1
|
Oldenmenger WH, Berger E, Stoppelenburg A. The inner struggle of nurses, exploring moral distress among hospital nurses: A cross-sectional study. Int J Nurs Stud 2024; 158:104864. [PMID: 39094220 DOI: 10.1016/j.ijnurstu.2024.104864] [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: 02/09/2024] [Revised: 06/12/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND As frontline caregivers, nurses often find themselves at the crossroads of complex ethical decisions that can significantly impact patient outcomes and their own well-being. Identifying the areas of experienced moral dilemmas in the workplace and gaining insight into the prevalence of moral distress can lead to a healthier workplace environment. OBJECTIVE This study aims to examine the frequency, intensity and level of moral distress among nurses who work in a hospital, and to identify the variables associated with the level of moral distress. DESIGN Cross-sectional study. SETTING One university hospital and six general hospitals. PARTICIPANTS 654 of the 1095 nurses working on inpatient units filled out the questionnaire (response rate 60 %). METHODS The intensity and frequency of moral distress was assessed using the Moral Distress Scale-Revised (MDS-R). We also asked two additional questions about considering leaving their job, and if they could describe a distressing case and how moral distress was discussed. Multivariable regression analysis was conducted to identify the variables associated with the level of moral distress. RESULTS The overall mean MDS-R score of the 654 included nurses was low at 36.4 (SD 26). Nurses reported to have frequent dilemmas regarding organizational aspects and aspects of end-of-life care. The multivariable analyses showed that higher levels of moral distress were experienced by registered nurses, nurses working on a medical ward, and nurses who had ever left or considered leaving their job, or considering leaving their job at the moment. CONCLUSIONS Although nurses in our study experiences low levels of moral distress, they do experience moral dilemmas related to organizational topics and end of life care. We all need to pay attention to these dilemmas and how to discuss them in order to achieve a resilient nursing profession at a time of major nursing shortages. TWEETABLE ABSTRACT Caring for increasingly complex patients in a dynamic healthcare system is likely to continue to produce morally challenging scenarios.
Collapse
Affiliation(s)
- Wendy H Oldenmenger
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands.
| | - Elke Berger
- Franciscus Gasthuis & Vlietland, Franciscus Academy, Rotterdam, the Netherlands
| | - Arianne Stoppelenburg
- Erasmus MC, University Medical Center Rotterdam, Department Public Health, Rotterdam, the Netherlands
| |
Collapse
|
2
|
Salas-Bergüés V, Pereira-Sánchez M, Martín-Martín J, Olano-Lizarraga M. Development of burnout and moral distress in intensive care nurses: An integrative literature review. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00027-2. [PMID: 39025685 DOI: 10.1016/j.enfie.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/24/2024] [Indexed: 07/20/2024]
Abstract
AIMS To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress. METHODS An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality. RESULTS Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress. CONCLUSIONS This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.
Collapse
Affiliation(s)
- V Salas-Bergüés
- Clínica Universidad de Navarra, Intensive Care Unit, Pamplona, Spain
| | - M Pereira-Sánchez
- Universidad de Navarra, School of Nursing, Department of Nursing Care for Adult Patients, Pamplona, Spain; Universidad de Navarra, ICCP-UNAV (Innovation for a Person-Centred Care Research Group), Pamplona, Spain
| | - J Martín-Martín
- Universidad de Navarra, School of Nursing, Department of Nursing Care for Adult Patients, Pamplona, Spain.
