1
|
Ahmad AM, Bani-Issa W, Refaat F. Factors contributing to moral distress among intensive care nurses: A scoping review. F1000Res 2024; 11:1574. [PMID: 39015746 PMCID: PMC11249504 DOI: 10.12688/f1000research.127120.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background: The intensive care unit (ICU) is a busy and complex workplace, and several work-related and personal factors are known to make ICU nurses more vulnerable to moral distress than other healthcare professionals. It is crucial to identify these factors to guide future studies and preventive strategies. This scoping review explores such factors to present current knowledge on the factors that trigger moral distress and to guide future research by reviewing studies to explore and summarize factors that trigger moral distress in ICU nurses. Methods: The PubMed, EBSCO, and CINAHL Plus databases were searched to identify potentially relevant studies published between 2011 to 2022. Inclusion criteria: peer-reviewed studies published in English that provided results regarding factors causes or correlated to moral distress in ICU nurses. After removing 618 duplicates, 316 papers were excluded after title and abstract screening, leaving 71 articles for full-text screening. A further 54 articles were excluded as their outcomes did not include factors that caused moral distress, or were not specific to ICU nurses, so 17 studies were eventually analysed using qualitative content analysis through an inductive approach. The findings of the articles were extracted and coded independently by two authors, and data were grouped and categorized. Results: The content categories of factors contributing to ICU nurses' moral distress were organized into themes and subthemes. Four major themes were identified: Powerlessness, end-of-life care, ineffective teamwork, and personal characteristics of ICU nurses. Conclusions: This review highlights the factors that contribute to moral distress in critical care nurses, which are mainly attributable to the organizational climate and the nature of the ICU clinical environment. Descriptive and intervention studies (experimental or action research) must investigate causality between identified variables to inform management strategies to improve support for ICU nurses' coping relative to moral distress.
Collapse
Affiliation(s)
| | | | - Fatma Refaat
- University of Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|
2
|
Marznaki ZH, Khalilizad M, Moradi A, Mamun MA. Impact of spirituality on elderly people's quality of life and life satisfaction after acute myocardial infarction: Iranian hospital-based study. BJPsych Open 2023; 10:e4. [PMID: 38059462 PMCID: PMC10755561 DOI: 10.1192/bjo.2023.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND As people age, survival after a heart attack can affect their quality of life and lead to a decrease in life satisfaction. After a myocardial infarction, elderly patients may experience physical, psychological, emotional and social changes that affect their thoughts and behaviour in relation to spirituality. AIMS To investigate the relationship between spiritual well-being and other sociodemographic and medical history-related factors on quality of life and life satisfaction among elderly people after myocardial infarction. METHOD In a census-based cross-sectional study conducted at the Imam Reza Hospital in Amol, Iran, from May 2020 to May 2021, data on sociodemographics, medical history, subjective well-being, life satisfaction and quality of life were collected from 502 participants who were referred at the heart clinic. RESULTS The findings showed that spiritual well-being dimensions (religious well-being, [self-assessment of one's relationship with God], and existential well-being, [self-assessment of one's sense of purpose in life and life satisfaction]) were not significantly associated with life satisfaction, but a high perception of both dimensions of spiritual well-being were associated with higher self-reported quality of life. A history of past-year hospital admission and cardiopulmonary resuscitation were significant predictors of life satisfaction, and educational level was a predictor of quality of life. CONCLUSIONS The study found no significant association between spiritual well-being and life satisfaction among elderly people following myocardial infarction. This finding might have been influenced by the physical and emotional challenges experienced by the participants during the COVID-19 pandemic. Further studies are needed to confirm this relationship.
Collapse
Affiliation(s)
| | - Majid Khalilizad
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti Hospital, Babol, Iran; and Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Azadeh Moradi
- Imam Reza Hospital at Amol City, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Dhaka, Bangladesh; Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh; and Department of Public Health, University of South Asia, Dhaka, Bangladesh
| |
Collapse
|
3
|
Manookian A, Nadali J, Ghiyasvandian S, Weaver K, Haghani S, Divani A. Spiritual care competence, moral distress and job satisfaction among Iranian oncology nurses. Int J Palliat Nurs 2023; 29:487-497. [PMID: 37862158 DOI: 10.12968/ijpn.2023.29.10.487] [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: 10/22/2023]
Abstract
BACKGROUND Nurses have a crucial role in identifying spiritual needs and providing spiritual care to patients living with cancer. AIM This study evaluated Iranian oncology nurses' spiritual care competence and its relationship with job satisfaction and moral distress. METHOD This cross-sectional study was conducted on 280 Iranian oncology nurses in 2020 using four questionnaires: demographic questionnaires, the Spiritual Care Competence Questionnaire (SCCQ), the Minnesota Job Satisfaction Questionnaire (MSQ) and the nurses' Moral Distress Questionnaire (MDS-R). FINDINGS The mean scores indicated a medium to high Spiritual Care Competence (SCC), mild to moderate moral distress and high job satisfaction. There was a positive correlation between SCC and external job satisfaction (r=184, p<0.05) and a negative correlation between SCC and moral distress (r=-0.356, p<0.05). CONCLUSIONS SCC diminishes with decreasing external job satisfaction and increasing moral distress. To improve the SCC of nurses working with patients living with cancer, it is recommended that nursing managers and policymakers revise the organisational policies to tackle the obstacles and consider the related factors to provide an ethical climate, implement quality spiritual care and increase job satisfaction.
