measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Non-Illness (FACIT-SP-NI). RESULTS 19% of surveyed GPs were at the highest risk for burnout, using accepted MBI 'cut off' levels. There was no evidence of a difference in burnout by gender, ethnicity, or length of service. GP burnout was associated with GP spiritual health, regardless of identification with a religion. GPs with low spiritual health were five times more likely to be in the highest risk group for burnout. CONCLUSIONS Burnout is at crisis levels amongst GPs in the UK NHS. A comprehensive response is required, identifying protective and precipitating factors for burnout. The potentially protective impact of spiritual health merits further investigation.
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Affiliation(s)
- Ishbel Orla Whitehead
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Suzanne Moffatt
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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24
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Rushton CH, Nelson KE, Antonsdottir I, Hanson GC, Boyce D. Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic: Secondary analysis. Nurs Manag (Harrow) 2022; 53:12-22. [PMID: 35776417 PMCID: PMC9245532 DOI: 10.1097/01.numa.0000834524.01865.cc] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It's crucial to understand the perspective of nurses during the pandemic to determine actionable steps for moving forward. This analysis looks at nurses' perceptions of their organizations' effectiveness during the first surge of the COVID-19 pandemic and its impact on moral injury and moral resilience.
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Affiliation(s)
- Cynda Hylton Rushton
- At Johns Hopkins University in Baltimore, Md., Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics, Nursing and Medicine at the Berman Institute of Bioethics & School of Nursing; Katie Nelson is a PhD candidate; Inga Antonsdottir is the program coordinator for the COVID Dementia Caregivers Supplement Project, and a graduate research assistant/coordinator for the Memory and Aging Services Innovation (MASI) Center in the Department of Psychiatry & Behavioral Sciences; Ginger C. Hanson is an assistant professor, and Danielle Boyce is an assistant professor, neurology
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25
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Yi LJ, Liu Y, Tang L, Cheng L, Wang GH, Hu SW, Liu XL, Tian X, Jiménez-Herrera MF. A Bibliometric Analysis of the Association Between Compassion Fatigue and Psychological Resilience From 2008 to 2021. Front Psychol 2022; 13:890327. [PMID: 35814110 PMCID: PMC9258720 DOI: 10.3389/fpsyg.2022.890327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Aims A negative association between the lower level of psychological resilience (PR) and increased risk of compassion fatigue (CF) and higher Coronavirus disease 2019 (COVID-19) stress has been revealed. However, bibliometric studies have not been performed to comprehensively investigate this topic. This study aimed to identify the status and trends in the CF and PR field from 2008 to 2021 and during the COVID-19 pandemic. Methods We identified relevant literature from the Web of Science Core Collection® database using "resilience" and "compassion fatigue" on September 30, 2021. All search results were exported in plain text format for collaboration network analysis, reference-based co-citation analysis, analysis of journals, and keywords-based co-occurrence analysis, which were performed using Citespace® 5.8.R1. Results A total of 388 publications were identified finally, and there has been an increasing trend in the annual number of publications with light fluctuations. The analysis of journals and keywords indicated that nurses and social workers are the main research targets, and their mental problems are the main research topics. The turnover intention of health care providers has been a research focus, particularly during the COVID-19. Conclusion The results of the present study help us understand the status of the CF and PR field and its recent developments.
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Affiliation(s)
- Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
- Department of Nursing, Universitat Rovira I Virgili, Tarragona, Spain
| | - Yi Liu
- Department of Physical Education, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Ling Tang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Liang Cheng
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Guo-Hao Wang
- Department of Management Engineering, Tangshan Industrial Vocational & Technical College, Tangshan, China
| | - Su-Wen Hu
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Xiao-Ling Liu
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Department of Ultrasound, Chongqing University Cancer Hospital, Chongqing, China
| | - Xu Tian
- Department of Nursing, Universitat Rovira I Virgili, Tarragona, Spain
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26
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Talebian F, Hosseinnataj A, Yaghoubi T. The Relationship between Resilience and Moral Distress among Iranian Critical Care Nurses: A Cross-sectional Correlational Study. Ethiop J Health Sci 2022; 32:405-412. [PMID: 35693570 PMCID: PMC9175217 DOI: 10.4314/ejhs.v32i2.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Critical care nurses usually experience high levels of moral distress due to the nature of their work. Resilience in critical care nurses can potentially facilitate effective adaptation to physical and emotional burden of caring for critically ill patients. The present study aimed to evaluate the relationship between resilience and moral distress among Iranian critical care nurses. Methods In this cross-sectional correlational study, 144 critical care nurses working in intensive care units (ICUs) of five teaching hospitals affiliated to Mazandaran University of Medical Sciences, were selected randomly, from July to October 2020. Data were collected using a 36-item moral distress questionnaire and a 25-item Connor-Davidson Resilience Scale (CD-RISC) questionnaire. Data were analyzed using independent t-test, ANOVA and Pearson correlation coefficient using SPSS 21 software. Results The mean score of moral distress in nurses was 66.93±2.47 and 95.8% of nurses had low-level moral distress. The mean score of resilience in nurses was 90.66±10.92 and 73.6% of nurses had high levels of resilience. There was a statistically significant relationship between the scores of moral distress and resilience. Also, there was a significant positive relationship between work experience and two subscales of resilience as "trust in individual instincts, tolerance of negative emotions" and "impact of spirituality" (p<0.001). Conclusion The results of the present study indicated a positive correlation between resilience and moral distress in nurses working in ICUs. It seems that when moral distress increases, critical care nurses increasingly use the mechanism of resilience for better permanence and active presence in the organization.
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Affiliation(s)
- Fateme Talebian
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Tahereh Yaghoubi
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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27
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Spilg EG, Rushton CH, Phillips JL, Kendzerska T, Saad M, Gifford W, Gautam M, Bhatla R, Edwards JD, Quilty L, Leveille C, Robillard R. The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatry 2022; 22:19. [PMID: 34991514 PMCID: PMC8734541 DOI: 10.1186/s12888-021-03637-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. METHODS A total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed. FINDINGS Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|]. INTERPRETATION Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.
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Affiliation(s)
- Edward G Spilg
- Department of Medicine, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
| | - Cynda Hylton Rushton
- Berman Institute of Bioethics & School of Nursing, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Jennifer L Phillips
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
- Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Tetyana Kendzerska
- Department of Medicine, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Mysa Saad
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
- Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Mamta Gautam
- Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Rajiv Bhatla
- Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Jodi D Edwards
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario, K1G 5Z3, Canada
| | - Lena Quilty
- Centre for Addiction and Mental Health, 1025 Queen Street, Toronto, Ontario, M6J 1H1, Canada
| | - Chloe Leveille
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Rebecca Robillard
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, Ontario, K1N 6N5, Canada
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