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Montazeri AS, Khoddam H, Borhani F, Kolagari S. Moral reckoning among nurses: A directed qualitative content analysis. Nurs Ethics 2024:9697330241255937. [PMID: 38887048 DOI: 10.1177/09697330241255937] [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: 06/20/2024]
Abstract
BACKGROUND When nurses face ethical challenges, they attempt to accept responsibility for their actions and start moral reckoning. Moral reckoning is the personal evaluation of one's behaviors or others' behaviors during ethically challenging situations. RESEARCH AIM This study aimed at exploring the concept of moral reckoning and its stages among Iranian nurses using Nathaniel's moral reckoning Theory. RESEARCH DESIGN This descriptive qualitative study was conducted in 2022 using directed content analysis. PARTICIPANTS AND RESEARCH CONTEXT Eighteen nurses were purposively recruited from three teaching hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Data were collected via in-depth semi-structured interviews which lasted 50 minutes on average and were concurrently analyzed via the three-step directed content analysis method proposed by Elo and Kyngas. ETHICAL CONSIDERATIONS This study earned the ethical approval of the Ethics Committee of Golestan University of Medical Sciences, Gorgan, Iran (code: IR.GOUMS.REC.1400.171). FINDINGS During data analysis, 157 final codes were developed and categorized into 23 subcategories, 10 categories, and four themes. The themes of the study are ease (with the two categories of becoming and interacting), upset (with the two categories of mental upset and behavioral upset), resolution (with the two categories of making a stand and giving up), and reflection (with the four categories of remembering, telling the story, examining conflicts, and living with consequences). CONCLUSION Ethically challenging situations alter the ease stage of moral reckoning among nurses, cause them mental and behavioral upset, and thereby, require them to make stand or give up. Then, they continuously examine events in their mind and finally, live with the positive and negative consequences of the events.
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Kovanci MS, Atli Özbaş A. Moral distress and moral sensitivity in clinical nurses. Res Nurs Health 2024; 47:312-323. [PMID: 38142307 DOI: 10.1002/nur.22366] [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: 05/16/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
Health care providers are expected to have a certain moral sensitivity (MS) to make an ethical assessment. Moral distress (MD) is a common phenomenon in nursing. It can negatively affect nurses physically, psychologically, socially, and spiritually. This study aimed to investigate the relationship between MD and MS among nurses using a cross-sectional descriptive design. The study was conducted in two stages. The first stage was a methodological study that analyzed validity and reliability of the Measure of MD-Healthcare Professionals. The second stage was a descriptive- predictive analysis that investigated the relationship between MD and MS. The MD intensity and frequency scores of the participants were high and moderately high, respectively. There was no direct effect on the total score and frequency of MS and MD. However, a direct and significant negative effect of MS was seen on the intensity of MD. Based on the results of this study, MS should be considered as a measure in studies aimed at understanding MD among clinical nurses. Empowerment programs should be established to increase the awareness of health workers about ethical and moral situations and to support them to cope with the problems they experience in these areas.
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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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Sharifnia AM, Green H, Fernandez R, Alananzeh I. Empathy and ethical sensitivity among intensive and critical care nurses: A path analysis. Nurs Ethics 2024; 31:227-242. [PMID: 37535974 DOI: 10.1177/09697330231167543] [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: 08/05/2023]
Abstract
BACKGROUND Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses' empathy and ethical sensitivity. Evidence in the literature indicates that nurses' emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity. AIM To investigate the relationship between nurses' empathy and ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis. RESEARCH DESIGN Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis. PARTICIPANTS AND RESEARCH CONTEXT Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021. ETHICAL CONSIDERATIONS The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki. FINDINGS Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity. CONCLUSIONS Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses.
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Affiliation(s)
- Amir Masoud Sharifnia
- Student Research Committee, Khomein University of Medical Sciences, Khomein, Iran; Isfahan University of Medical Sciences, Isfahan, Iran
| | - Heidi Green
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia; Centre for Evidence-Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Wollongong, NSW, Australia
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Ibrahim Alananzeh
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia; School of Humanities, Social Sciences and Health, UOWD, Dubai, UAE
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Ibrahim AM. Nurses' ethical responsibilities: Whistleblowing and advocacy in patient safety. Nurs Ethics 2024:9697330241235306. [PMID: 38415609 DOI: 10.1177/09697330241235306] [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: 02/29/2024]
Abstract
BACKGROUND In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives. AIM This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety. RESEARCH DESIGN A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale. PARTICIPANTS AND RESEARCH CONTEXT The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus. ETHICAL CONSIDERATIONS Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles. RESULTS Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making. CONCLUSION The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector.
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Mirhosseini S, Aghayan SS, Basirinezhad MH, Ebrahimi H. Health Care Providers' Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:908-918. [PMID: 35042392 PMCID: PMC8792911 DOI: 10.1177/00302228211057992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to investigate the health care providers' attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients.
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Affiliation(s)
- Seyedmohammad Mirhosseini
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Shahrokh Aghayan
- Department of Clinical Sciences, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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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 2023:9697330231221196. [PMID: 38116787 DOI: 10.1177/09697330231221196] [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: 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.
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Afoko V, Hewison A, Newham R, Neilson S. Moral distress in nurses in developing economies: an integrative literature review. J Res Nurs 2023; 28:609-627. [PMID: 38162718 PMCID: PMC10756174 DOI: 10.1177/17449871231216606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Moral distress has been extensively studied in developed economies; however, not much in terms of studies has been carried out in developing economies. Objective To review the literature reporting the experience of moral distress in nurses in health care settings in developing economies. Design An integrative literataure review was used. Method Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online Cochrane and Psych INFO were searched to retrieve titles and abstracts of papers on the experience of moral distress in nurses in developing economies. Results Sixteen articles reporting the experience of moral distress in nurses in developing economies published between 1984 and March 2019 were used for the review. Analysis of the findings revealed seven themes, nurses' experience of moral distress, inadequate material and human resources, end-of-life challenges, cultural and religious beliefs as a source of moral distress, perceived inactions of medical and nursing staff, impact of moral distress on nurses in developing economies and coping strategies. Conclusion There is paucity of empirical studies on moral distress in nurses in developing economies. More qualitative studies are needed in various cultural settings to enhance its understanding in nurses working in developing economies.
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Affiliation(s)
- Vivian Afoko
- Lecturer, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Alistair Hewison
- Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Roger Newham
- Associate Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Susan Neilson
- Senior Lecturer, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Efil S, Turen S, Demir G. Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes. Dimens Crit Care Nurs 2023; 42:325-332. [PMID: 37756505 DOI: 10.1097/dcc.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known. OBJECTIVES The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process. METHODS The research was conducted in Antalya, one of the most populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care. RESULTS The mean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98. CONCLUSION It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001). DISCUSSION It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care.
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Kulakaç N, Uzun S. The Effect of Burnout and Moral Sensitivity Levels of Surgical Unit Nurses on Job Satisfaction. J Perianesth Nurs 2023; 38:768-772. [PMID: 37269273 DOI: 10.1016/j.jopan.2023.01.012] [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: 09/26/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE This study was carried out to determine the effect of burnout and moral sensitivity levels of surgical unit nurses on their job satisfaction. DESIGN A descriptive and correlational design study. METHODS The population consisted of 268 nurses working in health institutions in the Eastern Black Sea Region of Turkey. The data were collected online between 1 and 30 April, 2022 using a sociodemographic data form, the Maslach Burnout Inventory, the Minnesota Job Satisfaction Scale, and the Moral Sensitivity Scale. Pearson correlation analysis and logistic regression analysis were used to evaluate the data. FINDINGS The nurses' moral sensitivity scale mean score was 105.2 ± 18.8, and the Minnesota job satisfaction scale mean score was 3.3 ± 0.7. The participants' mean emotional exhaustion score was 25.4 ± 7.3, the depersonalization score average was 15.7 ± 4.6, and the personal accomplishment mean score was 20.5 ± 6.7. The factors affecting the job satisfaction of nurses were found to be moral sensitivity, personal accomplishment, and satisfaction with the unit they worked. CONCLUSIONS Nurses had high levels of burnout due to emotional exhaustion, one of the subdimensions of burnout, and moderate levels of burnout due to depersonalization and personal accomplishment. The moral sensitivity and job satisfaction of nurses are moderate. As the nurses' accomplishment and ethical sensitivity levels increased and their emotional exhaustion levels decreased, their job satisfaction levels increased.
