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Lamoureux S, Mitchell AE, Forster EM. Moral distress among acute mental health nurses: A systematic review. Nurs Ethics 2024; 31:1178-1195. [PMID: 38490947 DOI: 10.1177/09697330241238337] [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: 03/17/2024]
Abstract
Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes.
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Safari F, MohammadPour A, BasiriMoghadam M, NamaeiQasemnia A. The relationship between moral distress and clinical care quality among nurses: an analytical cross-sectional study. BMC Nurs 2024; 23:732. [PMID: 39385129 PMCID: PMC11465671 DOI: 10.1186/s12912-024-02368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 09/24/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Nurses constitute the largest group of service providers in the healthcare system and significantly influence the quality of healthcare services. Factors such as ethical considerations may be related to the quality of care. This study aimed to determine the relationship between moral distress and the quality of clinical care among nurses working in Gonabad, Iran. METHODS An analytical cross-sectional study was conducted on 252 nurses working in emergency, internal medicine, surgery, psychiatry, critical care and maternity wards at Allameh Bohlool Hospital from May to July 2023. This research used demographic information questionnaire, the revised Moral Distress Scale (MDS-R), and the Quality Patient Care Scale (QUALPAC). The significance level for the study was set at p < 0.05. RESULTS There was a significant relationship between the frequency of moral distress and the quality of clinical care (p = 0.032), as well as between the intensity of moral distress and the quality of clinical care (p = 0.043). Nurses who experienced moral distress more frequently and intensely provided better quality care. However, there was no significant relationship between the effect of moral distress and the quality of clinical care (r = 0.032, p = 0.619). Additionally, a significant statistical relationship was found between the intensity of moral distress and the physical dimension of clinical care quality (r = 0.171, p = 0.007), indicating that increased moral distress intensity was associated with higher quality of physical care. CONCLUSIONS Nurses who experience higher levels of moral distress, both in terms of frequency and intensity, perform better in the care they provide and deliver it in the best possible manner, particularly in the physical dimension of care.
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Affiliation(s)
- Fateme Safari
- Department of Medical Surgical Nursing, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali MohammadPour
- Department of Medical Surgical Nursing, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
| | - Mahdi BasiriMoghadam
- Department of Medical Surgical Nursing, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Alireza NamaeiQasemnia
- Department of Medical Surgical Nursing, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Hu W, Shang K, Wang X, Li X. Cultural translation of the ethical dimension: a study on the reliability and validity of the Chinese nurses' professional ethical dilemma scale. BMC Nurs 2024; 23:711. [PMID: 39363170 PMCID: PMC11448433 DOI: 10.1186/s12912-024-02380-3] [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: 05/21/2024] [Accepted: 09/25/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Quantifying the professional ethical challenges that nurses encounter is crucial for both theoretical insights and practical outcomes. The objective of this research is to assess the psychometric properties of the Chinese adaptation of the Moral Distress Scale for Healthcare Professionals (MD-APPS). METHODS In 2024, a survey approach was utilized to engage with several tertiary-level healthcare institutions throughout China. A cohort of 448 nursing professionals who satisfied the specified selection benchmarks was consequently incorporated into the study. To evaluate the scale's reliability and validity, methods including the Content Validity Index (CVI), Factor Analysis-both Exploratory (EFA) and Confirmatory (CFA)-alongside assessments of internal consistency and test-retest reliability were employed. RESULTS Expert evaluations yielded an I-CVI of 0.90, suggesting good content validity for the MD-APPS's Chinese adaptation. Exploratory Factor Analysis (EFA) revealed a bi-dimensional framework with 7 components, explaining 56.34% of the cumulative variance. Confirmatory Factor Analysis (CFA) outcomes displayed a χ-square/df ratio of 1.542. The estimate for Robust RMSEA was 0.054, and the SRMR was ascertained to be 0.041. Indices for both Robust TLI and Robust CFI surpassed the 0.9 threshold, indicating an acceptable fit; this aspect was supported by a P-value (Chi-square) of 0.094. The internal consistency, measured by Cronbach's α, was found to be 0.74, while the test-retest reliability over a two-week period reached 0.964. These findings provide initial evidence for the psychometric properties of the Chinese MD-APPS. CONCLUSION The Chinese adaptation of the MD-APPS demonstrates promising initial psychometric properties, suggesting its potential suitability for exploring nurses' professional ethical challenges within the Chinese cultural context. This scale may facilitate the identification of diverse elements influencing nurses' professional ethics and the assessment of the ethical climate in nursing practices. However, further validation studies are needed to fully establish its psychometric robustness across various healthcare settings in China.
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Affiliation(s)
- Wei Hu
- First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Ke Shang
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Xin Wang
- Jinzhou Medical University, Jinzhou, Liaoning, China
- Huaian Hospital of Huaian City, Huai'an, Jiangsu, China
| | - Xia Li
- First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China.