| | - M Olano-Lizarraga
- Universidad de Navarra, School of Nursing, Department of Nursing Care for Adult Patients, Pamplona, Spain; Universidad de Navarra, ICCP-UNAV (Innovation for a Person-Centred Care Research Group), Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| |
Collapse
|
3
|
Bass GA, Chang CWJ, Winkle JM, Cecconi M, Kudchadkar SR, Akuamoah-Boateng K, Einav S, Duffy CC, Hidalgo J, Rodriquez-Vega GM, Gandra-d'Almeida AJ, Barletta JF, Kaplan LJ. In-Hospital Violence and Its Impact on Critical Care Practitioners. Crit Care Med 2024; 52:1113-1126. [PMID: 38236075 DOI: 10.1097/ccm.0000000000006189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To provide a narrative review of hospital violence (HV) and its impact on critical care clinicians. DATA SOURCES Detailed search strategy using PubMed and OVID Medline for English language articles describing HV, risk factors, precipitating events, consequences, and mitigation strategies. STUDY SELECTION Studies that specifically addressed HV involving critical care medicine clinicians or their practice settings were selected. The time frame was limited to the last 15 years to enhance relevance to current practice. DATA EXTRACTION Relevant descriptions or studies were reviewed, and abstracted data were parsed by setting, clinician type, location, social media events, impact, outcomes, and responses (agency, facility, health system, individual). DATA SYNTHESIS HV is globally prevalent, especially in complex care environments, and correlates with a variety of factors including ICU stay duration, conflict, and has recently expanded to out-of-hospital occurrences; online violence as well as stalking is increasingly prevalent. An overlap with violent extremism and terrorism that impacts healthcare facilities and clinicians is similarly relevant. A number of approaches can reduce HV occurrence including, most notably, conflict management training, communication initiatives, and visitor flow and access management practices. Rescue training for HV occurrences seems prudent. CONCLUSIONS HV is a global problem that impacts clinicians and imperils patient care. Specific initiatives to reduce HV drivers include individual training and system-wide adaptations. Future methods to identify potential perpetrators may leverage machine learning/augmented intelligence approaches.
Collapse
Affiliation(s)
- Gary A Bass
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Julie M Winkle
- Emergency Medicine, UC Health, University of Colorado Hospital, Aurora, CO
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Kwame Akuamoah-Boateng
- Department of Surgery Acute Care Surgical Services, Mary Baldwin University and Virginia Commonwealth University Health Richmond, Richmond, VA
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - Caoimhe C Duffy
- Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jorge Hidalgo
- Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Gloria M Rodriquez-Vega
- Department of Critical Care Medicine - HIMA-San Pablo, Caguas Puerto Rico
- University of Puerto Rico, School of Medicine, Caguas, Puerto Rico
| | | | - Jeffrey F Barletta
- Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale Campus, Glendale, AZ
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
4
|
Enright D, Colgan R, O'Connor E. Experience of Early Postgraduate Transition to Intensive Care Medicine: A Phenomenological Study. Cureus 2024; 16:e64185. [PMID: 39119395 PMCID: PMC11309786 DOI: 10.7759/cureus.64185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Background Clinical role transition is known to pose a challenge to doctors in training. The intensive care unit (ICU) is noted to be a demanding workplace environment, although relatively little is known about the experience of doctors as they transition to intensive care medicine (ICM) at the postgraduate level. Thus, this study aimed to explore the experience of registrar-grade doctors undergoing this transition and to examine the interplay between personal and professional life at this time. Methodology This qualitative study was guided by transcendental phenomenology and multiple and multidimensional transitions theory (MMT). Data were collected via 11 semi-structured interviews and analysed using a six-step analysis. Peer debriefing and a reflexive diary were used. Results The experience of doctors undergoing the transition to ICM was found to be influenced by the clinical environment of the ICU, a demanding and potentially stressful workplace, and one in which collegial support was valued. The previous experience of the individual undergoing the transition was relevant, and the impact of this transition on their professional development and identity was notable. Consistent with MMT, the interplay between personal and professional life was significant, as participants outlined the impact of anxiety before a shift, the emotional and cognitive burden of a shift, and the effect of this transition on their personal relationships. Conclusions This study observes the ICU to be an extremely challenging workplace environment, with a notable influence on the personal lives of those working therein. Nevertheless, ICM offers invaluable opportunities for learning and both personal and professional growth.