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Affiliation(s)
- Nurşen Kulakaç
- Department of Surgical Diseases Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey.
| | - Sevda Uzun
- Department of Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey
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Aydin Dogan R. Compassion fatigue and moral sensitivity in midwives in COVID-19. Nurs Ethics 2023; 30:776-788. [PMID: 36927231 PMCID: PMC10028444 DOI: 10.1177/09697330221146224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The Covid-19 pandemic has impacted compassion fatigue and the mental health of health care providers, particularly midwives and nurses. Although there are studies involving health workers such as nurses and physicians affected by the pandemic's compassion fatigue, few studies include midwives. RESEARCH OBJECTIVE The present study seeks to investigate the effects of compassion fatigue experienced by midwives working under intense stress during the third wave of the COVID-19 pandemic on the level of moral sensitivity. RESEARCH DESIGN This is a descriptive-correlation study. PARTICIPANTS The statistical population consisted of all the midwives in Türkiye hospitals in 2021. This cross-sectional study was collected through a questionnaire using convenience sampling. Three hundred and ten midwives working in different units of the country participated in the study. ETHICAL CONSIDERATIONS Approval from the researcher's university Institutional Review Board for ethical review was obtained with the code of IRB 20/510. FINDINGS The average age of the midwives is 34.29 ± 8.39. It has been noticed that 43.5% of the midwives work in public hospitals and 38.1% in family health and community health centers. Midwives' mean MR-CS score is 67.11 ± 25.13, secondary trauma sub-dimension average 15.77 ± 6.23, and occupational burnout sub-dimension 40.69 ± 16.35. The mean moral sensitivity questionnaire score is determined as 93.86 ± 19.51. It has been observed that the working style and working time are effective on compassion fatigue. In the linear regression model, 98% of compassion fatigue was explained. Age, secondary trauma, and occupational burnout sub-dimensions affect the model. DISCUSSION Working year, working style, second trauma, age, and occupational burnout parameters may help explain some of the links between midwives' symptoms of compassion fatigue. CONCLUSION The pandemic affects the compassion fatigue of midwives. It is crucial to provide social support to midwives and health workers to prevent compassion fatigue and examine and control groups at risk in mental health.
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Affiliation(s)
- Reyhan Aydin Dogan
- Department of Midwifery, Faculty of Health
Sciences, Karabuk University, Turkey
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Khaghanizadeh M, Koohi A, Ebadi A, Vahedian-Azimi A. The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial. BMC Med Ethics 2023; 24:58. [PMID: 37542315 PMCID: PMC10403849 DOI: 10.1186/s12910-023-00938-5] [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: 05/28/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity. METHODS In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. RESULTS Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009). CONCLUSIONS The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. REGISTRATION This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.
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Affiliation(s)
- Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Aliakbar Koohi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Sheykh bahayi Street, Vanak Square Tehran, Tehran, P.O. Box 19575-174, Iran
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Pooyanfard F, Razban F, Asadi N, Haji‐Maghsoudi S. Correlation between nurses' attitude and practice toward communication with patients of decreased level of consciousness and its relationship with ethical care in ICU: A cross-sectional study. Health Sci Rep 2023; 6:e1484. [PMID: 37636286 PMCID: PMC10450122 DOI: 10.1002/hsr2.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background and Aims Communication between intensive care unit (ICU) nurses and patients with decreased Level of Consciousness (DLOC) is now regarded as a difficult task. Proper communication is regarded as a crucial component of care and stems from the attitude and practice of nurses. Intensive care nurses are responsible for providing care to patients with DLOC in accordance with ethical principles because care and ethics cannot be separated. To better understand ICU nurses' attitudes and practice toward communicating with patients who have decreased levels of consciousness and how this affects the provision of ethical care, the current study was conducted. Methods This is a cross-sectional study. Two hundred ICU nurses from southeast Iran took part in this study. Three questioners, including attitude and practice toward communicating with patients who decreased Levels of consciousness, and ethical Care were used as data collection tools. Results The mean score for ICU nurses' attitude, practice, and ethical care towards communicating with patients with DLOC were, respectively, 4.02 ± 0.45,2.91 ± 0.49. The findings demonstrated a very weak correlation between the ICU nurses' attitude score and communication practice for DLOC patients (p = 0.04; r = 0.14). Conclusion Nurses who had a more positive attitude toward communicating with DLOC patients performed better in this area. It is suggested that nurses employed in ICUs should be monitored and judged based on how well they communicate with DLOC patients through workshops and conferences. By doing this, they would become more cognizant of the necessity for and effective methods of communication with these patients as well as the repercussions of their poor communication practice.
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Affiliation(s)
| | - Farideh Razban
- Nursing Research CenterKerman University of Medical SciencesKermanIran
| | - Neda Asadi
- Nursing Research CenterKerman University of Medical SciencesKermanIran
| | - Saiedeh Haji‐Maghsoudi
- Modeling in Health Research CenterInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
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Erel M, Marcus EL, DeKeyser Ganz F. Cognitive biases and moral characteristics of healthcare workers and their treatment approach for persons with advanced dementia in acute care settings. Front Med (Lausanne) 2023; 10:1145142. [PMID: 37425320 PMCID: PMC10325688 DOI: 10.3389/fmed.2023.1145142] [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: 01/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Palliative care (PC) delivery for persons with advanced dementia (AD) remains low, particularly in acute-care settings. Studies have shown that cognitive biases and moral characteristics can influence patient care through their effect on the thinking patterns of healthcare workers (HCWs). This study aimed to determine whether cognitive biases, including representativeness, availability, and anchoring, are associated with treatment approaches, ranging from palliative to aggressive care in acute medical situations, for persons with AD. Methods Three hundred fifteen HCWs participated in this study: 159 physicians and 156 nurses from medical and surgical wards in two hospitals. The following questionnaires were administered: a socio-demographic questionnaire; the Moral Sensitivity Questionnaire; the Professional Moral Courage Scale; a case scenario of a person with AD presenting with pneumonia, with six possible interventions ranging from PC to aggressive care (referring to life-prolonging interventions), each given a score from (-1) (palliative) to 3 (aggressive), the sum of which is the "Treatment Approach Score;" and 12 items assessing perceptions regarding PC for dementia. Those items, the moral scores, and professional orientation (medical/surgical) were classified into the three cognitive biases. Results The following aspects of cognitive biases were associated with the Treatment Approach Score: representativeness-agreement with the definition of dementia as a terminal disease and appropriateness of PC for dementia; availability-perceived organizational support for PC decisions, apprehension regarding response to PC decisions by seniors or family, and apprehension regarding a lawsuit following PC; and anchoring-perceived PC appropriateness by colleagues, comfort with end-of-life conversations, guilt feelings following the death of a patient, stress, and avoidance accompanying care. No association was found between moral characteristics and the treatment approach. In a multivariate analysis, the predictors of the care approach were: guilt feelings about the death of a patient, apprehension regarding senior-level response, and PC appropriateness for dementia. Conclusion Cognitive biases were associated with the care decisions for persons with AD in acute medical conditions. These findings provide insight into the potential effects of cognitive biases on clinical decisions, which may explain the disparity between treatment guidelines and the deficiency in the implementation of palliation for this population.
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Affiliation(s)
- Meira Erel
- Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
| | | | - Freda DeKeyser Ganz
- Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
- Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem, Israel
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Abstract
BACKGROUND Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses. OBJECTIVE This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics. METHODS We conducted a systematic search of 7 electronic databases (2000-2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis. RESULTS Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care. CONCLUSION Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress. IMPLICATIONS FOR PRACTICE Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.
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Goktas S, Aktug C, Gezginci E. Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic. Nurs Crit Care 2023; 28:261-271. [PMID: 35821613 PMCID: PMC9350110 DOI: 10.1111/nicc.12820] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems. AIM The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID-19 pandemic. DESIGN Descriptive cross-sectional survey. METHODS A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines. RESULTS In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = -.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001). CONCLUSION The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage. RELEVANCE TO CLINICAL PRACTICE The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.
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Affiliation(s)
- Sonay Goktas
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cemile Aktug
- Faculty of Health Sciences, Department of Nursing, Gümüşhane University, Gumushane, Turkey
| | - Elif Gezginci
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
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16
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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.