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Kendal S, Louch G, Walker L, Shafiq S, Halligan D, Brierley-Jones L, Baker J. Implementing and evaluating patient-focused safety technology on adult acute mental health wards. J Psychiatr Ment Health Nurs 2024; 31:742-754. [PMID: 38279658 DOI: 10.1111/jpm.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. WHAT ARE THE IMPLICATIONS FOR PRACTICE This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines. ABSTRACT INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. AIM Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff. METHOD Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. RESULTS Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. DISCUSSION Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context. IMPLICATIONS FOR PRACTICE The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.
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Affiliation(s)
| | - Gemma Louch
- Bradford Institute for Health Research, Bradford, UK
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Hisadomi K, Togari T. Does sense of coherence buffer the effects of moral dilemmas faced by psychiatric nurses in Japan? A cross-sectional study. Arch Psychiatr Nurs 2024; 52:8-15. [PMID: 39260988 DOI: 10.1016/j.apnu.2024.07.017] [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: 04/23/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 09/13/2024]
Abstract
Psychiatric nurses face moral dilemmas that affect their mental health. We investigated whether sense of coherence (SOC) buffers psychiatric nurses' perceived effects of moral dilemmas on their psychological distress. A total of 418 nursing professionals in 6 psychiatric hospitals in Japan completed self-administered questionnaires. A negative correlation was observed between "patient rights" (r = -0.24, p < 0.001), "relationships other than patient" (r = -0.28, p < 0.001), "nursing care" (r = -0.25, p < 0.001) of moral dilemmas and "manageability" of SOC. Additionally, a negative correlation was observed between "patient rights" (r = -0.22, p < 0.001), "relationships other than patient" (r = -0.21, p < 0.001) of moral dilemmas and "comprehensibility" of SOC. Hierarchical multiple regression analysis used the Kessler Psychological Distress Scale-10 (K10), which assessed the degree of mental distress, as the dependent variable, and moral dilemmas and SOC as the independent variables, along with their interaction terms. The K10 scores significantly changed depending on the degree of moral dilemmas in the low SOC group, but not in the high SOC group. SOC buffers the effects of psychiatric nurses' perceived moral dilemmas on their psychological distress.
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Pang F, Zhang Y, Liu H, Du A, Tian Y, Chen H, Xu Y. Factors associated with moral sensitivity among nurses in adult intensive care units: A cross-sectional study in China. Nurs Crit Care 2024. [PMID: 39291677 DOI: 10.1111/nicc.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Moral sensitivity may play a role in dealing with ethical issues in ICUs. However, the moral sensitivity of adult ICU nurses in China and its predictors have not been well investigated. AIMS To analyse the moral sensitivity of intensive care unit (ICU) nurses and its predictors. STUDY DESIGN A cross-sectional study through convenience sampling was conducted in the ICUs of five hospitals in China between November and December 2022. A total of 331 ICU nurses were recruited. Data were obtained using a self-developed socio-demographic characteristic questionnaire, the Moral Sensitivity Questionnaire, the Jefferson Scale of Empathy-Health Professionals and the Organizational Climate Scale for Nursing. The participating institutions received a link to the tools used for online data collection, which they then forwarded to nursing staff. RESULTS The valid response rate was 96.98% (n = 321). The total mean moral sensitivity score of nurses was 43.04 ± 5.95. The mean scores for empathic ability and organizational climate for nursing were 91.97 ± 17.88 and 101.28 ± 14.77, respectively. Regression analyses revealed that the primary factors associated with moral sensitivity among critical care nurses included work tenure (p < .05), empathic ability (p < .001) and organizational climate (p < .001). CONCLUSIONS High levels of moral sensitivity were found in critical care nurses in China. Work tenure, empathic ability and organizational climate were significant predictors of moral sensitivity in critical care nurses. RELEVANCE TO CLINICAL PRACTICE To enhance the ethical sensitivity of ICU nurses, we suggest to strengthen the training of novice nurses so that they can better face the moral dilemma in clinical practice. In addition, organizational managers should also take measures to create a positive and harmonious working atmosphere, promote the application of moral knowledge in nursing practice and enhance their moral sensitivity.
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Affiliation(s)
- Fang Pang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yaodan Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Aiping Du
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongming Tian
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Heyu Chen
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yu Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Woods MA, Hampton D, Okoli CTC, Heath J, Moreland G. Pilot Study Focused on Knowledge, Attitudes, and Health Access Behaviors of Psychiatric-Mental Health Nurses Regarding Suicide Prevention. J Am Psychiatr Nurses Assoc 2024; 30:852-857. [PMID: 38653730 DOI: 10.1177/10783903241247216] [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] [Indexed: 04/25/2024]
Abstract
OBJECTIVE: The purpose of this pilot study was to evaluate the effect of a web-based education module on the knowledge, attitudes, and ratings of willingness to access help related to suicide prevention in psychiatric-mental health nurses. METHODS: A quasi-experimental pretest-posttest design was employed. Registered nurses from two academic health center units and a 239-bed Psychiatric Hospital were invited to participate. Scores on knowledge of suicide risk and prevention, attitudes, subjective norms, perceived behavioral control, and intent to seek help upon experiencing suicidal ideations were obtained before and after administering a 25-min web-based training. RESULTS: Twenty-nine participants completed the pre-survey, web-based education module, and post-survey. Significant increases from baseline in the scores on knowledge, attitudes, subjective norms, and intentions related to help-seeking behaviors for nurse suicide prevention were noted. Perceived behavioral control median scores increased but were not statistically significant. More than 40% of the participants reported having experienced suicidal thoughts. CONCLUSIONS: Further study is needed to determine contributors to this higher rate. Understanding the effectiveness of strategies to reduce nurse suicide can provide insights into building better nurse suicide prevention programs.