Collapse
Affiliation(s)
- Arpi Manookian
- Associate Professor of Nursing, USERN CARE (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Iran
| | - Javad Nadali
- Clinical Instructor of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Iran
| | - Shahrzad Ghiyasvandian
- Professor of Nursing, Medical-Surgical Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Iran
| | - Kathryn Weaver
- Honorary Research Professor, Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Shima Haghani
- Biostatistical Supervisor, Biostatistics Department, Iran University of Medical Sciences, Iran
| | - Anahita Divani
- Oncology Nurse Practitioner, Cancer Institute of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran
| |
Collapse
|
4
|
Duzgun MV, Ozdemir C, Karazeybek E, Isler A. Psychometric properties of the Turkish version of the moral distress-appraisal scale for nurses. Arch Psychiatr Nurs 2023; 46:21-25. [PMID: 37813499 DOI: 10.1016/j.apnu.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 06/25/2023] [Indexed: 10/17/2023]
Abstract
Moral distress causes frustration, guilt, anger, stress, sadness, anxiety, fear, burnout, insecurity, and depression in nurses, and this is reflected in their work performances. Therefore, internationally validated tools and methodological studies are needed to measure moral distress among nurses. This study aims to evaluate the psychometric properties of the Turkish version of the Moral Distress-Appraisal Scale (MD-APPS) among nurses in Turkey. Psychometric properties of the Turkish version of the Moral Distress-Appraisal Scale (MD-APPS), which included internal consistency reliability and construct validity with factor analysis, were examined in a sample of 420 nurses working in different hospitals in Turkey completed the study between February and July 2022. The content validity index of the Turkish version of the MD-APPS based on expert opinions was 0.90. Through exploratory factor analysis for construct validity, a two-factor structure was obtained as in the original scale. The variance explained by these two factors was 56.67 %. Confirmatory factor analysis showed that the scale was valid, while internal consistency coefficient and test-retest results demonstrated that the scale was reliable. The Turkish version of the MD-APPS is a valid and reliable tool for evaluating moral distress among nurses.
Collapse
Affiliation(s)
- Mustafa Volkan Duzgun
- University of Akdeniz, Faculty of Nursing, Department of Pediatric Nursing, Dumlupınar Boulevard Campus, 07070 Antalya, Turkey.
| | - Cafer Ozdemir
- University of Akdeniz, Faculty of Nursing, Department of Surgical Nursing, Dumlupınar Boulevard Campus, 07070 Antalya, Turkey.
| | - Ebru Karazeybek
- University of Akdeniz, Faculty of Nursing, Department of Surgical Nursing, Dumlupınar Boulevard Campus, 07070 Antalya, Turkey.
| | - Ayşegül Isler
- University of Akdeniz, Faculty of Nursing, Department of Pediatric Nursing, Dumlupınar Boulevard Campus, 07070 Antalya, Turkey.
| |
Collapse
|
5
|
Shomalinasab E, Bagheri Z, Jahangirimehr A, Bahramnezhad F. The Nurses' Second Victim Syndrome and Moral Distress. Nurs Ethics 2023; 30:822-831. [PMID: 36988002 DOI: 10.1177/09697330221142079] [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: 03/30/2023]
Abstract
BACKGROUND The increasing prevalence of moral distress in the stressful environment of the intensive care unit (ICU) provides grounds for nursing error and endangers patients' health, safety, and even life. One of the most important reasons for this distress is the treatment team's second victim syndrome (SVS), especially nurses, following errors in the treatment system. OBJECTIVES The present study aimed to determine the relationship between moral distress and SVS in ICUs. RESEARCH DESIGN This cross-sectional study involved a sample size of 96 ICU nurses working in hospitals affiliated with Tehran University of Medical Sciences, Iran, in the 2021-2022 period, who were selected via a simple random sampling method. Data were collected using the Demographic Questionnaire, the second victim experience and support tool (SVEST) and Moral Distress Scale-Revised (MDS-R). Descriptive statistics (percentage, frequency, mean, and SD) and analytical tests (Spearman correlation coefficient test, independent t-test, and ANOVA) were employed for data analysis. PARTICIPANTS AND RESEARCH CONTEXT This study used a sample size of 96 intensive care unit nurses working in hospitals affiliated to Tehran University of Medical Sciences selected by simple random sampling. ETHICAL CONSIDERATIONS The study obtained research ethics approval, and all participants were informed of the voluntary and anonymous nature of their participation. FINDINGS The results showed that 59.4% of nurses suffered a low level of moral distress, and 40.6% suffered from a moderate level of moral distress. The SVS score of 86.5% of the nurses was moderate. There was no significant and direct correlation between moral distress and SVS in nurses; however, there was a significant and inverse correlation between the moral distress intensity and SVS (p = 0.011). CONCLUSION Despite no significant correlation between moral distress and SVS, these variables were at moderate levels. Accordingly, it is suggested to provide a proper ground for expressing morally stressful situations, counseling and training strategies to deal with moral distress, creating support resources for those suffering from SVS, and implementing empowerment programs.