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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
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Physical Therapists' Ethical and Moral Sensitivity: A STROBE-Compliant Cross-Sectional Study with a Special Focus on Gender Differences. Healthcare (Basel) 2023; 11:healthcare11030333. [PMID: 36766908 PMCID: PMC9914038 DOI: 10.3390/healthcare11030333] [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: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
(1) Background: Healthcare professionals´ clinical practice, their care of patients and the clinical decision-making process may be influenced by ethical and moral sensitivity. However, such outcomes have been scarcely studied in physical therapists. This study aimed to explore ethical sensitivity and moral sensitivity in practicing physical therapists, and to compare both variables by gender. (2) Methods: Cross-sectional study. 75 physical therapists (58.7% women; average age = 34.56 (8.68) years) were asked to fill in questionnaires measuring ethical sensitivity (Ethical Sensitivity Scale Questionnaire) and moral sensitivity (Revised-Moral Sensitivity Questionnaire). (3) Results: The sample showed high ethical sensitivity (116.14 ± 15.87 over 140) and high moral sensitivity (40.58 ± 5.36 over 54). When comparing by gender, women reported significantly higher ethical sensitivity than men (p = 0.043), as well as higher scores in the following dimensions: Caring by connecting with others (p = 0.012) and Working with interpersonal and group differences (p = 0.028). However, no differences were found in moral sensitivity (p = 0.243). (4) Conclusion: Physical therapists showed high levels of ethical and moral sensitivity, whilst women reported higher ethical sensitivity than men. Understanding physical therapists´ ethical and moral sensitivity is essential to design and implement integrated education programs directed to improve the quality of care of patients in their daily clinical practice.
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Salari N, Shohaimi S, Khaledi-Paveh B, Kazeminia M, Bazrafshan MR, Mohammadi M. The severity of moral distress in nurses: a systematic review and meta-analysis. Philos Ethics Humanit Med 2022; 17:13. [PMID: 36348378 PMCID: PMC9644548 DOI: 10.1186/s13010-022-00126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/03/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral distress in nurses. However, to date, a comprehensive study that shows the results of these research across the world was not found, therefore due to the importance of this issue, its role in the health of nurses and patients, and the lack of general statistics about it worldwide, the present study was conducted to determine the frequency and severity of moral distress in nurses through a systematic review and meta-analysis. METHODS In this review study, searching national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Embase, ScienceDirect, Scopus, CINHAL, PubMed, and Web of Science (WoS) between 2005 and February 2020 were extracted. The random-effects model was used for analysis, and the heterogeneity of studies with the I2 index was investigated. Data were analyzed using Comprehensive Meta-Analysis (Version 2). RESULTS The frequency of moral distress in 9 articles with a sample size of 1576 persons was 1.7 ± 0.5 from (0-4), in 13 articles with a sample size of 1870 persons, 3.07 ± 0.1 from (0-5), in 6 articles with a sample size of 1316 persons, 3.2 ± 0.29 from (0-6), in 18 articles with a sample size of 1959 persons, 4.6 ± 0.518 from (1-7) and in 35 articles with a sample size of 3718 persons, 81.1 ± 4.6 from (216-30), and the severity of moral distress in 4 articles with a sample size of 1116 persons, 1.7 ± 0.37 from (0-4), in 5 articles with a sample size of 1282 persons, 2.6 ± 0.28 from (0-5), in 5 articles with a sample size of 944 persons, 3.9 ± 0.63 from (0-6) and in 8 articles with a sample size of 901 persons was 82.3 ± 5.4 (0-216). CONCLUSION The results of this study showed that the frequency and severity of moral distress in nurses are high and are a serious problem in nurses. Therefore, policymakers in this field should consider its role in the health of nurses and patients.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad-Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
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19
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Dehghani A, Sobhanian M, Faseleh Jahromi M. The effect of communication skills training on nurses’ moral distress: A randomized controlled trial. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Parchami F, Jackson AC, Sharifi F, Parsapoor A, Bahramnezad F. Written and computer simulation on the moral sensitivity of nurses. Nurs Ethics 2022; 29:1739-1749. [PMID: 35801307 DOI: 10.1177/09697330221109945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Moral sensitivity is the first step towards ethical decision-making. This sensitivity should form a basic attitude in healthcare team members, particularly nurses, toward providing effective and ethical care. This is highlighted in intensive care units (ICUs) where close attention should be paid to patient rights and moral or ethical decision-making.Objective: The present study aimed at determining and comparing the effect of written simulation and computer simulation of a virtual patient on the development of moral sensitivity of ICU nurses.Research design: Randomized controlled trial with one control arm and two experimental arms.Participants and content: This study involved 204 ICU nurses working in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran, from 2019 to 2021 using a random allocation method. The participants were allocated to three groups comprising virtual patient computer simulation, written simulation, and the no simulation control group. After training based on a Patient Rights Charter, five scenarios, with themes reflecting the clauses of the Patient's Rights Charter, were written as a computer program and text for the computer simulation and written simulation groups, respectively. Finally, nurses' moral sensitivity was assessed using the Lützén moral sensitivity questionnaire as pre- and post-tests (immediately and 2 months after the intervention).Ethical considerations: Ethical permission was obtained for the study. All the participants signed the informed consent before the study onset.Results: The study results showed a significant difference in moral sensitivity among the three groups before the intervention (p = 0.003). Immediately after the intervention compared to pre-intervention, the three groups showed no significant differences in this regard (p = 0.056), however a significant difference among the three groups was found 2 months post-intervention (p < 0.001).
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Affiliation(s)
- Faezeh Parchami
- School of Nursing and Midwifery, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Alun C Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia; Faculty of Health, Deakin University, Geelong, VIC, Australia; Centre on Behavioural Health, Hong Kong University, Hong Kong, PRC, China
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Research Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Bahramnezad
- School of Nursing & Midwifery, Nursing and Midwifery Care Research Center, Spiritual Health Group, Research Center of Quran, Hadith and Medicine,48439 Tehran University of Medical Sciences, Tehran, Iran
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21
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Nazari S, Poortaghi S, Sharifi F, Gorzin S, Afshar PF. Relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. BMC Health Serv Res 2022; 22:840. [PMID: 35773700 PMCID: PMC9244299 DOI: 10.1186/s12913-022-08258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The quality of care has a significant impact on the condition of elderly patients. Many factors affect the quality of care, including ethical considerations. Ethical considerations, such as moral sensitivity, change in times of crisis. The present study was conducted to assess the relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. METHODS This was a cross-sectional descriptive correlational study. The participants included 445 nurses that were selected by quota sampling method from hospitals admitting COVID-19 patients. The data were collected using the Moral Sensitivity Questionnaire (MSQ) and Quality Patient Care Scale (QUALPAC) as self-reports. We used the SPSS software v.16 for statistical analysis. RESULTS The total score of moral sensitivity and quality of care was 52.29 ± 16.44 and 2.83 ± 0.23, respectively. Moral sensitivity negatively correlates with psychological, social, and physical aspects (P < 0.05). Modifying autonomy, interpersonal orientation, and experiencing moral conflict predicted β = 0.10 of the psychosocial aspect of quality of care. Structural moral meaning and expressing benevolence predicted the changes in the physical dimension of quality of care (β = 0.02). CONCLUSION The quality of care had a significant inverse correlation with moral sensitivity. Multiple regression analysis showed that modifying autonomy, interpersonal orientation, and experiencing moral conflict could predict the psychosocial dimensions. Structuring moral meaning could predict the physical dimension. The communication aspects were not related to any of the dimensions of moral sensitivity.
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Affiliation(s)
- Shima Nazari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarieh Poortaghi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Science, Tehran, Iran
| | - Shaghayegh Gorzin
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Farokhnezhad Afshar
- Department of Gerontology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Shahid Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran.
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22
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Kovanci MS, Akyar I. Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review. Nurs Ethics 2022; 29:1476-1490. [PMID: 35724332 DOI: 10.1177/09697330221105638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Moral distress is a phenomenon that all nurses experience at different levels and contexts. The level of moral distress can be affected by individual values and the local culture. The sources of the values shape the level of moral distress experienced and the nurses' decisions. AIM The present scoping review was conducted to examine the situations that cause moral distress in ICU nurses in different countries. RESULTS A scoping review methodology was adopted for the study, in line with the approach of Arksey, and O'Malley Literature was searched within PubMed/Medline, Scopus, Web of Science, and PsycINFO indexed keywords such as "moral distress", "Critical Care Nurse", and "Moral Distress Scale-Revised". Of the 617 identified citations, 12 articles matched the inclusion criteria. CONCLUSION The moral distress experienced in countries and regions with similar cultures and geographies was parallel. The situations that cause the most moral distress are futile-care to prolong death, unnecessary tests and treatments, and working with incompetent healthcare personnel.