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Affiliation(s)
- Marc A Woods
- Marc A. Woods, DNP, MSN, RN, NEA-BC, UK Healthcare, Lexington, KY, USA
| | - Debra Hampton
- Debra Hampton, PhD, MSN, RN, NEA-BC, CENP, FACHE, FAONL, University of Kentucky, Lexington, KY, USA
| | - Chizimuzo T C Okoli
- Chizimuzo T. C. Okoli, PhD, MPH, MSN, PMHNP-BC, APRN, NCTTP, FAAN, Eastern State Hospital and University of Kentucky, Lexington, KY, USA
| | - Janie Heath
- Janie Heath, PhD, APRN-BC, FAAN, FNAP, FAANP, University of Kentucky, Lexington, KY, USA
| | - Gwen Moreland
- Gwen Moreland, DNP, RN, NEA-BC, UK Health care, Lexington, KY, USA
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Wang Q, Luan Y, Liu D, Dai J, Wang H, Zhang Y, Wang S, Dong X, Bi H. Guided self-help mindfulness-based intervention for increasing psychological resilience and reducing job burnout in psychiatric nurses: A randomized controlled trial. Int J Nurs Pract 2024; 30:e13204. [PMID: 37727093 DOI: 10.1111/ijn.13204] [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: 01/11/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
AIMS The present study aimed to explore the effects of a guided self-help mindfulness intervention on psychological resilience and job burnout among psychiatric nurses. BACKGROUND Psychiatric nurses work in challenging and potentially high stress settings. Mindfulness interventions can improve psychological resilience and reduce job burnout of nurses. However, face-to-face delivery of mindfulness interventions may be inconvenient for individuals. Guided self-help interventions may be more accessible. METHODS This randomized controlled trial was conducted from January to August 2022. One hundred and eighteen psychiatric nurses were randomized into the intervention and control groups. The individuals in the intervention group received an 8-week guided self-help mindfulness intervention, while the individuals in the control group received a psycho-educational brochure. The Five Facet Mindfulness Questionnaire, the Connor-Davidson Resilience Scale and the Maslach Burnout Inventory-Human Services Survey were used to evaluate the levels of mindfulness, psychological resilience and job burnout, respectively. RESULTS After an 8-week intervention, compared with the control group, the levels of mindfulness and psychological resilience were higher, while the level of job burnout was lower in the intervention group. CONCLUSIONS The guided self-help mindfulness intervention can improve psychological resilience and reduce job burnout among psychiatric nurses.
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Affiliation(s)
- Qi Wang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yue Luan
- Third Hospital of Daqing, Daqing, Heilongjiang, China
| | - Dandan Liu
- Third Hospital of Daqing, Daqing, Heilongjiang, China
| | - Jiali Dai
- Third Hospital of Daqing, Daqing, Heilongjiang, China
| | - Haina Wang
- Third Hospital of Daqing, Daqing, Heilongjiang, China
| | - Yang Zhang
- Third Hospital of Daqing, Daqing, Heilongjiang, China
| | - Shuang Wang
- Third Hospital of Daqing, Daqing, Heilongjiang, China
| | - Xiaomei Dong
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Hongsheng Bi
- Third Hospital of Daqing, Daqing, Heilongjiang, China
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Hadson K, de Jacq K, Travers J, Gao Y, Norful AA. A Multimethod Exploration of Moral Distress and Moral Injury Among Health Care Assistants Working in Psychiatric Settings. NURSE LEADER 2024; 22:428-433. [PMID: 39328931 PMCID: PMC11424046 DOI: 10.1016/j.mnl.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Moral distress and moral injury among health workers yield adverse physical, psychological, and labor force outcomes. Research is limited on how psychiatric healthcare assistants experience these issues. In this multi-method study, we conducted a quantitative survey and qualitative interviews to examine moral distress and injury among psychiatric healthcare assistants. Almost half screened positive for moral injury. Three qualitative themes emerged: 1) hierarchies prevent contributions to care; 2) trust as a factor in de-escalating patient violence; and 3) navigating psychosocial challenges. Further research is recommended to investigate how to best support and inform practice and policy changes for psychiatric healthcare assistants.