Collapse
Affiliation(s)
| | - Roslyn Colgan
- Anaesthetics, Mater Misericordiae University Hospital, Dublin, IRL
| | - Enda O'Connor
- Anaesthesia and Critical Care, Saint James Hospital, Dublin, IRL
| |
Collapse
|
5
|
Jucker JA, Cannizzaro V, Kirsch RE, Streuli JC, De Clercq E. Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit. Nurs Crit Care 2024; 29:765-776. [PMID: 38511290 DOI: 10.1111/nicc.13051] [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: 02/24/2023] [Revised: 12/06/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Using extracorporeal membrane oxygenation (ECMO) in paediatric and neonatal intensive care units (PICU/NICU) creates ethical challenges and carries a high risk for moral distress, burn out and team conflicts. AIM The study aimed to gain a more comprehensive understanding of the underlying factors affecting moral distress when using ECMO for infants and children by examining the attitudes of ECMO nurses. METHODS Four focus groups discussions were conducted with 21 critical care nurses working in a Swiss University Children's Hospital. Purposive sampling was adopted to identify research participants. The data were analysed using reflexive thematic analysis. RESULTS Unlike "miracle machine" stories in online media reports, specialized nurses working in PICU/NICU expressed both their hopes and fears towards this technology. Their accounts also contained references to events and factors that triggered experiences of moral distress: the unspeakable nature of the death of a child or infant; the seemingly lack of honest and transparent communication with parents; the apparent loss of situational awareness among doctors; the perceived lack of recognition for the role of nurses and the variability in end-of-life decision-making; the length of time it takes doctors to take important treatment decisions; and the resource intensity of an ECMO treatment. CONCLUSION The creation of a multidisciplinary moral community with transparent information among all involved health care professionals and the definition of clear treatment goals as well as the implementation of paediatric palliative care for all paediatric ECMO patients should become a priority if we want to alleviate situations of moral distress. RELEVANCE FOR CLINICAL PRACTICE The creation of a multidisciplinary moral community, clear treatment goals and the implementation of palliative care for all paediatric ECMO patients are crucial to alleviate situations of moral distress for nurses, and thus to improve provider well-being and the quality of patient care in PICU/NICU.
Collapse
Affiliation(s)
- Jovana A Jucker
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Zürich, Switzerland
- Department of Neonatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
- Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Roxanne E Kirsch
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jürg C Streuli
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
- Children's Research Center, University Children's Hospital, Zürich, Switzerland
- Stiftung Dialog Ethik, Zürich, Switzerland
| | - Eva De Clercq
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
- Stiftung Dialog Ethik, Zürich, Switzerland
| |
Collapse
|
6
|
Beheshtaeen F, Torabizadeh C, Khaki S, Abshorshori N, Vizeshfar F. Moral distress among critical care nurses before and during the COVID-19 pandemic: A systematic review. Nurs Ethics 2024; 31:613-634. [PMID: 38116787 DOI: 10.1177/09697330231221196] [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: 12/21/2023]
Abstract
Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic review. The findings indicate that personal, caring-related, and organizational factors can influence nurses' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses' age and work experience affect critical care nurses' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses' primary causes of moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care.
Collapse
|
7
|
Wilson MA, Shay A, Harris JI, Faller N, Usset TJ, Simmons A. Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review. AJPM FOCUS 2024; 3:100173. [PMID: 38304024 PMCID: PMC10832382 DOI: 10.1016/j.focus.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction Healthcare clinicians are often at risk of psychological distress due to the nature of their occupation. Military healthcare providers are at risk for additional psychological suffering related to unique moral and ethical situations encountered in military service. This scoping review identifies key characteristics of moral distress and moral injury and how these concepts relate to the military healthcare clinician who is both a care provider and service member. Methods A scoping review of moral distress and moral injury literature as relates to the military healthcare clinician was conducted on the basis of the Joanna Briggs Institute scoping review framework. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid), PsycInfo, 2 U.S. Defense Department sources, conference papers index, and dissertation abstracts. Reference lists of all identified reports and articles were searched for additional studies. Results A total of 573 articles, published between the years 2009 and 2021, were retrieved to include a portion of the COVID-19 pandemic period. One hundred articles met the inclusion criteria for the final full-text review and analysis. Discussion This scoping review identified moral distress and moral injury literature to examine similarities, differences, and overlaps in the defining characteristics of the concepts and the associated implications for patients, healthcare clinicians, and organizations. This review included the unfolding influence of the COVID-19 pandemic on moral experiences in health care and the blurring of those lines between civilian and military healthcare clinicians. Future directions of moral injury and moral distress research, practice, and care are discussed.