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Affiliation(s)
- Mustafa Sabri Kovanci
- Psychiatric Nursing Department, Faculty of Nursing, 37515Hacettepe University, Ankara, Turkey
| | - Imatullah Akyar
- Internal Medicine Nursing Department, Faculty of Nursing, 37515Hacettepe University, Ankara, Turkey
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Miraghaie AM, Pouretemad H, Villa AEP, Mazaheri MA, Khosrowabadi R, Lintas A. Electrophysiological Markers of Fairness and Selfishness Revealed by a Combination of Dictator and Ultimatum Games. Front Syst Neurosci 2022; 16:765720. [PMID: 35615426 PMCID: PMC9124946 DOI: 10.3389/fnsys.2022.765720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Individual behavior during financial decision making is motivated by fairness, but an unanswered question from previous studies is whether particular patterns of brain activity correspond to different profiles of fairness. Event Related Potentials (ERPs) were recorded from 39 participants who played the role of allocators in a Dictator Game (DG) and responders in an Ultimatum Game (UG). Two very homogeneous groups were formed by fair and selfish individuals. At fronto-central cortical sites, the latency of ERP early negativity (N1) was 10 ms shorter in selfish participants than in fair participants. In fair DG players, the subsequent positive wave P2 suggested that more cognitive resources were required when they allocated the least gains to the other party. P2 latency and amplitude in the selfish group supported the hypothesis that these participants tended to maximize their profit. During UG, we observed that medial frontal negativity (MFN) occurred earlier and with greater amplitude when selfish participants rejected less favorable endowment shares. In this case, all players received zero payoffs, which showed that MFN in selfish participants was associated with a spiteful punishment. At posterior-parietal sites, we found that the greater the selfishness, the greater the amplitude of the late positive component (LPC). Our results bring new evidence to the existence of specific somatic markers associated with the activation of distinct cerebral circuits by the evaluation of fair and unfair proposals in participants characterized by different expressions of perceived fairness, thus suggesting that a particular brain dynamics could be associated with moral decisions.
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Affiliation(s)
- Ali M. Miraghaie
- Faculty of Psychology, Shahid Beheshti University, Tehran, Iran
- NeuroHeuristic Research Group, HEC-Lausanne, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Ali M. Miraghaie
| | - Hamidreza Pouretemad
- Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran
- Hamidreza Pouretemad
| | - Alessandro E. P. Villa
- NeuroHeuristic Research Group, HEC-Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Mohammad A. Mazaheri
- Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran
| | - Reza Khosrowabadi
- Institute for Cognitive and Brain Science, Shahid Beheshti University, Tehran, Iran
| | - Alessandra Lintas
- NeuroHeuristic Research Group, HEC-Lausanne, University of Lausanne, Lausanne, Switzerland
- LABEX, HEC-Lausanne, University of Lausanne, Lausanne, Switzerland
- Alessandra Lintas
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Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095132. [PMID: 35564527 PMCID: PMC9103890 DOI: 10.3390/ijerph19095132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
Moral sensitivity helps individuals resolve moral dilemmas as a precursor to moral decision-making. Intensive care unit (ICU) nurses are at high risk for encountering moral dilemmas and should have the moral sensitivity to recognize moral issues. The activities of ICU nurses in moral decision-making are guided by moral sensitivity but are also based on emotional intelligence (EI). EI, be recognized as an integral part of moral sensitivity with long-standing theoretical foundations. It is necessary to explicate the true role of EI in moral sensitivity through empirical research. To measure the level of moral sensitivity of ICU nurses and determine the relationship between moral sensitivity and EI. We recruited 467 ICU nurses of ten hospitals from March to June 2021 in Hunan Province, China for a cross-sectional questionnaire survey. The moral sensitivity and EI were measured using the Moral Sensitivity Questionnaire-Revised Version into Chinese (MSQ-R-CV) and the Wong and Law Emotional Intelligence Scale-Version into Chinese (WLEIS-C). A self-report questionnaire covered sociodemographic characteristics. The average moral sensitivity score of ICU nurses was 39.41 ± 7.21. The average EI score was significantly positively correlated with the moral sensitivity score (p < 0.001). This study demonstrated that the moral sensitivities of ICU nurses were at medium levels. EI of ICU nurses can indeed affect their moral sensitivity, and the impact of each element of EI should be clarified for practical application.
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Işik MT, Özdemir RC, Serinkaya D. Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors. Indian J Crit Care Med 2022; 26:288-293. [PMID: 35519912 PMCID: PMC9015944 DOI: 10.5005/jp-journals-10071-24143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Technological advances in critical care contribute to patient survival, but healthcare professionals working in these units, which require technical expertise, experience highly challenging ethical decision-making processes. Aim The aim of this study is to determine the attitudes of intensive care nurses toward ethical problems they face during clinical practice and the affecting factors. Method The study included a total of 294 nurses working in the intensive care units at a city hospital. Data was collected using the Personal Information Form and Ethical Attitude Scale for Nursing Care. Findings About 58.8% of the participants were females and 71.1% had undergraduate degrees. The total scale score was 56.48 ± 15.98. A statistically significant difference was found between participants’ gender, weekly working hours, ethical definition status, and scale score averages. Conclusion More than half experienced frequent ethical problems and tried to solve them on their own. Trainings aimed at developing ethical sensitivity and participation in symposiums/conferences that address ethical issues specific to intensive care are recommended. How to cite this article Işik MT, Özdemir RC, Serinkaya D. Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors. Indian J Crit Care Med 2022;26(3):288-293.
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Affiliation(s)
| | - Rana Can Özdemir
- Department of Medical History and Ethics, Akdeniz Üniversitesi, Antalya, Turkey
- Rana Can Özdemir, Department of Medical History and Ethics, Akdeniz Üniversitesi, Antalya, Turkey, e-mail:
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Caram CDS, Rezende LC, Fonseca MP, Almeida NG, Rezende LS, Nascimento J, Barreto BI. STRATEGIES FOR COPING WITH MORAL DISTRESS ADOPTED BY NURSES IN TERTIARY CARE: A SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
ABSTRACT Objective: to map the scientific evidence on strategies for coping with moral distress adopted by nurses in the context of health services in tertiary care. Method: this is a Scoping Review based on the PRISMA-ScR recommendations. The searches were performed in September 2020 in the MEDLINE®, National Library of Medicine, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane and Biblioteca Virtual en Saúde databases. The eligibility criterion was to include studies that discussed strategies for coping with moral distress adopted by nurses in tertiary care, finding 2,041 studies, which were organized and screened in the Endnote software. The data were organized in Excel spreadsheets and analysis of the results was performed using the ATLAS.ti software. Results: the final selected sample consisted of 23 studies, which were grouped in two axes: strategies and recommendations. Four articles were included in the “strategies” axis, which reported actions taken to face moral distress, detailing the intervention and their results. The others, included in the “recommendations” axis, are articles whose focus was the experience of moral distress, suggesting important aspects to face it. Conclusion: recognition of moral distress by nurses and the opportunity for collective discussion and exchange of experiences are ways of collectively facing the situations. In addition, the institution's active participation in carrying out interventions was recommended. However, gaps were noticed in the production of studies that actually go deeper into intervention actions to cope with moral distress.
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Nemati R, Moradi A, Marzban M, Farhadi A. The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic. Work 2021; 70:1039-1046. [PMID: 34842218 DOI: 10.3233/wor-210558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance. OBJECTIVE This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis. RESULTS The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014). CONCLUSION The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.
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Affiliation(s)
- Reza Nemati
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ainaz Moradi
- Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Marzban
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
| | - Akram Farhadi
- Department of Health Education and Promotion, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran
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Moghaddam-Tabrizi F, Sodeify R. Lived Experiences of Nurses in the Care of Patients with COVID-19: A Study of Hermeneutic Phenomenology. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:537-543. [PMID: 34900654 PMCID: PMC8607901 DOI: 10.4103/ijnmr.ijnmr_319_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/04/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nurses are at the forefront of caring for patients with COVID-19 and face a life-threatening risk to perform their duties. The complexity of disease conditions such as emerging disease may interfere with good nursing care and holistic care. The aim of this study is to reveal the lived experiences of nurses in the care of patients with COVID-19. MATERIALS AND METHODS This qualitative study was conducted in Khoy, Iran from March 2020 to May 2020. Fourteen nurses underwent in-depth semi-structured interviews at COVID-19 Central Hospital. All interviews were recorded, transcribed, and analyzed. Diekelmann's hermeneutic phenomenological approach was used to analyze and interpret the data. MAXQDA software version 2007 was used to manage and organize the data. RESULTS After extensive analysis and reflection, four main themes emerged, including staying in an ethical dilemma, emotional turmoil, response to professional commitments, and seeking help. CONCLUSIONS The results of this study provided basic information about the lived experiences of nurses in different dimensions. Nursing managers need to be aware of these needs and expectations and provide a variety of programs and strategies not only to support nurses but also to ensure the quality of patient care.