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Affiliation(s)
- Kimberly Hadson
- New York University Rory Meyers College of Nursing, 433 1 Avenue, New York, NY, USA
- NewYork-Presbyterian Hospital, 5141 Broadway, New York, NY 10034, New York, NY, USA
| | - Krystyna de Jacq
- State University of New York Polytechnic Institute, 100 Seymour Road, Utica, NY, USA
| | - Jasmine Travers
- New York University Rory Meyers College of Nursing, 433 1 Avenue, New York, NY, USA
| | - Yuandi Gao
- Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY, USA
| | - Allison A Norful
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, USA
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Beadle ES, Walecka A, Sangam AV, Moorhouse J, Winter M, Munro Wild H, Trivedi D, Casarin A. Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies. PLoS One 2024; 19:e0303013. [PMID: 38935754 PMCID: PMC11210881 DOI: 10.1371/journal.pone.0303013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/17/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions. METHODS A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic. RESULTS Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients' care options, professionals' beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals' moral comfort. Patients' care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change. CONCLUSION This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals' disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals' beliefs, repercussions on professionals' wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.
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Affiliation(s)
- Emily S. Beadle
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | | | - Amy V. Sangam
- Intensive Care Unit, Royal Free Hospital, London, United Kingdom
| | | | - Matthew Winter
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Helen Munro Wild
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, School of Health and Social Work, The University of Hertfordshire, Hatfield, United Kingdom
| | - Annalisa Casarin
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Daguman EI, Hutchinson M, Lakeman R. Uncovering Complexities in Reducing Aggression, Conflict and Restrictive Practices in Acute Mental Healthcare Settings: An Overview of Reviews. Int J Ment Health Nurs 2024. [PMID: 38886873 DOI: 10.1111/inm.13376] [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: 02/04/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy-based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.
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Affiliation(s)
| | | | - Richard Lakeman
- Southern Cross University, Lismore, New South Wales, Australia
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Goudarzian AH, Nikbakht Nasrabadi A, Sharif-Nia H, Farhadi B, Navab E. Exploring the concept and management strategies of caring stress among clinical nurses: a scoping review. Front Psychiatry 2024; 15:1337938. [PMID: 38863606 PMCID: PMC11165118 DOI: 10.3389/fpsyt.2024.1337938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Objective The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of caring stress, a scoping review study was designed. This scoping review aimed to investigate the concept of caring stress among clinical nurses and examine the strategies used for its management. Methods This review employed a scoping review methodology to comprehensively map the essential concepts and attributes of the phenomenon by drawing on a wide range of sources. International databases including PubMed, Scopus, Web of Science, Google Scholar, and Scientific Information Database (SID) were searched to gather relevant studies published until October 1, 2023. MESH terms included "caring stress", "care", "stress", "nurse", and "stress management" were used. Two reviewers independently collected data from full-text papers, ensuring that each paper underwent assessment by at least two reviewers. Results Out of 104,094 articles initially searched, 22 articles were included in this study. High workloads, transmitting the infection, stressful thoughts, stressful emotions, and stressful communications were the significant concepts and factors of caring stress among nurses. Also, rest breaks during patient care shifts, playing music in the ward, and denial of critical situations were examples of positive and negative coping and management ways to reduce caring stress. Conclusion Effective stress management strategies can lead to better patient care and safety. Stressed nurses are more likely to make errors or become less vigilant in their duties, impacting patient outcomes. By addressing caring stress, clinical practice can prioritize patient well-being. Further research is required to delve deeper into this critical issue concerning nurses in the future.
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Affiliation(s)
- Amir Hossein Goudarzian
- Department of Psychiatric Nursing, School of nursing and midwifery, Tehran University of Medical Science, Tehran, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Nikbakht Nasrabadi
- Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Bahar Farhadi
- School of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Elham Navab
- Department of Critical Care and Geriatric Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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DePorre AG, Hall M, Bernstein AM, Nadler C, Puls HT. Factors Associated With Prolonged Mental Health Admissions at US Children's Hospitals. Hosp Pediatr 2024; 14:328-336. [PMID: 38584580 DOI: 10.1542/hpeds.2023-007684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Mental health (MH) hospitalizations at medical hospitals are associated with longer length of stay (LOS) compared with non-MH hospitalizations, but patient factors and costs associated with prolonged MH hospitalizations are unknown. The objective of this paper is to assess patient clinical and demographic factors associated with prolonged MH hospitalizations and describe variation in MH LOS across US children's hospitals. METHODS We studied children aged 5 to 20 years hospitalized with a primary MH diagnosis during 2021 and 2022 across 46 children's hospitals using the Pediatric Health Information System database. Generalized estimating equations, clustered on hospital, tested associations between patient characteristics with prolonged MH hospitalization, defined as those in the 95th percentile or above (>14 days). RESULTS Among 42 654 primary MH hospitalizations, most were aged 14 to 18 (62.4%), female (68.5%), and non-Hispanic white (53.8%). The most common primary MH diagnoses were suicide/self-injury (37.4%), depressive disorders (16.6%), and eating disorders (10.9%). The median (interquartile range) LOS was 2 days (1-5), but 2169 (5.1%) experienced a hospitalization >14 days. In adjusted analyses, race and ethnicity, category of MH diagnosis, and increasing medical and MH complexity were associated with prolonged hospitalization. CONCLUSIONS Our results emphasize several diagnoses and clinical descriptors for targeted interventions, such as behavioral and inpatient MH resources and discharge planning. Expanded investment in both community and inpatient MH supports have the potential to improve health equity and reduce prolonged MH hospitalizations.