Collapse
Affiliation(s)
- Esmat Shomalinasab
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Fatemeh Bahramnezhad
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Topan A, Taşdelen Y, Yiğit D, Terzi S, Üstüner Top F. Moral Distress and Its Relating Factors Among Pediatric Emergency Department Nurses: A Cross-Sectional Study. Pediatr Emerg Care 2023; 39:692-697. [PMID: 37463256 DOI: 10.1097/pec.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Emergency services are patient circulation units that require chaos, trauma, and high tension. It was aimed to determine the moral distress levels of pediatric nurses in pediatric emergency and emergency departments and relevant factors. METHODS This study is a descriptive and cross-sectional study. It consists of 255 nurses with their data. The Participant Information Form and the Moral Distress Scale-Revised for Pediatric Nurses (MDS-R) were used to collect data. RESULTS In the study, the mean score of MDS-R frequency was found to be 27.36 ± 13.16, the mean score of MDS-R intensity to be 37.65 ± 17.53, and the mean total score of MDS-R to be 58.96 ± 39.40. It was determined that 93.7% of the nurses received training on moral distress, and education level was effective on moral distress levels of the nurses. The nurses working in the pediatric emergency service had higher moral distress levels than the nurses serving pediatric patients in the emergency department ( P(total MDS-R) = 0.02, P(frequency of MDS-R) = 0.008). Job satisfaction ( P(total MDS-R) = 0.003, P(frequency of MDS-R) < 0.001, P(intensity of MDS-R) < 0.001) and frequency of thinking about changing working unit ( P(frequency of MDS-R) = 0.02, P(intensity of MDS-R) = 0.01) were found to be effective on the level of moral distress. It was determined that the type of emergency service, the working time in the emergency service, and the level of job satisfaction significantly affected the total moral distress scores of the nurses ( P < 0.001, R2 = 0.09). CONCLUSIONS It was found in the study that nurses had low levels of moral distress; however, many factors relevant to working conditions were associated with moral distress. The pediatric emergency service nurses were determined to experience a higher moral distress compared with the emergency department nurses serving pediatric patients.
Collapse
Affiliation(s)
- Aysel Topan
- From the Department of Nursing, Faculty of Health Science, Zonguldak Bülent Ecevit University, Zonguldak
| | - Yeliz Taşdelen
- Department of Nursing, Faculty of Health Science, Karabük University, Karabük
| | | | | | - Fadime Üstüner Top
- Department of Pediatric Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey
| |
Collapse
|
7
|
Watts T, Sydor A, Whybrow D, Temeng E, Hewitt R, Pattinson R, Bundy C, Kyle RG, Jones B. Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed-methods systematic review and thematic synthesis. Nurs Open 2023; 10:6014-6032. [PMID: 37458290 PMCID: PMC10416007 DOI: 10.1002/nop2.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
AIM To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and professional and career intentions. DESIGN Joanna Briggs Institute mixed-methods systematic review and thematic synthesis. Registered in Prospero (Redacted). METHODS Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction. RESULTS Searches yielded 2343 hits. Seventy-seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well-being. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to this systematic review.
Collapse
Affiliation(s)
- Tessa Watts
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Anna Sydor
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Dean Whybrow
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Eunice Temeng
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Rachael Hewitt
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | | | - Richard G. Kyle
- Public Health WalesCardiffUK
- Academy of NursingUniversity of ExeterExeterUK
| | - Bethan Jones
- School of Healthcare SciencesCardiff UniversityCardiffUK
- School of Health and Social WellbeingUniversity of West of EnglandBristolUK
| |
Collapse
|
8
|
Tavakol N, Molazem Z, Rakhshan M, Asemani O. An educational program of reducing moral distress (PRMD) in nurses; designing and evaluating. BMC MEDICAL EDUCATION 2023; 23:501. [PMID: 37434166 DOI: 10.1186/s12909-023-04445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Moral distress is common phenomenon that has negative consequences on nurses, patients, and healthcare systems. This study aims to design and evaluate an educational program to reduce moral distress in nurses. METHODS This multiphase mixed-method study was done in three stage on February 2021 in Shiraz/Iran. In pre-implementation stage, a content analysis study was conducted on 12 participants were interviewed using purposive sampling and then the program was designed according to qualitative data, panel of expertise and literature review according the seven steps of Ewles and Sminett's model and implemented in one group on 40 nurses using a quasi-experimental design. In Post-Implementation stage, effectiveness of program was evaluated through quantitative and qualitative methods. Quantitative data were gathered by Hamric's 21-question moral distress questionnaire analyzed via SPSS v.25 and analysis of variance repeated measures test. Also, a content analysis study was conducted on 6 PRMD participants using purposive sampling. In Program evaluation stage, convergence of quantitative and qualitative data and the effects of the program were examined. Trustworthiness of qualitative data was accomplished by Lincoln and Guba criteria. RESULTS First quantitative study revealed the causes of moral distress consisted of deficiency in professional competency, unsuitable organizational culture, personal factors, environmental and organizational factors, management factors, insufficiencies in proficient and efficient communication and nurses' observation of moral dilemma. Results of quantitative stage showed that there was a significant difference (p < 0.05) between the mean score of moral distress before, after, 1 and 2 months after the intervention. The participants in secondary qualitative stage, reported increasing their moral knowledge and skills, improving ethical climate, and moral empowerment. CONCLUSION The use of different educational tools and teaching methods and the participation of managers in designing strategies had a very effective role in the effectiveness of this educational program.