Collapse
Affiliation(s)
- Melissa A. Wilson
- U.S. Air Force Research Laboratory, Dayton, Ohio
- College of Health, Education and Human Services Department of Nursing, Wright State University, Dayton, Ohio
| | - Amy Shay
- School of Nursing, Indiana University, Indianapolis, Indiana
| | | | | | - Timothy J. Usset
- Division of Health Policy & Management, University of Minnesota, Minneapolis, Minnesota
| | - Angela Simmons
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
8
|
Wang MK, Geen O, Mach ZH, Khalid Z. Resident Burnout on the Internal Medicine Ward. J Gen Intern Med 2024; 39:366-372. [PMID: 37946021 PMCID: PMC10897070 DOI: 10.1007/s11606-023-08505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Burnout is common among medical trainees. Whether brief periods of training on the internal medicine ward leads to resident burnout is unknown. METHODS A survey-based study was conducted at a single academic institution. Medical residents undertaking four-week rotations on the internal medicine ward were included. Burnout was measured at the beginning and end of each rotation using the Maslach Burnout Inventory - Human Services Survey. Burnout was defined as either an emotional exhaustion score of ≥ 27 or a depersonalization score of ≥ 10. Self-reported workplace conditions, behaviors and attitudes were recorded. RESULTS The survey response rate was 71% and included 148 participants. The overall prevalence of burnout was 17% higher at the end of the rotation compared to the beginning of the rotation (71% vs. 54%; P < 0.001). Forty-three percent of residents without pre-rotation burnout developed post-rotation burnout. Residents with post-rotation burnout were more likely to report at least one suboptimal behavior or attitude related to patient care or professionalism (84% vs. 35%; P < 0.001). Respondents with new onset burnout were less likely to report being appreciated for their work, having their role as a learner emphasized, and receiving satisfactory support from allied healthcare professionals. New onset burnout was inversely associated with completing a second consecutive internal medicine ward rotation (adjusted OR 0.19; 95% CI, 0.04-0.90; P = 0.04). CONCLUSION Seven in ten residents are in a state of burnout after completing internal medicine ward rotations. Interventions to mitigate burnout development during periods of high intensity clinical training are needed.
Collapse
Affiliation(s)
- Michael Ke Wang
- Department of Medicine, McMaster University, Hamilton, Canada.
| | - Olivia Geen
- Department of Medicine, Trillium Health Partners, Mississauga, Canada
| | - Zi Hymn Mach
- Department of Medicine, Trillium Health Partners, Mississauga, Canada
| | - Zahira Khalid
- Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
9
|
Abstract
BACKGROUND Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. OBJECTIVE This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany. RESEARCH DESIGN A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic regressions, and Rasch analyses were performed. PARTICIPANTS AND RESEARCH CONTEXT The invitation to participate was sent to every German home-care service (n = 16,608). ETHICAL CONSIDERATIONS The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. RESULTS A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. CONCLUSIONS To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector.