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Affiliation(s)
- Fatemah Moghaddam-Tabrizi
- Department of Nursing and Midwifery, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Roghieh Sodeify
- Department of Medical Surgical Nursing, School of Nursing, Khoy University of Medical Sciences, Khoy, Iran
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Bagherzadeh M, Jafari H, Charati JY, Shafipour V. The effect of an empowerment program on the moral sensitivity and caring behaviors of emergency nurses in Iran. Nurse Educ Pract 2021; 57:103243. [PMID: 34717168 DOI: 10.1016/j.nepr.2021.103243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 09/06/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
AIM The present study aimed to evaluate the effect of an empowerment program on the moral sensitivity and caring behaviors of nurses in emergency departments in Iran. BACKGROUND Emergency department is often a high stress environment. Nurses who worked in the emergency departments are expected to work under pressure to many standards, guidelines and protocols related to patient care. It will expose emergency department nurses to psychological pressures and moral conflicts. A nurse's sensitivity to ethical issues is necessary to provide humane care; it is considered to be a professional competence for nurses. METHODS This study had a controlled quasi-experimental design. Data were collected before, immediately after, and 1 month after the intervention using a moral sensitivity questionnaire and a caring behavior questionnaire. A total of 131 emergency department nurses from 4 teaching hospitals were divided into an intervention group and a control group. The intervention group received six 60-minute training sessions; the control group did not receive the training. RESULTS The mean moral sensitivity and caring behavior scores for both groups increased significantly immediately and 1 month after the intervention. However, the significance was higher in the intervention group than in the control group. A comparison of the mean moral sensitivity and caring behavior scores between the groups immediately and 1 month after the intervention did not show a statistically significant difference. CONCLUSIONS Implementing a training program on ethical issues could thus have a significant impact on the clinical performance of nurses, which could be maintained through follow-up.
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Affiliation(s)
- Mahboubeh Bagherzadeh
- Student Research Committee, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hedayat Jafari
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Faculty of Health, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vida Shafipour
- Department of Medical-Surgical Nursing, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran.
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Chen Q, Su X, Liu S, Miao K, Fang H. The relationship between moral sensitivity and professional values and ethical decision-making in nursing students. NURSE EDUCATION TODAY 2021; 105:105056. [PMID: 34265538 DOI: 10.1016/j.nedt.2021.105056] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND More researchers have paid attention to the ethical decision-making in nursing worldwidely due to the increasing complexity of ethical issues and dilemmas. Ethical decision-making ability is regarded as one of the core competences of nursing practice and has the potential to resolve ethical issues. It is important to identify the key variables related to ethical decision-making and understand their relationship between them respectively. It is also helpful to design interventions to promote nursing students' ability to resolve ethical dilemmas. OBJECTIVE This study aims to examine the relationship between moral sensitivity, professional values and ethical decision-making respectively, and to explore whether professional values have mediating effect on the relationship between moral sensitivity and ethical decision-making among nursing undergraduates in Chinese nursing education context. DESIGN This study is a cross-sectional descriptive correlational design. METHODS 263 nursing undergraduates from Nursing and Health School, Zhengzhou University in Henan province of China participated in the study and received the investigation. Their ethical decision-making, moral sensitivity and professional values were measured through the following three questionnaires, including the Judgement About Nursing Decision (JAND), Chinese Moral Sensitivity Questionnaire-Revised Version (MSQ-R-CV) and Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV). The data were processed and analysed by SPSS 23.0 and AMOS 24.0. The statistical methods included descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation analyses and structural equation modeling. RESULTS Moral sensitivity is positively correlated with ethical decision-making (P < 0.01). Professional values is positively correlated with ethical decision-making (P < 0.01) and also has a mediating effect on the relationship between moral sensitivity and ethical decision-making (P < 0.01). CONCLUSION The investigation contributes to a broader understanding of the factors that influence nursing students' ethical decision-making. Developing ethics education around nursing students' professional values and moral sensitivity can improve their ethical decision-making ability.
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Affiliation(s)
- Qin Chen
- School of Nursing and Health, Zhengzhou University, China.
| | - Xiangdan Su
- No.3 Affiliated Hospital of Zhengzhou University, China
| | - Siyu Liu
- School of Nursing and Health, Zhengzhou University, China
| | - Kangkang Miao
- School of Nursing and Health, Zhengzhou University, China
| | - Huili Fang
- School of Nursing and Health, Zhengzhou University, China
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Chen XL, Fei Huang F, Zhang J, Li J, Ye BY, Chen YX, Zhang YH, Li F, Yu CF, Zhang JP. Tertiary hospital nurses' ethical sensitivity and its influencing factors: A cross-sectional study. Nurs Ethics 2021; 29:104-113. [PMID: 34296649 DOI: 10.1177/09697330211005103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND High ethical sensitivity positively affects the quality of nursing care; nevertheless, Chinese nurses' ethical sensitivity and the factors influencing it have not been described. RESEARCH OBJECTIVES The purpose of this study was to describe ethical sensitivity and to explore factors influencing it among Chinese-registered nurses, to help nursing administrators improve nurses' ethical sensitivity, build harmony between nurses and patients, and promote the patients' health. RESEARCH DESIGN This was a descriptive, cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT We recruited 500 nurses from several departments in three tertiary hospitals. The Chinese Moral Sensitivity Questionnaire-Revised version and the Jefferson Scale of Empathy-Health Professionals were used to assess the nurses' ethical sensitivity and empathy ability, respectively. Fifteen sociodemographic variables were included in the questionnaires. ETHICAL CONSIDERATIONS Informed consent was obtained from the participants regarding participation and data storage and handling. This program has been examined and supported by the research center of medical ethics and professional ethics of Guilin Medical University. The Approval No. was 2016RWYB04. The whole research process is conducted strictly according to ethical requirements. RESULTS The valid response rate was 84.40% (n = 422). The total score of Chinese Moral Sensitivity Questionnaire-Revised was 35.82 ± 8.17. The subscale scores of moral responsibility and strength and sense of moral burden were 21.50 ± 4.91 and 14.33 ± 3.98, respectively. Significant differences were found among age groups, gender, years of working, category of profession, and quality of family communication regarding nurses' ethical sensitivity (p < 0.05). Regression analysis showed that the main factors influencing nurses' ethical sensitivity were gender, years of working, quality of family communication, career satisfaction, and empathic ability. DISCUSSION Our findings suggest that Chinese nurses' ethical sensitivity in tertiary hospitals in Guilin is at a medium level. CONCLUSION The director of nursing schools and hospitals in China should pay attention to nurses' ethical sensitivity and should intensify education and training to improve nurses' ethical sensitivity. Further studies should focus on interventions aimed at improving Chinese nurses' ethical sensitivity.
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Affiliation(s)
- Xue Lei Chen
- Central South University, China; Guilin Medical University, China
| | | | | | | | | | | | | | - Fang Li
- The First Affiliated Hospital of Guilin Medical University, China
| | - Chun Fang Yu
- The Second Affiliated Hospital of Guilin Medical University, China
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Zhang N, Bu X, Xu Z, Gong Z, Gilal FG. Effect of Ethical Leadership on Moral Sensitivity in Chinese Nurses: A Multilevel Structural Equation Model. ANS Adv Nurs Sci 2021; 44:E78-E92. [PMID: 34397481 DOI: 10.1097/ans.0000000000000357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the relationship between ethical leadership (a contextual factor at the higher organizational level) and nurses' moral sensitivity (the individual outcome at a lower level), a cross-sectional quantitative study design was used. Participants were 525 nurses at 65 various departments in public tertiary hospitals. These results showed that ethical climate played a mediating role in the relationship between ethical leadership and nurses' moral sensitivity. Moreover, nurses' employment type moderated the mediating effect of ethical leadership on their moral sensitivity. Additionally, the link between ethical climate and moral sensitivity of contract nurses was stronger than that of nurses employed by the state.