Collapse
Affiliation(s)
- Nahid Tavakol
- Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Ethics Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Zahra Molazem
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Asemani
- Department of Medical Ethics and Philosophy of Health, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, IR, Iran
- Center for Interdisciplinary Research in Islamic Education and Health Sciences, Shiraz University of Medical Sciences, Shiraz, IR, Iran
| |
Collapse
|
9
|
Xiao Q, Liang X, Liu L, Klarin A, Zhang C. How do work–life balance programmes influence nurses' psychological well‐being? The role of servant leadership and learning goal orientation. J Adv Nurs 2023. [DOI: 10.1111/jan.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
|
10
|
Koonce M, Hyrkas K. Moral distress and spiritual/religious orientation: Moral agency, norms and resilience. Nurs Ethics 2023; 30:288-301. [PMID: 36536511 DOI: 10.1177/09697330221122905] [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: 12/24/2022]
Abstract
BACKGROUND Nurses tasked with providing care which they perceive as increasing suffering often experience moral distress. Response to moral distress in nurse wellbeing has been widely studied. Less research exists that probes practicing nurses' foundations of moral beliefs. AIMS The purpose of this phenomenological study was to gain understanding of nurse meaning-making of morally distressing situations, with particular attention to ethical norms, moral agency and resiliency, and nurse religious/spiritual orientation. DESIGN This exploratory study employed semi-structured interviews using open-ended questions. Qualitative data analysis was assisted by MAXQDA software. PARTICIPANTS AND RESEARCH CONTEXT Nine pulmonary care nurses during COVID-19 in a tertiary care teaching hospital in the northeastern United States. ETHICAL CONSIDERATIONS The study was approved by the IRB. Participants were consented before the study and confidentiality was preserved. FINDINGS/RESULTS The study revealed three main themes of meaning-making, rooted in the identity of the "good nurse": Being true to one's own values, pursuing ideal patient care ("doing good"), and conforming to/challenging values of the system and culture. Tensions were found between (a) nurse's own values (b) duty to institutional norms and duty to nurse's personal code of ethics, and (c) perceptions of institutional support in response to nurse moral distress. Religion was described as a remote source of nurse moral values, among other sources. Spiritual practices were not experienced as sufficient in coping with moral distress at the bedside. CONCLUSIONS The study suggests nurses need more opportunities to engage in reflection on their practice and values. The findings also indicate need for accessible institutional supports for nurses experiencing moral distress and strategic use of chaplains in helping with moral distress. Further research is needed on the interplay of nurse spirituality, moral agency, and reflective practice in the face of morally challenging situations.
Collapse
Affiliation(s)
- Myrna Koonce
- Spiritual Care Coordinator for Palliative Medicine, 92602Maine Medical Center, Portland, ME, USA
| | - Kristiina Hyrkas
- Center for Nursing Research and Quality Outcomes, 92602Maine Medical Center, Portland, ME, USA
| |
Collapse
|
11
|
Alimoradi Z, Jafari E, Lin CY, Rajabi R, Marznaki ZH, Soodmand M, Potenza MN, Pakpour AH. Estimation of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics 2023; 30:334-357. [PMID: 36704986 PMCID: PMC9902807 DOI: 10.1177/09697330221135212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. AIM To estimate moral distress among nurses. METHODS This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. ETHICAL CONSIDERATION The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. RESULTS Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. CONCLUSION The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.
Collapse
Affiliation(s)
| | - Elahe Jafari
- 113106Qazvin University of Medical Sciences, Qazvin, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | | | | | | | - Marc N Potenza
- Yale University, USA; Connecticut Council on Problem Gambling, USA; Connecticut Mental Health Center, USA; Wu Tsai Institute, Yale University, USA
| | - Amir H Pakpour
- Jönköping University, Sweden; Qazvin University of Medical Sciences, Iran
| |
Collapse
|
12
|
Momennasab M, Homayoon Z, Torabizadeh C. Critical Care Nurses' Adherence to Ethical Codes and Its Association with Spiritual Well-Being and Moral Sensitivity. Crit Care Res Pract 2023; 2023:8248948. [PMID: 37197156 PMCID: PMC10185430 DOI: 10.1155/2023/8248948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 04/08/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023] Open
Abstract
Background Adherence to ethical codes is a major pillar of nursing care that is affected by various factors. Identifying these factors can lead to better ethical performance. The present study was conducted to determine critical care nurses' adherence to ethical codes and its association with spiritual well-being (SWB) and moral sensitivity (MS). Methods In this descriptive-correlational study, data were collected using the moral sensitivity questionnaire (MSQ) by Lützén et al., Paloutzian and Ellison's spiritual well-being scale (SWBS), and the adherence to ethical codes questionnaire. The study was conducted on 298 nurses working in critical care units of hospitals affiliated with Shiraz University of Medical Sciences in southern Iran in 2019. This study was examined and approved by the Ethics Committee of Shiraz University of Medical Sciences. Results The majority of the participants were female (76.2%) and single (60.1%), with a mean age of 30.69 ± 5.74 years. The mean scores of adherence to ethical codes, SWB, and MS were 64.06 (good), 91.94 (moderate), and 134.08 (moderate), respectively. Adherence to ethical codes had a positive correlation with the total score of SWB (P < 0.001, r = 0.25) and MS (P < 0.001, r = 0.27). A positive correlation was also observed between MS and SWB (P < 0.001, r = 0.41). Meanwhile, MS (β = 0.21) had a greater effect than SWB (β = 0.157) on adherence to ethical codes. Conclusion Critical care nurses showed a good adherence to ethical codes. MS and SWB also positively affected their adherence to ethical codes. Nursing managers can use these findings to devise plans for the promotion of MS and SWB in nurses and thus help improve their ethical performance.
Collapse
Affiliation(s)
- Marzieh Momennasab
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Homayoon
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Giannetta N, Villa G, Bonetti L, Dionisi S, Pozza A, Rolandi S, Rosa D, Manara DF. Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10640. [PMID: 36078353 PMCID: PMC9517876 DOI: 10.3390/ijerph191710640] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No systematic review in the literature has analyzed the intensity and frequency of moral distress among ICU nurses. No study seems to have mapped the leading personal and professional characteristics associated with high levels of moral distress. This systematic review aimed to describe the intensity and frequency of moral distress experienced by nurses in ICUs, as assessed by Corley's instruments on moral distress (the Moral Distress Scale and the Moral Distress Scale-Revised). Additionally, this systematic review aimed to summarize the correlates of moral distress. METHODS A systematic search and review were performed using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Library of Medicine (MEDLINE/PubMed), and Psychological Abstracts Information Services (PsycINFO). The review methodology followed PRISMA guidelines. The quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. RESULTS Findings showed a moderate level of moral distress among nurses working in ICUs. The findings of this systematic review confirm that there are a lot of triggers of moral distress related to patient-level factors, unit/team-level factors, or system-level causes. Beyond the triggers of moral distress, this systematic review showed some correlates of moral distress: those nurses working in ICUs with less work experience and those who are younger, female, and intend to leave their jobs have higher levels of moral distress. This systematic review's findings show a positive correlation between professional autonomy, empowerment, and moral distress scores. Additionally, nurses who feel supported by head nurses report lower moral distress scores. CONCLUSIONS This review could help better identify which professionals are at a higher risk of experiencing moral distress, allowing the early detection of those at risk of moral distress, and giving the organization some tools to implement preventive strategies.