Collapse
Affiliation(s)
- Julia Petersen
- Julia Petersen, Federal Institute for Occupational Safety and Health Dresden, Fabricestrasse 8, D-01099, Dresden,
| |
Collapse
|
10
|
Kok N, Zegers M, Teerenstra S, Fuchs M, van der Hoeven JG, van Gurp JLP, Hoedemaekers CWE. Effect of Structural Moral Case Deliberation on Burnout Symptoms, Moral Distress, and Team Climate in ICU Professionals: A Parallel Cluster Randomized Trial. Crit Care Med 2023; 51:1294-1305. [PMID: 37272981 DOI: 10.1097/ccm.0000000000005940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Moral case deliberation (MCD) is a team-based and facilitator-led, structured moral dialogue about ethical difficulties encountered in practice. This study assessed whether offering structural MCD in ICUs reduces burnout symptoms and moral distress and strengthens the team climate among ICU professionals. DESIGN This is a parallel cluster randomized trial. SETTING Six ICUs in two hospitals located in Nijmegen, between January 2020 and September 2021. SUBJECTS Four hundred thirty-five ICU professionals. INTERVENTIONS Three of the ICUs organized structural MCD. In three other units, there was no structural MCD or other structural discussions of moral problems. MEASUREMENTS AND MAIN RESULTS The primary outcomes investigated were the three burnout symptoms-emotional exhaustion, depersonalization, and a low sense of personal accomplishment-among ICU professionals measured using the Maslach Burnout Inventory on a 0-6 scale. Secondary outcomes were moral distress (Moral Distress Scale) on a 0-336 scale and team climate (Safety Attitude Questionnaire) on a 0-4 scale. Organizational culture was an explorative outcome (culture of care barometer) and was measured on a 0-4 scale. Outcomes were measured at baseline and in 6-, 12-, and 21-month follow-ups. Intention-to-treat analyses were conducted using linear mixed models for longitudinal nested data. Structural MCD did not affect emotional exhaustion or depersonalization, or the team climate. It reduced professionals' personal accomplishment (-0.15; p < 0.05) but also reduced moral distress (-5.48; p < 0.01). Perceptions of organizational support (0.15; p < 0.01), leadership (0.19; p < 0.001), and participation opportunities (0.13; p < 0.05) improved. CONCLUSIONS Although structural MCD did not mitigate emotional exhaustion or depersonalization, and reduced personal accomplishment in ICU professionals, it did reduce moral distress. Moreover, it did not improve team climate, but improved the organizational culture.
Collapse
Affiliation(s)
- Niek Kok
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Malaika Fuchs
- Department of Intensive Care, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Johannes G van der Hoeven
- Department Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle L P van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Cornelia W E Hoedemaekers
- Department Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Peccoralo LA, Pietrzak RH, Tong M, Kaplan S, Feingold JH, Feder A, Chan C, Verity J, Charney D, Ripp J. A Longitudinal Cohort Study of Factors Impacting Healthcare Worker Burnout in New York City During the COVID-19 Pandemic. J Occup Environ Med 2023; 65:362-369. [PMID: 36727906 PMCID: PMC10171104 DOI: 10.1097/jom.0000000000002790] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to longitudinally examine the prevalence and correlates of burnout in frontline healthcare workers (FHCWs) during COVID-19 in New York City. METHODS A prospective cohort study of 786 FHCWs at Mount Sinai Hospital was conducted during the initial COVID surge in April to May 2020 (T1) and November 2020 to January 2021 (T2) to assess factors impacting burnout. RESULTS Burnout increased from 38.9% to 44.8% ( P = 0.002); 222 FHCWs (28.3%) had persistent burnout, 82 (10.5%) had early burnout, and 129 (16.5%) had delayed burnout. Relative to FHCWs with no burnout ( n = 350; 44.7%), those with persistent burnout reported more prepandemic burnout (relative risk [RR], 6.67), less value by supervisors (RR, 1.79), and lower optimism (RR, 0.82), whereas FHCWs with delayed burnout reported more prepandemic burnout (RR, 1.75) and caring for patients who died (RR, 3.12). CONCLUSION FHCW burnout may be mitigated through increasing their sense of value, support, and optimism; treating mental health symptoms; and counseling regarding workplace distress.
Collapse
|
12
|
Development of Moral Injury in ICU Professionals During the COVID-19 Pandemic: A Prospective Serial Interview Study. Crit Care Med 2023; 51:231-240. [PMID: 36661451 PMCID: PMC9847689 DOI: 10.1097/ccm.0000000000005766] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, ICU professionals have faced moral problems that may cause moral injury. This study explored whether, how, and when moral injury among ICU professionals developed in the course of the COVID-19 pandemic. DESIGN This is a prospective qualitative serial interview study. SETTING Two hospitals among which one university medical center and one teaching hospital in the Netherlands. SUBJECTS Twenty-six ICU professionals who worked during the COVID-19 pandemic. INTERVENTIONS None. MEASUREMENTS MAIN RESULTS In-depth interviews with follow-up after 6 and 12 months. In total, 62 interviews were conducted. ICU professionals narrated about anticipatory worry about life and death decisions, lack of knowledge and prognostic uncertainty about COVID-19, powerlessness and failure, abandonment or betrayal by society, politics, or the healthcare organization, numbness toward patients and families, and disorientation and self-alienation. Centrally, ICU professionals describe longitudinal processes by which they gradually numbed themselves emotionally from patients and families as well as potentially impactful events in their work. For some ICU professionals, organizational, societal, and political responses to the pandemic contributed to numbness, loss of motivation, and self-alienation. CONCLUSIONS ICU professionals exhibit symptoms of moral injury such as feelings of betrayal, detachment, self-alienation, and disorientation. Healthcare organizations and ICU professionals themselves should be cognizant that these feelings may indicate that professionals might have developed moral injury or that it may yet develop in the future. Awareness should be raised about moral injury and should be followed up by asking morally injured professionals what they need, so as to not risk offering unwanted help.