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Affiliation(s)
- Na Zhang
- School of Economics and Management, Beijing Information Science & Technology University, Beijing, China (Dr Zhang); School of Economics and Management, University of Science and Technology Beijing, Beijing, China (Mr Bu); Medical College, Hebei University of Engineering, Handan, China (Dr Xu); School of Business, Liaocheng University, Liaocheng, China (Dr Gong); and Department of Business Administration, Sukkur IBA University, Sukkur, Pakistan (Dr Gilal)
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Afrasiabifar A, Mosavi A, Dehbanizadeh A, Khaki S. Nurses' caring behaviour and its correlation with moral sensitivity. J Res Nurs 2021; 26:252-261. [PMID: 35251248 PMCID: PMC8895006 DOI: 10.1177/1744987120980154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Different and contradictory results have been reported for nurses' caring behaviour and moral sensitivity. AIMS The present study aimed to examine the correlation between nurses' caring behaviour and moral sensitivity. METHODS The research was a descriptive, correlational study. Data were collected using moral sensitivity (range: 0-100) and caring behaviour (range: 24-144) questionnaires. A total of 250 nurses who worked in the clinical wards of Yasuj teaching hospitals in 2018, were selected by systematic random sampling. The collected data were analysed using SPSS version 19 for descriptive statistics and Pearson correlation tests. RESULTS Seventy-four percent of nurses had moderate moral sensitivity (50-74). Nurses' moral sensitivity and caring behaviour mean scores were reported to be 59.5 ± 11.1 (range: 31-87) (Potential range 0--100) and 110.99 ± 17.99 (range: 69-94) (Potential range 22-144), respectively. The Pearson test showed a positive correlation between nurses' caring behaviour and moral sensitivity at a 99% level (p = 0.001). CONCLUSIONS Nurses' moral sensitivity and caring behaviour were found to be moderate and good, respectively. Furthermore, there was a positive correlation between moral sensitivity and caring behaviour in nurses, that is, nurses provided better caring behaviour as levels of moral sensitivity increased.
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Affiliation(s)
| | - Asadolah Mosavi
- Clinical Nurse, School of Nursing, Yasuj University of Medical Sciences, Iran
| | | | - Sahar Khaki
- Clinical Nurse, School of Nursing, Yasuj University of Medical Sciences, Iran
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Prompahakul C, Keim-Malpass J, LeBaron V, Yan G, Epstein EG. Moral distress among nurses: A mixed-methods study. Nurs Ethics 2021; 28:1165-1182. [PMID: 33888021 DOI: 10.1177/0969733021996028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. OBJECTIVE This study aims to describe the experience of moral distress and related factors among Thai nurses. DESIGN A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated. PARTICIPANTS Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand. ETHICAL CONSIDERATIONS This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151. RESULTS A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress. DISCUSSION Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient's and family's religious perspective that ties into the concept of moral distress needs to be explored. CONCLUSIONS Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context.
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Safarpour H, Ghazanfarabadi M, Varasteh S, Bazyar J, Fuladvandi M, Malekyan L. The Association between Moral Distress and Moral Courage in Nurses: A Cross-Sectional Study in Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 25:533-538. [PMID: 33747844 PMCID: PMC7968592 DOI: 10.4103/ijnmr.ijnmr_156_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/15/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022]
Abstract
Background: Moral distress and moral courage among healthcare professionals have received considerable attention in recent years. However, there is a paucity of studies investigating these topics among nurses. Thus, the present study aimed to evaluate the association between moral distress and moral courage among nurses in an Iranian sample population. Materials and Methods: The present cross-sectional study was conducted during February–December 2018. Corley's Moral Distress (MDS-R) and Sekerka's moral courage scales were used to collect the data. MDS-R is a 21-items scale which includes frequency and intensity ranges from 0 (never) to 4 (very frequently) and 0 (none) to 4 (great extent), respectively. In addition, the moral courage scale contains 15 items ranging from “never true” (1 point) to “always true” (7 points). In total, 225 eligible nurses were entered into this study. Finally, SPSS-16 was used for statistical analysis at the α = 0.05 level. Results: The mean scores of the frequency and intensity of moral distress and moral courage were 45.41 (95% CI = 43.37-47.45), 44.24 (95% CI = 42.98-45.42), and 59.63 (95% CI = 58.50-60.87), respectively. Eventually, a significant relationship was found between the moral courage and frequency of moral distress (r = 0.46, p < 0.001) and the intensity of moral distress (r = 0.73, p < 0.001). Conclusions: In general, encouraging healthcare managers and administrators is considered as crucial for developing supportive structures and highly sensitive management which promotes moral courage while reducing moral distress in nurses' work setting.
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Affiliation(s)
- Hamid Safarpour
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ghazanfarabadi
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Saeideh Varasteh
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Jafar Bazyar
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Masoumeh Fuladvandi
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Leila Malekyan
- Clinical Research Center, Pastor Educational Hospital, Bam University of Medical Sciences, Bam, Iran
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Babamohamadi H, Bakuei Katrimi S, Paknazar F. Moral distress and its contributing factors among emergency department nurses: A cross-sectional study in Iran. Int Emerg Nurs 2021; 56:100982. [PMID: 33714726 DOI: 10.1016/j.ienj.2021.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Moral Distress (MD) is a common experience in nursing practice and constitutes one of the main reasons for professional burnout, job withdrawal, fatigue, and avoidance of patient care among nurses. The causes, frequency and severity of MD vary according to the ward and hospital of service. The present study was conducted to determine the frequency and severity of MD and its contributing factors among Emergency Department (ED) nurses in Iran. METHODS This descriptive cross-sectional study was conducted in 2019.A total of 203 participants were selected by census sampling from the 248 nurses working in the EDs of hospitals in Semnan Province, Iran. Data were collected using Corley's Moral Distress Scale-Revised and analyzed using descriptive and inferential statistics. FINDINGS The mean severity and frequency of MD were 1.36 ± 0.74 and 1.20 ± 0.68 out of 4, respectively. The MD levels were significantly higher in female nurses (p = 0.002), those under 30 years of age (p = 0.003), with less than ten years' work experience (p = 0.03), and with higher levels of education (p < 0.001). In addition, inverse and significant relationships were found between MD and the nurses' age (r = -0.202,p = 0.004) and work experience(r = -0.149, p = 0.034). CONCLUSION According to the results, nurses had moderate levels of MD. Numerous factors, including age, gender, work experience, and education, were associated with the total MD score.To reduce MD and its negative effects on nurses, it is necessary to address these factors and appropriately plan to identify and manage MD so as to improve the quality of nursing care.
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Affiliation(s)
- Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | | | - Fatemeh Paknazar
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Biostatistics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Hosseinabadi-Farahani M, Fallahi-Khoshknab M, Arsalani N, Hosseini M, Mohammadi E. Justice and unintentional discrimination in health care: A qualitative content analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:51. [PMID: 34084798 PMCID: PMC8057166 DOI: 10.4103/jehp.jehp_885_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Discrimination in health care is a common phenomenon whose complete understanding has always been a major concern of health-care systems to control and reduce it. This study aimed to explore the experiences of unintentional discrimination and related factors in health-care providers. MATERIALS AND METHODS: This qualitative study was conducted with a content analysis approach in 2019. Data were collected through semi-structured interviews with 13 health-care providers including two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling. The obtained data were analyzed by Graneheim and Lundman method. RESULTS: Three main categories and eight subcategories were obtained from the data analysis: (1) forced discrimination (superiors' pressures and executive orders, occupational concerns, and fear of the superiors); (2) guided discrimination (professional challenges, managers' policymaking, and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of medical equipment). CONCLUSION: The results of this study suggest that health-care providers such as doctors and nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing the factors that lead to superiors' pressures and occupational forces and improving the medical ethics knowledge should be considered by health-care managers.