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Affiliation(s)
- Adrienne G DePorre
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Matt Hall
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
- Childrens Hospital Association, Lenexa, Kansas
| | - Alec M Bernstein
- Developmental and Behavioral Health
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Cy Nadler
- Developmental and Behavioral Health
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Henry T Puls
- Divisions of Hospital Medicine
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
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Webb EL, Ireland JL, Lewis M, Morris D. Potential Sources of Moral Injury for Healthcare Workers in Forensic and Psychiatric Settings: A Systematic Review and Meta-ethnography. TRAUMA, VIOLENCE & ABUSE 2024; 25:918-934. [PMID: 37083056 PMCID: PMC10913356 DOI: 10.1177/15248380231167390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A systematic literature review was conducted to identify peer-reviewed articles reporting on sources of moral injury or similar concepts (e.g., moral distress) for healthcare workers in such settings. Thirty articles were included and analyzed using a meta-ethnographic approach. Synthesis yielded three third-order factors, each reflecting a moral dichotomy: (a) "between profession and system," (b) "between relations with patients and relations with others," and (c) "between principles and practices." Findings illustrated the hierarchical relationships between dichotomies, with discordance between values of the healthcare profession and features of the healthcare system providing the conditions for PMIEs to occur. The review advances conceptual understandings of PMIEs in forensic and psychiatric settings, illustrating the multilayered dimensions within which morally injurious events are experienced. Theoretical and practical implications are offered that may support the early detection and prevention of moral injury in healthcare professionals.
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Affiliation(s)
- Elanor Lucy Webb
- Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK
| | - Jane L. Ireland
- University of Central Lancashire, Preston, UK
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Michael Lewis
- University of Central Lancashire, Preston, UK
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Deborah Morris
- Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK
- University of Buckingham, UK
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15
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O'Malley M, O'Mahony J, Happell B, Mulcahy H. The nurse bombarded, consumed and vulnerable: An interpretative phenomenological analysis of mental health nurses' self-care at work. J Psychiatr Ment Health Nurs 2024; 31:66-76. [PMID: 37534379 DOI: 10.1111/jpm.12956] [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: 10/08/2022] [Revised: 05/16/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Self-care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self-care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self-care practices is essential. There is currently a paucity of literature on this topic. AIM To explore mental health nurses' views about what influences their ability to self-care in relation to workplace stress and the impact on their practice and work environment. METHODS An Interpretative Phenomenological Analysis approach was utilized. In-depth interviews explored how nurses perceived the influence of environment and relationships on self-care practices in the workplace. RESULTS Participants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes-the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling undervalued. Participants described conflict between workload demands and expectations and the desire to provide optimal care. CONCLUSIONS Stressful working environments pose major barriers to effective self-care. Feeling bombarded and vulnerable, impacts nurses' lives personally and professionally. IMPLICATIONS FOR PRACTICE Mental health nurses' self-care is crucial for quality practice. Strategies to address relational, personal and environmental barriers to self-care are therefore necessary.
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Affiliation(s)
- Maria O'Malley
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - James O'Mahony
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Brenda Happell
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Helen Mulcahy
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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16
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Webb K, Penz K. Strategies to Reduce the Impact of Trauma in Psychiatric Nurses: An Integrative Review of the Literature. Issues Ment Health Nurs 2024; 45:173-185. [PMID: 38232041 DOI: 10.1080/01612840.2023.2278784] [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: 01/19/2024]
Abstract
BACKGROUND Psychiatric nurses are at a higher risk for exposure to violence and aggression, leading to potential burnout, moral injury, post-traumatic stress, and turnover. There is little evidence of a preferred strategy to support nurses and decrease the impact of traumatic experiences on psychiatric nurses. The aim of this integrative review was to explore potential strategies to decrease the impact of traumatic experiences among nurses in psychiatric settings. METHODS Following a systematic search of PsycINFO/Ovid, CINAHL, and MEDLINE/Pubmed, Joanna Briggs Institute quality appraisal tools were used to analyze quality of the articles. Thirteen articles met the inclusion/exclusion criteria for this study. Data were analyzed and synthesized into three key themes and seven sub-themes. RESULTS Three themes were noted to be common to the included texts. 1. Interpersonal Supports (Formal Support, Peer/Supervisor Support, and Informal Family/Social Support). 2. Organizational Supports (Perception of Job Safety/Satisfaction, Promoting Personal Resilience, Supporting Team Resilience, and Organizational Commitment to Resilience). 3. Protection of Personal Resources. CONCLUSIONS Many common suggestions for decreasing the impact of exposure to violence and trauma were noted across the thirteen articles, however, there is little evidence of a preferred strategy, how strategies are developed and employed or the efficacy of any particular strategy. Further investigation is needed to identify and evaluate supportive interventions, their feasibility and efficacy.