Collapse
Affiliation(s)
- Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Centre, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Debora Rosa
- Department of Cardiovascular, Neural, and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
15
|
Carletto S, Ariotti MC, Garelli G, Di Noto L, Berchialla P, Malandrone F, Guardione R, Boarino F, Campagnoli MF, Savant Levet P, Bertino E, Ostacoli L, Coscia A. Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148526. [PMID: 35886379 PMCID: PMC9323986 DOI: 10.3390/ijerph19148526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022]
Abstract
Moral distress (MD) in healthcare providers is widely recognized as a serious issue in critical care contexts. It has the potential to have negative impacts on both personal and professional wellbeing, the quality of care provided and staff turnover. The aim of this study was to investigate the relationship between MD and burnout among neonatal intensive care unit (NICU) healthcare professionals and identify the possible factors associated with its occurrence. Participants were asked to complete an online survey, which covered sociodemographic and professional information and included two self-report questionnaires (Italian Moral Distress Scale-Revised and Maslach Burnout Inventory). The sample comprised 115 healthcare providers (nurses and physiotherapists: 66.1%; physicians: 30.4%; healthcare assistants: 3.5%) working in four NICUs located within the province of Turin, Italy. The results revealed overall low levels of MD, with no significant differences between nurses/physiotherapists and physicians. Nurses/physiotherapists showed a statistically significant higher percentage of personal accomplishment burnout (32.9%) compared with physicians (8.6%; p = 0.012). MD was associated with the emotional exhaustion dimension of burnout. Spirituality and/or religiousness was shown to be a moderating variable. Further research is needed to deepen our understanding of the correlation between MD and burnout and the role of spirituality and/or religiousness as moderators.
Collapse
Affiliation(s)
- Sara Carletto
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, 10126 Turin, TO, Italy;
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
| | - Maria Chiara Ariotti
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| | - Giulia Garelli
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
| | - Ludovica Di Noto
- Formerly at the School of Medicine, University of Torino, 10126 Turin, TO, Italy;
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
| | - Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
- Correspondence:
| | - Roberta Guardione
- Neonatal Care Unit, City of Health and Science University Hospital of Torino, 10126 Turin, TO, Italy; (R.G.); (M.F.C.)
| | - Floriana Boarino
- Neonatal Care Unit, Santa Croce Hospital ASL TO5, 10024 Moncalieri, TO, Italy;
| | - Maria Francesca Campagnoli
- Neonatal Care Unit, City of Health and Science University Hospital of Torino, 10126 Turin, TO, Italy; (R.G.); (M.F.C.)
| | - Patrizia Savant Levet
- Neonatal Intensive Care Unit, Maria Vittoria Hospital, ASL Città di Torino, 10144 Turin, TO, Italy;
| | - Enrico Bertino
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| | - Luca Ostacoli
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
| | - Alessandra Coscia
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| |
Collapse
|
16
|
Nikbakht Nasrabadi A, Wibisono AH, Allen KA, Yaghoobzadeh A, Bit-Lian Y. Exploring the experiences of nurses' moral distress in long-term care of older adults: a phenomenological study. BMC Nurs 2021; 20:156. [PMID: 34465316 PMCID: PMC8406037 DOI: 10.1186/s12912-021-00675-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study. Methods A qualitative, phenomenological study was conducted with 9 participants using in-depth semi-structured interviews. The purpose was to gain insight into the lived experiences and perceptions of moral distress among ICU nurses in hospitals affiliated with Tehran University of Medical Sciences during their long-term care of older adults. Results Five major themes are identified from the interviews: advocating, defense mechanisms, burden of care, relationships, and organizational issues. In addition, several subthemes emerged including respectful end of life care, symptom management, coping, spirituality, futile care, emotional work, powerlessness, relationships between patients and families, relationships with healthcare teams, relationships with institutions, inadequate staffing, inadequate training, preparedness, education/mentoring, workload, and support. Conclusions This qualitative study contributes to the limited knowledge and understanding of the challenges nurses face in the ICU. It also offers possible implications for implementing supportive interventions.
Collapse
Affiliation(s)
| | - Ahmad Hasyim Wibisono
- Medical Surgical Nursing Department, School of Nursing, Brawijaya University, Malang, Indonesia
| | - Kelly-Ann Allen
- School of Educational Psychology and Counseling, Faculty of Education, Monash University, Clayton, Australia.,Centre for Wellbeing Science, University of Melbourne, Melbourne, Australia
| | | | - Yee Bit-Lian
- Nursing Division, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
17
|
Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168723. [PMID: 34444469 PMCID: PMC8392524 DOI: 10.3390/ijerph18168723] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022]
Abstract
Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations, or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%), or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with increased risk of anxiety, depression, post-traumatic stress disorder, and burnout. Conversely, feeling appreciated by the community protected against these risks in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.