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Affiliation(s)
| | | | - Narges Arsalani
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, University of Tarbiat Modares, Tehran, Iran
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KOVANCI MS, HİÇDURMAZ D. Ahlaki Cesaret: Tanımı, Ahlaki Sıkıntı ve Ahlaki Duyarlılık İle İlişkisi ve Geliştirilmesi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.683548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hakimi H, Joolaee S, Ashghali Farahani M, Rodney P, Ranjbar H. Moral neutralization: Nurses' evolution in unethical climate workplaces. BMC Med Ethics 2020; 21:114. [PMID: 33203415 PMCID: PMC7672869 DOI: 10.1186/s12910-020-00558-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Good quality of care is dependent on nurses’ strong clinical skills and moral competencies, as well. While most nurses work with high moral standards, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The study reported in this paper aimed to explore the experiences of nurses regarding negative changes in their moral practice. Materials and methods This was a qualitative study utilizing an inductive thematic analysis approach, which was conducted from February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews. Results The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: (1) feeling discouraged; (2) normalization; (3) giving up; (4) becoming a justifier; and (5) moral indifference. Conclusions Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both patients and health systems. Some unethical behaviors in nurses can be explained by this process.
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Affiliation(s)
- Hamideh Hakimi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soodabeh Joolaee
- UBC Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, BC, Canada
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Patricia Rodney
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran.
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Poveda-Moral S, Rodríguez-Martín D, Codern-Bové N, José-María P, Sánchez-Valero P, Pomares-Quintana N, Vicente-García M, Falcó-Pegueroles A. Managing ethical aspects of advance directives in emergency care services. Nurs Ethics 2020; 28:91-105. [PMID: 32996375 DOI: 10.1177/0969733020952112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient's advance directives and implement them. OBJECTIVES To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. RESEARCH DESIGN, PARTICIPANTS, AND CONTEXT This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. ETHICAL CONSIDERATIONS This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients' anonymity and willingness to participate in the study were guaranteed. FINDINGS There were four types of barriers that hindered the proper management of patients' advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals' decision-making. DISCUSSION These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals' beliefs and the opinions of colleagues and family members, can also influence the professionals' final decisions. CONCLUSION The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated.
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Affiliation(s)
- Silvia Poveda-Moral
- University of Barcelona, Spain; 212203Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (Universitat Autònoma de Barcelona), Spain; Barcelona College of Nursing, Spain
| | | | - Núria Codern-Bové
- 212203Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (Universitat Autònoma de Barcelona), Spain
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Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int J Nurs Stud 2020; 111:103767. [PMID: 32956930 DOI: 10.1016/j.ijnurstu.2020.103767] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND An increasing number of professionals are challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distress in different studies. Yet, there has not been, so far, a systematic assessment of the qualitative properties of the various instruments measuring moral distress in healthcare workers based on a universally accepted standardized framework. OBJECTIVE (1) To identify all instruments for the measurement of moral distress available in recent literature; (2) to evaluate the evidence regarding their measurement properties; (3) to facilitate the selection of the most appropriate instrument to be adopted in practice and research. DESIGN Systematic literature review. DATA SOURCES PubMed, CINAHL, and PyscINFO. REVIEW METHODS The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of the identified studies. The quality of measurement properties of each instrument was evaluated using Terwee's quality criteria. RESULTS Among the 1268 studies found, 88 full-text articles evaluated moral distress adopting different tools. Thirty two of them had a methodological design. The measurement instruments assessed in this review are different in terms of targeted population and items. The instruments were then divided into two main categories: (1) Corley's instruments on moral distress (Moral distress scale and Moral Distress Scale - Revised) and (2) instruments not directly derived from Corley's moral distress theory (Moral Distress thermometer, Moral Distress Risk Scale, Ethical Stress Scale or Moral Distress in Dementia Care Survey). The first set is the most frequently studied and used in different clinical settings and healthcare populations. A variety of psychometric properties have been evaluated for each instrument, revealing different qualities in the methodology used. CONCLUSIONS Several instruments assessing moral distress in healthcare workers have been identified and evaluated in this systematic review. Based on the criteria used here, Corley's instruments on moral distress seems to be the most useful and most appropriate to the clinical setting for practice and research purposes. TWEETABLE ABSTRACT The aim of this systematic review was to identify the instruments measuring moral distress now available in the literature, in order to (1) assess the evidence about their measurement properties, (2) support the selection of the most appropriate instrument to be used in practice and research.
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Affiliation(s)
- Noemi Giannetta
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Giulia Villa
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pennestrì
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Sala
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Mordacci
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
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Yasin JCM, Barlem ELD, Barlem JGT, Silveira RSD, Dalmolin GDL, Andrade GBD. The ethical dimension of problems faced in general medicine: relationship with moral sensitivity. Rev Lat Am Enfermagem 2020; 28:e3309. [PMID: 32876289 PMCID: PMC7458576 DOI: 10.1590/1518-8345.4033.3309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/23/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: to identify the main ethical problems and how these relate to the moral sensitivity of nurses working in a general medicine ward. Method: this qualitative, exploratory, and descriptive study was conducted in a university hospital located in the south of Brazil. A total of 18 nurses working in a general medicine ward were interviewed. A semi-structured interview script was used, and data were analyzed using discursive textual analysis. Results: nurses considered the main ethical problems to include conflicts at the institutional level, situations involving conflicts with patients and/or family members, and conflicts within the staff. The perception of nurses and how they deal with these problems relate to moral sensitivity. Two categories emerged: experiencing ethical problems, and relationship with moral sensitivity. Conclusion: because of the multidimensional nature of moral sensitivity, it trains and enables nurses to recognize and deal with ethical problems faced in clinical practice so that nurses become able to make fair and prudent decisions, improving the quality of nursing care.
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Sedaghati A, Assarroudi A, Akrami R, Rad M. Moral Distress and its Influential Factors in the Nurses of the Nursing Homes in Khorasan Provinces in 2019: A Descriptive-Correlational Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:319-324. [PMID: 33014744 PMCID: PMC7494168 DOI: 10.4103/ijnmr.ijnmr_158_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/09/2019] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
Background: Nurses in nursing homes are constantly faced with various moral decisions in terms of elderly care, which in turn causes moral distress. This study aimed to evaluate the moral distress status and its influential factors in the nursing homes in Khorasan provinces, Iran. Materials and Methods: This descriptive-correlational study was conducted on 227 nurses engaged in the nursing homes of Khorasan provinces in 2019. The subjects were selected via census sampling. Data were collected using demographic, occupational, and care center characteristics questionnaire and a moral distress questionnaire. Data analysis was performed in SPSS version 16 using the Mann–Whitney U and Kruskal–Wallis test. Results: The mean (SD) score of moral distress was 28.68 (19.19), and 93.83% of the subjects reported low levels of moral distress. Significant correlations were observed between moral distress and age, work experience, workplace, nurse–physician relations, motivation of the nurses, care facilities, and medical equipment. Furthermore, the highest mean (SD) score of moral distress belonged to the items regarding the lack of work experience 12.19 (3.12). Conclusions: According to the results, moral distress in the nurses of the studied nursing home was relatively low. Despite the favorable outcome of the study, the age discrimination of nurses by nursing homes should not be overlooked.
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Affiliation(s)
- Ali Sedaghati
- Student Research Committee, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Abdolghader Assarroudi
- Iranian Research Center on Healthy Aging, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Rahim Akrami
- Department of Biostatistics and Epidemiology, School of Health, Medicine and Quran Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mostafa Rad
- Assistant Professor in Nursing, Iranian Research Center on Healthy Aging, Department of Nursing, Nursing and Midwifery School, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Salehi PP, Jacobs D, Suhail-Sindhu T, Judson BL, Azizzadeh B, Lee YH. Consequences of Medical Hierarchy on Medical Students, Residents, and Medical Education in Otolaryngology. Otolaryngol Head Neck Surg 2020; 163:906-914. [DOI: 10.1177/0194599820926105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ObjectiveTo (1) review concepts of medical hierarchy; (2) examine the role of medical hierarchy in medical education and resident training; (3) discuss potential negative impacts of dysfunctional hierarchy in medical and surgical training programs, focusing on otolaryngology; and (4) investigate solutions to these issues.Data SourcesOvid Medline, Embase, GoogleScholar, JSTOR, Google, and article reference lists.Review MethodsA literature search was performed to identify articles relating to the objectives of the study using the aforementioned data sources, with subsequent exclusion of articles believed to be outside the scope of the current work. The search was limited to the past 5 years.ConclusionsTwo types of hierarchies exist: “functional” and “dysfunctional.” While functional medical hierarchies aim to optimize patient care through clinical instruction, dysfunctional hierarchies have been linked to negative impacts by creating learning environments that discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout. On the other hand, functional hierarchies may improve resident education and well-being, as well as patient safety.Implications for PracticeOtolaryngology–head and neck surgery programs ought to work toward creating healthy systems of hierarchy that emphasize collaboration and improvement of workplace climate for trainees and faculty. The goal should be to identify aspects of dysfunctional hierarchy in one’s own environment with the ambition of rebuilding a functional hierarchy where learning, personal health, and patient safety are optimized.