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Affiliation(s)
- Kayla Webb
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kelly Penz
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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DeAlmeida K, Blanco K, Metz K, Bohr NL. Inpatient pediatric nursing staff experiences treating psychiatric patients: A mixed methods study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12441. [PMID: 37747199 DOI: 10.1111/jcap.12441] [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: 05/09/2023] [Revised: 08/21/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Abstract
PROBLEM A gap in the literature exists attempting to understand the impact that the influx of pediatric psychiatric patients has had on inpatient general medicine pediatric nursing staff. METHODS A mixed-method research study was conducted among full- and part-time pediatric nurses and nursing assistants working on general pediatric units. Quantitative data was collected via an anonymous survey using the Professional Quality of Life Scale version 5 and Support Appraisal for Work Stressors scale. Surveys were followed by semistructured interviews. FINDINGS Of the 158 staff eligible, 47 (29.7%) participated in the quantitative portion. [Correction added on 29 September 2023, after the first online publication: In the preceding sentence, the participation rate was revised from 23.5% to 29.7% in this version.] Significant differences were found between roles, with nurses experiencing lower levels of compassion satisfaction and higher levels of burnout. Role differences were seen in supervisor support and nonwork support, with nurses reporting less support from both. Supervisor support showed a significant correlational relationship with compassion satisfaction and burnout. Nonwork support showed similar correlations with compassion satisfaction and burnout. Themes that emerged from the interviews were Barriers to Care, Emotional Impact, and "Help Me Help You." CONCLUSION Nurses may be at greater risk for compassion fatigue due to perceived inadequate support from leadership, unclear role expectations, and lack of resources.
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Affiliation(s)
- Katelyn DeAlmeida
- Nursing Research Department, UChicago Medicine, Chicago, Illinois, USA
| | - Keli Blanco
- Nursing Research Department, UChicago Medicine, Chicago, Illinois, USA
| | - Katherine Metz
- Nursing Research Department, UChicago Medicine, Chicago, Illinois, USA
| | - Nicole L Bohr
- Nursing Research Department, UChicago Medicine, Chicago, Illinois, USA
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Bergem AK, Thorvaldsen NØ, Häikiö K, Olsen-Bergem H. "Some missions can be quite emotionally painful." Paramedic´s experience exercising coercion during assignments-A qualitative study. PLoS One 2024; 19:e0290593. [PMID: 38165987 PMCID: PMC10760701 DOI: 10.1371/journal.pone.0290593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/09/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND More than 70% of respondents in a previous survey among paramedics reported use of coercion or physical force towards patients. Coercion outside hospital is not permitted, and neither routines nor equipment intended for physical restraint is available in the Norwegian ambulance services. Paramedics carry out assignments involving use of force and coercion on unclear legal grounds, with no training in techniques or proper equipment. Attitudes and experiences of healthcare workers regarding incidents involving coercion in mental health care services are frequently reported in the research literature, yet little is known about paramedics' experiences, and which factors contribute to their moral stress. METHODS In the period June-August 2021, almost 400 employees in the ambulance services in a county in the eastern part of Norway were invited to answer a digital questionnaire. One question had an open text field with the question "Can you say something about how you experience transporting patients where force has to be used to secure the patient during transport?". The answers were analyzed using Graneheim and Lundman's content analysis. RESULTS We received eighty-five completed responses (response rate 21%). Force was used by 62 paramedics. Twenty-three left the text field open. The answers showed many unique responses. Content analysis resulted in two overarching themes; 1) lack of routines, equipment, and training regarding use of coercion and force in the ambulance service, and 2) paramedics were confronted with ethical dilemmas, alone and without support from legislation or management. CONCLUSIONS The paramedics experienced discomfort related to the exercise of force and coercion during ambulance assignments due to the experience of unclear legislation, lack of training, routines, and equipment in addition to frequent ethical dilemmas and the concern about lack of support from the employer. A clearer legal basis, adapted equipment in the ambulance and regular training, will contribute to greater security in the performance of the work, which will provide safer and more caring treatment for the patients and less moral stress for the staff. With established routines, the employer will be implicitly obliged, and paramedics will be safer in the performance of their work. Ethical reflection must be offered and put into a system.