Collapse
|
18
|
Murphy JM, Chin ED, Westlake CA, Asselin M, Brisbois MD. Pediatric Hematology/Oncology Nurse Spirituality, Stress, Coping, Spiritual Well-being, and Intent to Leave: A Mixed-method Study. J Pediatr Oncol Nurs 2021; 38:349-363. [PMID: 34077278 DOI: 10.1177/10434542211011061] [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] [Indexed: 12/18/2022] Open
Abstract
Background: Intense emotional demands of oncology nursing create a stressful work environment and increase the likelihood of leaving. The study aims to explore, describe, and understand how pediatric hematology/oncology nurses caring for chronically ill or dying patients use their spirituality to cope with job stress, maintain spiritual well-being (SWB), and continue to work in this specialty. Methods: A concurrent mixed-method research design consisted of a web-based survey and interview. Data collection included demographics, intent to leave questions, and four valid and reliable research instruments measuring spirituality, stress, coping, and SWB. A responsive interview guide directed interviews. Results: Quantitative analysis (n = 130) revealed moderate to high levels of spirituality, moderate stress, coping, and SWB. Stress and SWB were weakly, inversely correlated (r = -.221, p = .011) indicating lower stress was associated with greater SWB. Coping and SWB were weakly, positively correlated (r = .248, p = .005) indicating greater coping was associated with greater SWB. An intent to leave in the next year was reported by 5.4%. Emerging themes from qualitative data (n = 22) included faith-informed or existential spirituality, work environment, and emotional/psychological stressors such as feeling overwhelmed or witnessing suffering and coping through self-care and spirituality. Dimensions of SWB included spiritually based coping and life's meaning and purpose. Intent to leave was related to the work environment or travel distance. Discussion: A nurse's spirituality offers a mechanism for coping with accumulated losses and grief encountered in clinical practice and in turn supports SWB.
Collapse
Affiliation(s)
- Jane M Murphy
- Surgical Programs, 1862Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth D Chin
- College of Nursing and Health Sciences, 14709University of Massachusetts Dartmouth, Dartmouth, MA, USA
| | - Cheryl A Westlake
- 388087MemorialCare Shared Services, Fountain Valley, CA, USA.,School of Nursing, Azusa Pacific University, Azusa, CA, USA
| | - Marilyn Asselin
- College of Nursing and Health Sciences, 14709University of Massachusetts Dartmouth, Dartmouth, MA, USA
| | - Maryellen D Brisbois
- College of Nursing and Health Sciences, 14709University of Massachusetts Dartmouth, Dartmouth, MA, USA
| |
Collapse
|
19
|
Maazallahi M, Ghonchepour A, Sohrabi M, Golestani Z, Parandeh Afshar P, Malakoutikhah A, Dehghan M. Spiritual Well-Being among Medical and Nonmedical Science Students. SCIENTIFICA 2021; 2021:6614961. [PMID: 33986969 PMCID: PMC8093076 DOI: 10.1155/2021/6614961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/27/2021] [Accepted: 04/17/2021] [Indexed: 12/02/2022]
Abstract
Spiritual well-being is one dimension of health that provides a person with stability, meaning, fulfillment in life, and self-belief. This study aimed to compare the spiritual well-being among students of Kerman University of Medical Sciences and the Shahid Bahonar University of Kerman. With the demographic questionnaire and 20-item spiritual well-being scale of the "Paloutzian and Ellison" questionnaire, a cross-sectional study was conducted on 626 students of the universities of medical and nonmedical sciences by the quota sampling method in Kerman in 2017-2018. The scores of spiritual well-being and its two components were significantly higher in nonmedical science students (89.83 ± 16.79) than in the medical science students (81.61 ± 15.21) (p < 0.05). In addition, one percent of the nonmedical science students had a low level, 67.7% had a moderate level, and 31.3% had a high level of spiritual well-being. 0.3% of the medical science students had a low level, 84% had a moderate level, and 15.7% had a high level of spiritual well-being. Since spirituality is important for the profession of medical science students, it may be necessary to expand this component in their curriculum.
Collapse
Affiliation(s)
- Mahboobeh Maazallahi
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Asma Ghonchepour
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Zakiyeh Golestani
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Peiman Parandeh Afshar
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Malakoutikhah
- Student Research Committee, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Alazmani-Noodeh F, Abdi K, Ranjbar H. The moderating effect of spiritual beliefs on job dissatisfaction related to the futile care. BMC Nurs 2021; 20:64. [PMID: 33882900 PMCID: PMC8058750 DOI: 10.1186/s12912-021-00582-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/12/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction This study aimed to assess the experience of providing futile care among intensive care unit nurses and to examine the moderating effect of spiritual beliefs on job dissatisfaction related to the sense of futile care among nurses in Intensive Care Units. Materials and methods The study had two phases. The first phase was a qualitative study. Twenty-two semi-structured interviews were conducted. In the second phase, we employed a cross-sectional design. The data from 236 nurses were collected using nurses’ perceptions of futile care questionnaire, Minnesota Satisfaction Questionnaire, and Spirituality and Spiritual Care Rating Scale. Results The main theme of the qualitative phase was a feeling of self as a useful tool in God’s hand. Sub-themes were providing care while knowing it is futile, not knowing the patient destiny, having hope for care to be fruitful, experiences patient recovery, acting to be a part of God’s plan. Futile care and job experience were two predictors of low job satisfaction. Spiritual well-being had a moderating effect and increased job satisfaction. Conclusions Futile care can decrease job satisfaction, while spiritual well-being can reduce its negative effect. Supporting spiritual aspects of nursing care can decrease turn-over intention among nurses.