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Affiliation(s)
- Parsa P. Salehi
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Jacobs
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Timur Suhail-Sindhu
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Benjamin L. Judson
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Babak Azizzadeh
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Yan Ho Lee
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Kuilman L, Jansen GJ, Mulder LB, Middel B, Roodbol PF. Re-assessing the validity of the Moral Sensitivity Questionnaire (MSQ): Two new scales for moral deliberation and paternalism. J Eval Clin Pract 2020; 26:659-669. [PMID: 31975512 DOI: 10.1111/jep.13353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/25/2019] [Accepted: 12/28/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The current study and previous research have called the six-component model of Lützen's 30-item Moral Sensitivity Questionnaire (MSQ) into question. For this reason, we re-examined the construct validity of this instrument. METHODS In this cross-sectional study, which was based on a convenience sample of Dutch nurse practitioners (NPs) and physician assistants (PAs), we tested the validity of MSQ items using exploratory and confirmatory factor analyses (EFA and CFA, respectively). RESULTS The EFA revealed a two-component model, which was then tested as a target model with CFA and was found to have good model fit. Some items were correlated with two uncorrelated latent constructs, which we labelled as "paternalistic" and "deliberate" attitudes towards patients. CONCLUSIONS As in previous studies, the analyses in the current study, which was conducted among PAs and NPs, did not reveal six dimensions for the 30 items. Two new latent dimensions of moral sensitivity were psychometrically tested and confirmed. These two components relate to studies investigating ethical behaviour, and they can be used to describe the moral climate in healthcare organizations. The scales are indicators of the extent to which health professionals behave in a deliberate (sensitive) or paternalistic (insensitive) manner towards the opinions of patients within the context of medical decision-making.
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Affiliation(s)
- Luppo Kuilman
- Nursing Research Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Physician Assistant Studies, College of Health and Human Service, Northern Arizona University, Arizona, USA
| | - Gerard J Jansen
- Nursing Research Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Laetitia B Mulder
- Department of Human Resource Management & Organizational Behaviour, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Berrie Middel
- Department of Health Sciences, Community & Occupational Medicine Division, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Petrie F Roodbol
- Nursing Research Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Jones-Bonofiglio K. Acute Care Contexts. HEALTH CARE ETHICS THROUGH THE LENS OF MORAL DISTRESS 2020. [DOI: 10.1007/978-3-030-56156-7_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Yasin JCM, Barlem ELD, Barlem JGT, Andrade GBD, Silveira RSD, Dalmolin GDL. ELEMENTS OF MORAL SENSITIVITY IN THE PRACTICE OF CLINICAL HOSPITAL NURSES. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify the elements of moral sensitivity held by nurses working in a medical clinic unit. Method: this exploratory-descriptive study with a qualitative approach addressed 18 nurses from a medical clinic of a university hospital located in southern Brazil using semi-structured interviews, which were analyzed using discursive textual analysis. Results: data were structured into six categories: relational orientation; experiencing moral dilemmas; following rules; benevolent motivation; structuring moral meaning; and autonomy. These categories enabled the identification of important elements of moral sensitivity, such as acknowledging the ethical dimension of one’s attitudes, acknowledging the uniqueness of each patient, dealing with conflict between workers and patients and/or their companions, adapting to the workplace, empathy, dialogue, clinical decision-making, meeting the needs of patients, understanding patients’ health condition, respect, welcoming patients’ desires and providing guidance that concerns patients’ requests and refusals. Conclusion: the elements of moral sensitivity identified in this study contribute to support nurses when making clinical decisions, especially when facing ethical issues arising in a medical clinic setting.
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Tomaschewisk-Barlem JG, Schallenberger CD, Ramos-Toescher AM, Barlem ELD, Rocha LP, Castanheira JS. Estratégias para o desenvolvimento da sensibilidade moral: perspectiva dos enfermeiros de unidades de terapia intensiva. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo conhecer estratégias para o desenvolvimento da sensibilidade moral na perspectiva dos enfermeiros que atuam em unidades de terapia intensiva. Método pesquisa qualitativa, do tipo exploratório descritiva, realizada com 19 enfermeiros atuantes em três unidades de terapia intensiva de um hospitalfilantrópico do Sul do Brasil através de entrevistas semiestruturadas, analisadas mediante análise textual discursiva. Resultados emergiram duas categorias: desenvolvimento da sensibilidade moral a partir da formação acadêmica e desenvolvimento da sensibilidade moral a partir da experiência profissional. Entre as estratégias verificadas destacaram-se as discussões e reflexões acerca de problemas éticos, a vivência de atividades extracurriculares, a comunicação efetiva, o trabalho multidisciplinar, a realização de reuniões, a busca pelo conhecimento e a educação permanente em saúde. Conclusões e implicações para a prática o desenvolvimento da sensibilidade moral dos enfermeiros pode auxiliá-los no reconhecimento e enfrentamento de situações eticamente inadequadas, de modo a favorecer o exercício da autonomia e a capacidade de lidar com os conflitos éticos emergentes do contexto de trabalho. Neste estudo, foi possível conhecer ainda, que priorizar espaços para a reflexão e discussão coletiva nos ambientes de formação e atuação da enfermagem, oportuniza o fortalecimento de tomadas de decisões éticas, coerentes, autônomas e eficientes.
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Prompahakul C, Epstein EG. Moral distress experienced by non-Western nurses: An integrative review. Nurs Ethics 2019; 27:778-795. [PMID: 31750780 DOI: 10.1177/0969733019880241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Moral distress has been identified as a significant issue in nursing practice for many decades. However, most studies have involved American nurses or Western medicine settings. Cultural differences between Western and non-Western countries might influence the experience of moral distress. Therefore, the literature regarding moral distress experiences among non-Western nurses is in need of review. AIM The aim of this integrative review was to identify, describe, and synthesize previous primary studies on moral distress experienced by non-Western nurses. REVIEW METHOD Whittemore and Knafl's integrative review methodology was used to structure and conduct the review of the literature. RESEARCH CONTEXT AND DATA SOURCES Key relevant health databases included the Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar databases. Two relevant journals, Nursing Ethics and Bioethics, were manually searched. ETHICAL CONSIDERATION We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. FINDINGS A total of 17 primary studies published between 1999 and 2019 were appraised. There was an inconsistency with regard to moral distress levels and its relationship with demographic variables. The most commonly cited clinical causes of moral distress were providing futile care for end-of-life patients. Unit/team constraints (poor collaboration and communication, working with incompetent colleagues, witnessing practice errors, and professional hierarchy) and organizational constraints (limited resources, excessive administrative work, conflict within hospital policy, and perceived lack of support by administrators) were identified as moral distress's stimulators. Negative impacts on nurses' physical, psychological, and spiritual well-being were also reported. CONCLUSION Further research is needed to investigate moral distress among other healthcare professions which may further build understanding. More importantly, interventions to address moral distress need to be developed and tested.
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Kamali F, Yousefy A, Yamani N. Design and psychometric properties of an instrument to assess metacognition in moral reasoning in medicine. Nurs Open 2019; 6:1331-1345. [PMID: 31660160 PMCID: PMC6805282 DOI: 10.1002/nop2.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/04/2019] [Accepted: 05/29/2019] [Indexed: 11/06/2022] Open
Abstract
AIM The present study aims at designing and assessing the psychometric properties of MCMR instruments to lead the medical ethics education to further goals and more definite steps. DESIGN This is a cross sectional study. METHOD This study was conducted in two phases; identifying the items and designing the instrument. In the preliminary phase, the qualitative study was carried out using conventional content analysis method. In the second phase, psychometric evaluation of instrument was done using face and content validity, construct validity and reliability. RESULTS On the first phase of this study, 135 items were identified. After determining face and content validity, 111 items reached the stage of exploratory factor analysis. This instrumental analysis indicated the existence of 74 items and ten factors whose variance of the total is explained as 46.883%. Cronbach's alpha value was 0/75. And the intra-cluster correlation coefficient was 0.808.
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Affiliation(s)
- Farahnaz Kamali
- Department of Medical Education, Medical Education Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Alireza Yousefy
- Department of Medical Education, Medical Education Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Nikoo Yamani
- Department of Medical Education, Medical Education Research CenterIsfahan University of Medical SciencesIsfahanIran
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