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Affiliation(s)
- Anne Kristine Bergem
- Dept of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Nina Øye Thorvaldsen
- Dept of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Häikiö
- Dept of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heming Olsen-Bergem
- Dept of Oral Surgery and Oral Medicine, Institute for Clinical Dentistry, Oslo University, Oslo, Norway
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Tomura M. Psychiatric nurses' experience of moral distress: Its relationship with empowerment and coping. Nurs Ethics 2023; 30:1095-1113. [PMID: 37226471 DOI: 10.1177/09697330231153915] [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: 05/26/2023]
Abstract
BACKGROUND Research has shown that moral distress negatively impacts nurses, patients, and organizations; however, several scholars have argued that it can be an opportunity for positive outcomes. Thus, factors that may mitigate moral distress and catalyze positive change need to be explored. RESEARCH AIM The purpose of this study was to explore the relationships among structural and psychological empowerment, psychiatric staff nurses' experience of moral distress, and strategies for coping with moral distress. RESEARCH DESIGN A descriptive cross-sectional correlational study. PARTICIPANTS AND RESEARCH CONTEXT A total of 180 registered nurses working in psychiatric hospitals in Japan participated. This study examined relationships among key variables using four questionnaires to assess structural and psychological empowerment, moral distress for psychiatric nurses, and coping strategies. Statistical analyses of correlations and multiple regressions were conducted. ETHICAL CONSIDERATIONS The study was approved by the institutional review board at the author's affiliated university. FINDINGS Psychiatric nurses perceived moderate levels of structural and psychological empowerment, and their experiences of moral distress were related to low staffing. Structural empowerment was negatively related to the frequency of moral distress but not the intensity. Contrary to expectations, psychological empowerment was not found to mitigate nurses' moral distress. Multivariate regression analyses revealed that the significant predictors of moral distress were the leaving issues unresolved coping style, the problem-solving coping style, and a lack of formal power, which explained 35% and 22% of the variance in the frequency and intensity of moral distress, respectively. CONCLUSIONS In psychiatric hospitals in Japan, nurses experience moral distress that compromises the quality of care they provide. Therefore, formal support for nurses in voicing and investigating their moral concerns is required to bestow formal power by establishing a ward culture that includes shared governance.
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Affiliation(s)
- Michiko Tomura
- Psychiatric Nursing, Japanese Red Cross Hiroshima College of Nursing, Hatsukaichi, Japan
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20
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Bruggmann MS, Schneider DG, Ramos FRS, Dalmolin GDL, Rodrigues J, Bhering Á. Intensity and frequency of moral distress in mental health nurses in Brazil. Rev Esc Enferm USP 2023; 57:e20230122. [PMID: 37695606 PMCID: PMC10476911 DOI: 10.1590/1980-220x-reeusp-2023-0122en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/05/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To assess the intensity and frequency of moral distress in mental health nurses in Brazil. METHOD Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. RESULTS Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. CONCLUSION The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.
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Affiliation(s)
| | | | - Flávia Regina Souza Ramos
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil
| | | | - Jeferson Rodrigues
- Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Ácmon Bhering
- Secretaria Municipal de Educação de Florianópolis, SC, Brazil
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Guinaudeau J, Baier PC, Kühlmeyer K, Borzikowsky C, Terheyden L, Witt VD, Rogge A. [Changes in the routine work and moral distress in psychiatric care during the COVID-19 pandemic : A survey among physicians active in inpatient care in Germany]. DER NERVENARZT 2023; 94:827-834. [PMID: 37405400 PMCID: PMC10499671 DOI: 10.1007/s00115-023-01499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND During the COVID-19 pandemic a number of ethical challenges have arisen in the healthcare system. A psychological response to moral challenges is termed moral distress (MD). OBJECTIVE Identification of causes of MD in inpatient psychiatric care in the context of the COVID-19 pandemic in Germany. MATERIAL AND METHODS A survey was conducted using a self-administered non-validated online questionnaire as part of a cross-sectional study, in which 26 items about the experience of MD were examined and open questions about the handling of the pandemic and its effects on everyday work were posed. Physicians who worked in inpatient psychiatric care during the COVID-19 pandemic in Germany were surveyed anonymously with a convenience sample. The data acquisition took place between 17 November 2020 and 6 May 2021. RESULTS A total of 141 participants were included. They indicated multiple pandemic-related changes in their daily work partly resulting in MD. CONCLUSION MD is a neglected potential burden of inpatient psychiatric care under pandemic conditions (and beyond), which requires further research and an adequate handling. These results include implications for decision makers in crisis teams as well as a need for support services such as clinical ethics consultation services.