Collapse
Affiliation(s)
| | - Kamel Abdi
- Nursing Department, Faculty of Medicine, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region, Iraq
| | - Hadi Ranjbar
- Institute for Futures Studies In Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Soleimani MA, Dalvand N, Ranjbaran M, Lehto RH, Bahrami N. Predictive factors associated with death depression in women with breast cancer. DEATH STUDIES 2020; 46:1880-1890. [PMID: 33377851 DOI: 10.1080/07481187.2020.1864682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A cross-sectional study with a convenience sample of 241 patients with breast cancer was conducted to investigate death depression and its explanatory factors in Iranian women who were diagnosed and undergoing treatment for breast cancer. Patients with significantly higher death depression were those who were housewives (β = 0.6, p = 0.016), unskilled workers (β = 15.8, p = 0.002), and retired (β = 13.1, p = 0.002) as compared with those who were professionally employed with higher socio-economic status (β = 17.4, p = 0.002); and those receiving combination therapy as compared to surgery only (β = 6.3, p = 0.02). For patients with higher spiritual health scores, death depression was significantly lower (β = -0.2, p < 0.001).
Collapse
Affiliation(s)
- Mohammad Ali Soleimani
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Narges Dalvand
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mehdi Ranjbaran
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rebecca H Lehto
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Nasim Bahrami
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|
24
|
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.
Collapse
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
| | | |
Collapse
|
25
|
Solaimanizadeh F, Mohammadinia N, Solaimanizadeh L. The Relationship Between Spiritual Health and Religious Coping with Death Anxiety in the Elderly. JOURNAL OF RELIGION AND HEALTH 2020; 59:1925-1932. [PMID: 31471742 DOI: 10.1007/s10943-019-00906-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The elderly is a period of life when a person reaches the age of 65 years. This study aimed to determine the relationship between spiritual health and religious coping with the death anxiety in the elderly people. The study is a descriptive cross-sectional study: 180 Elderly according to similar studies. Data gathering tools are Paloutzain and Ellison SH questionnaire, religious coping questionnaire and death anxiety questionnaire. SPSS16 and descriptive and analytical tests were used; there was a relationship between religious health and religious coping with the anxiety (p < 0.05).The M(SD) religious health is 39.25 (11.67), existential health is 40.50 (11.29), total spiritual health is 79.75 (22.03), and also the M(SD) religious coping is 23.84 (5.02). Considering the relationship between RC and SH with DA in the elderly, it is necessary to make the necessary spiritual-religious arrangements to reduce DA.
Collapse
Affiliation(s)
| | - Neda Mohammadinia
- Department of Nursing, Faculty of Nursing and Midwifery, Bam University of Medical Science, Bam, Iran
| | - Laleh Solaimanizadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Bam University of Medical Science, Bam, Iran.
| |
Collapse
|
26
|
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]
|
27
|
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.
Collapse
|
28
|
Paal P, Neenan K, Muldowney Y, Brady V, Timmins F. Spiritual leadership as an emergent solution to transform the healthcare workplace. J Nurs Manag 2019; 26:335-337. [PMID: 29878549 DOI: 10.1111/jonm.12637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Piret Paal
- Institute for Nursing Science and Practice, Paracelsus Medical Private University, Salzburg, Austria
| | - Kathleen Neenan
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Yvonne Muldowney
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Vivienne Brady
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Fiona Timmins
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| |
Collapse
|
29
|
Ramos FRS, Barlen ELD, Brito MJM, Vargas MA, Schneider DG, de Farias Brehmer LC. Validation of the Brazilian Moral Distress Scale in Nurses. J Nurs Meas 2019; 27:335-357. [PMID: 31511413 DOI: 10.1891/1061-3749.27.2.335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and PurposeTo determine the psychometric properties of the Brazilian Moral Distress Scale in Nurses (MDSN-BR).DesignIn this methodological, cross-sectional study, the criterion, content, and construct validation stages were presented.MethodA 57-item questionnaire was applied to 1,227 brazilian nurses through an online form. The exploratory factor analyses revealed significant conceptual relations among its items in six constructs, expressing the consistency of the scale.ResultsThe validated version of the instrument consists of six constructs and 49 items—Cronbach's alpha .980 (instrument) and of constructs: (a) (.942) Acknowledgment, power, and professional identity; (b) (.961) Safe and qualified care; (c) (.924) Defense of values and rights; (d) (.944) Work conditions; (e) (.933) Ethical infractions; (f) (.914) Work teams.ConclusionThe results provide evidence supporting the reliability and trustworthiness of the scale in the selected population.
Collapse
|
30
|
Pahlevan Sharif S, Ong FS. Education Moderates the Relationship Between Spirituality with Quality of Life and Stress Among Malay Muslim Women with Breast Cancer. JOURNAL OF RELIGION AND HEALTH 2019; 58:1060-1071. [PMID: 29511922 DOI: 10.1007/s10943-018-0587-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to investigate the relationship between spirituality with quality of life and stress of Malay Muslim breast cancer patients in Malaysia. In addition, the moderating role of education on this relationship was examined. Participants consisted of 145 conveniently selected Malay breast cancer patients. The results indicated that the more spiritual respondents reported a higher level of quality of life and lower level of stress. Moreover, education weakened the relationship between spirituality with quality of life and stress.
Collapse
Affiliation(s)
- Saeed Pahlevan Sharif
- Taylor's Business School, Taylor's University, No. 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
- Department of Nursing, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran.