Collapse
|
13
|
Alimoradi Z, Jafari E, Lin CY, Rajabi R, Marznaki ZH, Soodmand M, Potenza MN, Pakpour AH. Estimation of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics 2023; 30:334-357. [PMID: 36704986 PMCID: PMC9902807 DOI: 10.1177/09697330221135212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. AIM To estimate moral distress among nurses. METHODS This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. ETHICAL CONSIDERATION The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. RESULTS Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. CONCLUSION The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.
Collapse
Affiliation(s)
| | - Elahe Jafari
- 113106Qazvin University of Medical Sciences, Qazvin, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | | | | | | | - Marc N Potenza
- Yale University, USA; Connecticut Council on Problem Gambling, USA; Connecticut Mental Health Center, USA; Wu Tsai Institute, Yale University, USA
| | - Amir H Pakpour
- Jönköping University, Sweden; Qazvin University of Medical Sciences, Iran
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
Hinzmann D, Schütte-Nütgen K, Büssing A, Boenisch O, Busch HJ, Dodt C, Friederich P, Kochanek M, Michels G, Frick E. Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:333. [PMID: 36612657 PMCID: PMC9819312 DOI: 10.3390/ijerph20010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.
Collapse
Affiliation(s)
- Dominik Hinzmann
- Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 München, Germany
| | | | - Arndt Büssing
- Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Boenisch
- Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Christoph Dodt
- Emergency Department, München Klinik, 81925 Munich, Germany
| | | | - Matthias Kochanek
- Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
| | - Guido Michels
- Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
| | - Eckhard Frick
- School of Medicine, Technical University of Munich, 80333 München, Germany
- Spiritual Care and Psychosomatic Health, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, 80539 Munich, Germany
| |
Collapse
|
16
|
Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey. J Trauma Acute Care Surg 2022; 93:846-853. [PMID: 35916626 DOI: 10.1097/ta.0000000000003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda. METHODS We recruited interdisciplinary experts in surgical critical care and recruited them to identify current gaps in clinical critical care research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. The first of four survey rounds asked participants to generate key research questions. On subsequent rounds, we asked survey participants to rank the priority of each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category. RESULTS Twenty-five subject matter experts generated 595 questions. By Round 3, 249 questions reached ≥60% consensus. Of these, 22 questions were high, 185 were medium, and 42 were low priority. The clinical states of hypovolemic shock and delirium were most represented in the high-priority questions. Traumatic brain injury was the only specific injury pattern with a high-priority question. CONCLUSION The National Trauma Research Action Plan critical care research panel identified 22 high-priority research questions, which, if answered, would reduce preventable death and disability after injury. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level IV.
Collapse
|
17
|
Carletto S, Ariotti MC, Garelli G, Di Noto L, Berchialla P, Malandrone F, Guardione R, Boarino F, Campagnoli MF, Savant Levet P, Bertino E, Ostacoli L, Coscia A. Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148526. [PMID: 35886379 PMCID: PMC9323986 DOI: 10.3390/ijerph19148526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022]
Abstract
Moral distress (MD) in healthcare providers is widely recognized as a serious issue in critical care contexts. It has the potential to have negative impacts on both personal and professional wellbeing, the quality of care provided and staff turnover. The aim of this study was to investigate the relationship between MD and burnout among neonatal intensive care unit (NICU) healthcare professionals and identify the possible factors associated with its occurrence. Participants were asked to complete an online survey, which covered sociodemographic and professional information and included two self-report questionnaires (Italian Moral Distress Scale-Revised and Maslach Burnout Inventory). The sample comprised 115 healthcare providers (nurses and physiotherapists: 66.1%; physicians: 30.4%; healthcare assistants: 3.5%) working in four NICUs located within the province of Turin, Italy. The results revealed overall low levels of MD, with no significant differences between nurses/physiotherapists and physicians. Nurses/physiotherapists showed a statistically significant higher percentage of personal accomplishment burnout (32.9%) compared with physicians (8.6%; p = 0.012). MD was associated with the emotional exhaustion dimension of burnout. Spirituality and/or religiousness was shown to be a moderating variable. Further research is needed to deepen our understanding of the correlation between MD and burnout and the role of spirituality and/or religiousness as moderators.