| | - Fon Sim Ong
- University of Nottingham Malaysia Campus, Jalan Broga, 43500, Semenyih, Selangor, Malaysia
| |
Collapse
|
31
|
Sannino P, Giannì ML, Carini M, Madeo M, Lusignani M, Bezze E, Marchisio P, Mosca F. Moral Distress in the Pediatric Intensive Care Unit: An Italian Study. Front Pediatr 2019; 7:338. [PMID: 31456996 PMCID: PMC6700377 DOI: 10.3389/fped.2019.00338] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: There is paucity of data within the Italian context regarding moral distress in intensive pediatric settings. The aim of the present study was to assess the frequency, intensity, and level of moral distress experienced by nurses working in a sample of pediatric intensive care units (PICUs). Materials and Methods: A cross-sectional questionnaire survey was conducted in eight PICUs from five northern Italian regions in a convenience sample of 136 nurses. Moral distress was evaluated using the modified Italian version of the Moral Distress Scale Neonatal-Pediatric Version (MDSNPV). Each item was scored in terms of frequency and intensity on a five-point Likert scale, ranging from 0 to 4. The total frequency and intensity scores for all the 21 clinical items were comprised between 0 and 84. For each item, the level of moral distress was derived by multiplying the frequency score by the intensity score and quantified with a score ranging from 0 to 16. The total score of the moral distress level for the 21 items ranged from 0 to 336. Results: The mean total scores for the frequency, intensity and level of moral distress were 24.1 ± 10.4, 36.2 ± 18.6, and 57.7 ± 37.1, respectively. The clinical situations identified as the major causes of moral distress among nurses in the present study involved end-of-life care and resuscitation. At multivariate logistic regression analysis, number of deaths occurring in PICUs, having children and intention to leave work due to moral distress resulted to be independently associated with a higher total moral distress level. Conclusions: The results of the present study contribute to the understanding of moral distress experience in acute pediatric care settings, including the clinical situations associated with a higher moral distress level, and highlight the importance of sharing thoughts, feelings and information within the multidisciplinary health care professional team for effective shared decision making, particularly in situations involving end-of-life care and resuscitation.
Collapse
Affiliation(s)
- Patrizio Sannino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, Milan, Italy
| | - Maria Lorella Giannì
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Micaela Carini
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Madeo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, Milan, Italy
| | - Maura Lusignani
- ASST Grande Ospedale Metropolitano Niguarda, Bachelor of Nursing, Course Session, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elena Bezze
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
32
|
Yaghoobzadeh A, Soleimani MA, Allen KA, Chan YH, Herth KA. Relationship Between Spiritual Well-Being and Hope in Patients with Cardiovascular Disease. JOURNAL OF RELIGION AND HEALTH 2018; 57:938-950. [PMID: 28770520 DOI: 10.1007/s10943-017-0467-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Spirituality and hope have been identified as important constructs in health research, since both are thought to enhance a person's ability to cope with the consequences of serious illness. The aim of this study was to examine the relationship between spiritual well-being and hope in patients with cardiovascular disease. Using descriptive, correlational methodology, the investigator gathered data on a convenience sample of 500 patients with cardiovascular disease who were hospitalized in a medical institution in Iran. The study was conducted over a four-month period. Participants completed a demographic questionnaire, the Spiritual Well-Being Scale (SWBS) and the Herth Hope Index (HHI). The mean score on the SWBS and HHI was 86.21 (SD 12.46) and 34.80 (SD 5.05), respectively. Multivariate predictors for spiritual well-being were female gender (p = 0.047), religiosity (p = 0.018), and hope (p < 0.001). Significant predictors of hope were marital status (p < 0.001), educational status (p < 0.001), economic status (p < 0.001), and spiritual well-being (p < 0.001). Findings suggest that multiple factors may impact spiritual well-being and hope. Therefore, this study has implications for those providing care to patients with cardiovascular disease.
Collapse
Affiliation(s)
- Ameneh Yaghoobzadeh
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Ali Soleimani
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Kelly A Allen
- The Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Australia
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Kaye A Herth
- Minnesota State University, Mankato, Mankato, MN, USA
| |
Collapse
|
33
|
Soleimani MA, Sharif SP, Yaghoobzadeh A, Yeoh KK, Panarello B. Exploring the Relationship Between Spiritual Well-Being and Death Anxiety in Survivors of Acute Myocardial Infarction: Moderating Role of Sex, Marital Status and Social Support. JOURNAL OF RELIGION AND HEALTH 2018; 57:683-703. [PMID: 29318435 DOI: 10.1007/s10943-017-0554-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Previous empirical studies have shown that both spiritual well-being (SWB) and death anxiety (DA) significantly affect the mental health of patients with acute diseases. In this regard, our paper contributes to the extant literature by scrutinizing the conditional relationship between SWB and DA as well as the various mechanisms underpinning such a relationship in patients with acute myocardial infraction (AMI). A descriptive, correlational methodology was utilized. Our main sample consisted of 300 patients with acute myocardial infraction who were hospitalized in a specialized medical institution in Iran throughout a two-month period (i.e. August-October 2015). Patients completed Spiritual Well-Being Scale (SWBS) and Templer's Death Anxiety Scale (TDAS). Even though our study showed that the relationship between SWB and DA in patients with AMI is non-significant, we found that (1) single patients with higher SWB have lower DA, (2) single patients with higher SWB as well as social support have significantly lower DA, and (3) for single men/men without social support, there is a negative relationship between SWB and DA. The relationship between SWB and DA is influenced by factors such as sex, marital status and social support. In addition, the specific nature of this relationship (i.e. strength and sign) is dependent upon the sociodemographic characteristics of patients as well as other contextual influences. Result revealed that although relationship between SWB and DA is non-significant, this is influenced by factors such as sex and social support. In addition, the specific nature of this relationship (i.e. strength and sign) is dependent upon the sociodemographic characteristics of patients as well as other contextual influences.
Collapse
Affiliation(s)
- Mohammad Ali Soleimani
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Ameneh Yaghoobzadeh
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ken Kyid Yeoh
- Nottingham University Business School, University of Nottingham Malaysia Campus, Jalan Broga, 43500, Semenyih, Selangor Darul Ehsan, Malaysia
| | - Bianca Panarello
- Interpersonal Relationships and Development Laboratory, Psychology Department, Concordia University (PY-205), 7141 Sherbrooke Street, West Montreal, QC, H4B 1R6, Canada
| |
Collapse
|