Collapse
Affiliation(s)
- Sara Carletto
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, 10126 Turin, TO, Italy;
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
| | - Maria Chiara Ariotti
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| | - Giulia Garelli
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
| | - Ludovica Di Noto
- Formerly at the School of Medicine, University of Torino, 10126 Turin, TO, Italy;
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
| | - Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
- Correspondence:
| | - Roberta Guardione
- Neonatal Care Unit, City of Health and Science University Hospital of Torino, 10126 Turin, TO, Italy; (R.G.); (M.F.C.)
| | - Floriana Boarino
- Neonatal Care Unit, Santa Croce Hospital ASL TO5, 10024 Moncalieri, TO, Italy;
| | - Maria Francesca Campagnoli
- Neonatal Care Unit, City of Health and Science University Hospital of Torino, 10126 Turin, TO, Italy; (R.G.); (M.F.C.)
| | - Patrizia Savant Levet
- Neonatal Intensive Care Unit, Maria Vittoria Hospital, ASL Città di Torino, 10144 Turin, TO, Italy;
| | - Enrico Bertino
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| | - Luca Ostacoli
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
| | - Alessandra Coscia
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| |
Collapse
|
18
|
Zhang Z, Qu H, Gong W. Multifactor Logistic Analysis to Explore the Risk Factors of Safety Risks in the Transport of Critically Ill Patients with ICU and the Improvement of Nursing Strategies. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3330667. [PMID: 35607648 PMCID: PMC9124074 DOI: 10.1155/2022/3330667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
Objective Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and the improvement of nursing strategies. Methods Two hundred critical transport patients with ICU treated in our hospital from January 2019 to April 2021 were enrolled. According to the occurrence of unsafe events in transit, the patients were assigned to the control group (165 cases without unsafe events, n = 165) and the study group (35 cases with safety incidents, n = 35). Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and to enhance nursing strategies. Results (1) General data of the subjects: among the 200 critically ill patients with ICU who needed in-hospital transport, the age ranged from 18 to 85 years with an average age of 52.48 ± 3.31, including 89 males and 111 females. There were 35 cases of gastrointestinal bleeding, 16 cases of respiratory failure, 23 cases of heart failure, 43 cases of myocardial infarction, 26 cases of cerebrovascular accident, 14 cases of ectopic pregnancy, 25 cases of severe injury, and 18 cases of mechanical ventilation. There were 35 cases in the study group with accidents and 45 cases in group B without accidents. (2) Among the 200 patients, 35 patients had complications during the transit process in the intermediate people's court, with an incidence rate of 17.5%. It included blood pressure fluctuation (n = 6), artificial airway obstruction (n = 6), decrease in blood oxygen saturation (n = 10), dyspnea (n = 5), fall pain (n = 3), elevated intracranial pressure (n = 2), and other factors (n = 3). There exhibited no significant difference in blood oxygen saturation at each time point during transport (P > 0.05). There exhibited no significant difference in SpO2 before transport. The comparison of 5 min and 10 min blood oxygen saturation during transit in the study group was lower compared to the control group (P < 0.05). (3) In a univariate analysis of safety risks for critically ill ICU patients, home escorts did not show significant differences in hospital transport for critically ill ICU patients (P > 0.05). There were significant differences in terms of age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline (P < 0.05). The results of multivariate logistic regression analysis indicated that age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline were the risk factors affecting the safe transport of critically ill patients (P < 0.05). Conclusion Age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline are the independent risk factors that affect the safe transport of emergency or ICU critically ill patients. Therefore, in order to reduce the risk of transshipment, we must enhance the safety awareness of escorts, strengthen the management and training of escorts, promote rules and regulations, and formulate dangerous plans, so as to eliminate the occurrence of unsafe factors.
Collapse
Affiliation(s)
- Zhenyu Zhang
- Department of Intensive Care Unit (Eastern), Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Hui Qu
- Department of Intensive Care Unit (Western), Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Wei Gong
- Department of Cardiac Intensive Care Unit, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| |
Collapse
|
19
|
A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031666. [PMID: 35162689 PMCID: PMC8835282 DOI: 10.3390/ijerph19031666] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Abstract
Ethical dilemmas for healthcare workers (HCWs) during pandemics highlight the centrality of moral stressors and moral distress (MD) as well as potentially morally injurious events (PMIEs) and moral injury (MI). These constructs offer a novel approach to understanding workplace stressors in healthcare settings, especially in the demanding times of COVID-19, but they so far lack clear identification of causes and consequences. A scoping review of moral stressors, moral distress, PMIEs, and MI of healthcare workers during COVID-19 was conducted using the databases Web of Science Core Collection and PsycINFO based on articles published up to October 2021. Studies were selected based on the following inclusion criteria: (1) the measurement of either moral stress, MD, PMIEs, or MI among HCWs; (2) original research using qualitative or quantitative methods; and (3) the availability of the peer-reviewed original article in English or German. The initial search revealed n = 149,394 studies from Web of Science and n = 34 studies from EBSCOhost. Nineteen studies were included in the review. Conditions representing moral stressors and PMIEs as well as MD and MI as their potential outcomes in healthcare contexts during COVID-19 are presented and discussed. Highlighting MD and MI in HCWs during COVID-19 brings attention to the need for conceptualizing the impact of moral stressors of any degree. Therefore, the development of a common, theoretically founded model of MD and MI is desirable.
Collapse
|
20
|
Tran Y, Liao HH, Yeh EH, Ellis LA, Clay-Williams R, Braithwaite J. Examining the pathways by which work-life balance influences safety culture among healthcare workers in Taiwan: path analysis of data from a cross-sectional survey on patient safety culture among hospital staff. BMJ Open 2021; 11:e054143. [PMID: 34728459 PMCID: PMC8565544 DOI: 10.1136/bmjopen-2021-054143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study is to examine the pathways by which work-life balance influences safety climate in hospital settings. DESIGN A national cross-sectional survey on patient safety culture. SETTINGS Healthcare workers from 56 hospitals in Taiwan, covering three work settings: intensive care units, operation rooms and emergency departments. PARTICIPANTS 14 345 healthcare workers took part in the survey and were included in the present analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The Safety Attitudes, Maslach's Burn-out Inventory and Work-life balance questionnaires were used to measure patient safety culture, teamwork, leadership, emotional exhaustion and work-life balance. Path analysis was conducted to determine the relationship between work-life balance and safety climate. We tested for mediating and moderating factors influencing this relationship. RESULTS The path between work-life balance and safety climate was found to be significant (b=0.32, p<0.001) and explained through a serial mediation. This relationship was found to be mediated by emotional exhaustion followed by teamwork climate in a full mediation. Leadership factors such as identifying as a manager, moderated the indirect pathway between work-life balance and safety climate through teamwork climate (index of moderation: b=0.083, bias corrected 95% CI 0.044 to 0.120) but not through emotional exhaustion or the serial pathway. Subgroup analysis from non-managers on their perception of management was also found to moderate this relationship. CONCLUSION We found work-life balance to be associated with safety climate through a fully mediated model. The mediation pathways are moderated by self-identified leadership and perceptions of leadership. Understanding the pathways on how work-life balance influences safety climate provides an explanatory model that can be used when designing effective interventions for implementation in system-based approaches to improve patient safety culture in hospital settings.
Collapse
Affiliation(s)
- Yvonne Tran
- MU Hearing, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Hsun-Hsiang Liao
- Joint Commission of Taiwan, Banciao, Taiwan
- Departmment of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - En-Hui Yeh
- Joint Commission of Taiwan, Banciao, Taiwan
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|