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Affiliation(s)
- Jeanne Guinaudeau
- Zentrum für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein, Niemannsweg 147, 24105, Kiel, Deutschland.
| | - Paul Christian Baier
- Zentrum für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein, Niemannsweg 147, 24105, Kiel, Deutschland
| | - Katja Kühlmeyer
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Christoph Borzikowsky
- Institut für Medizinische Informatik und Statistik, Christian-Albrechts-Universität zu Kiel, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Laura Terheyden
- Klinik für Neurologie, Nordseeklinik Helgoland, Helgoland, Deutschland
| | | | - Annette Rogge
- Klinik für Neurologie, Nordseeklinik Helgoland, Helgoland, Deutschland
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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Chew QH, Lee TS, Sim K. Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review. Postgrad Med 2023; 135:646-668. [PMID: 37776227 DOI: 10.1080/00325481.2023.2266007] [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: 07/06/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings. METHODS Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its effects on MHP (consequences) were extracted from the studies. RESULTS The majority of studies were conducted in the West (n = 26, 74.3%). Contributors to moral injury were found at the individual (e.g. poor competence), practice setting (e.g. lack of resources), and organizational levels (e.g. inconsistent policies). Moral injury had negative repercussions for the individual (e.g. psychological and physical symptoms), healthcare teams (e.g. lack of trust and empathy), and healthcare system (e.g. staff attrition). CONCLUSIONS Seen through the moral habitability framework, interventions must include an acknowledgment of the influence of various factors on the ability of MHP to enact their moral agency, and seek to establish safe moral communities within a supportive moral climate.
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Affiliation(s)
- Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Tih-Shih Lee
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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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.
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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
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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.
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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
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Fischer-Grönlund C, Brännström M, Isaksson U. Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Med Ethics 2023; 24:35. [PMID: 37254086 DOI: 10.1186/s12910-023-00916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). METHODS Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole. RESULTS The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912). CONCLUSIONS We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.
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Affiliation(s)
| | - Margareta Brännström
- Department of Nursing, Umeå University, Campus Skellefteå, 93187, Skellefteå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Linnaeus v 9, 90736, Umeå, Sweden
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Ventovaara P, Af Sandeberg M, Blomgren K, Pergert P. Moral distress and ethical climate in pediatric oncology care impact healthcare professionals' intentions to leave. Psychooncology 2023. [PMID: 37144967 DOI: 10.1002/pon.6148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To assess perceptions of ethical climate, experiences of moral distress, and intentions to leave among healthcare professionals in Nordic pediatric oncology care. METHODS A cross-sectional survey with registered nurses, physicians, and nursing assistants at 20 Nordic pediatric cancer centers. Data were collected by using translated versions of the Swedish Hospital Ethical Climate Survey-Shortened and the Swedish Moral Distress Scale-Revised. Descriptive analyses and non-parametric tests were used to describe, summarize, and compare data. RESULTS According to 543 healthcare professionals (response rate 58%), the ethical climate in Nordic pediatric oncology care was positive. Inadequate staffing levels, poor continuity and lack of time were the most common causes of moral distress. Registered nurses experienced significantly higher levels of moral distress compared to physicians and nursing assistants. About 6% of the respondents considered leaving due to moral distress. Typically, they assessed the ethical climate as less positive and reported higher levels of moral distress than those who had no intention to leave. CONCLUSIONS Organizational actions that ensure safe staffing levels and improve the continuity of care are needed to prevent moral distress and high staff turnover.
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Affiliation(s)
- Päivi Ventovaara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Haematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Haematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Haematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
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Козігора М. ВПРОВАДЖЕННЯ ЕКСПЕРИМЕНТАЛЬНОЇ ПРОГРАМИ З ПРОФІЛАКТИКИ МОРАЛЬНОЇ ТРАВМИ У МАЙБУТНІХ ВЧИТЕЛІВ ПІД ЧАС ВОЄННОГО СТАНУ. PSYCHOLOGICAL PROSPECTS JOURNAL 2022. [DOI: 10.29038/2227-1376-2022-40-koz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Мета. У статті розглянуто вивчення поняття моральної травми (МТ) у науковій літературі. Мета нашого дослідження – висвітлення та обґрунтування експериментальної програми спецкурсу для майбутніх вчителів.
Методи. У статті ми використали метод теоретичного аналізу й узагальнення та метод природнього експерименту з впровадження програми спецкурсу для майбутніх вчителів «Моральна травма: діагностика та профілактика у майбутніх вчителів під час воєнного стану». У дослідженні взяли участь студенти 3-х курсів освітнього ступеня «бакалавр» спеціальності 013 Початкова освіта Комунального закладу вищої освіти «Луцький педагогічний коледж» Волинської обласної ради». Програма розрахована на один семестр 2022/2023 н.р. та включає 11 лекційних та 5 практичних занять.
Результати аналізу наукових джерел дають змогу стверджувати, що МТ на сучасному етапі може виникати не тільки у військовослужбовців, а й у цивільних, найчастіше у медичних працівників та вчителів. В Україні відсутні дослідження, що стосуються саме МТ у вчителів, хоча це дуже актуальна тема в період широкомасштабної війни в країні. В рамках дослідження проявів МТ під час воєнного конфлікту ми розробили експериментальну програму для майбутніх вчителів. Наш спецкурс базується на основі духовно-орієнтованої когнітивно-процесуальної терапії. При МТ може виникати сором, гнів, почуття провини, втрата віри, а такі моральні поняття, як милосердя, прощення, молитва, покаяння, справедливість можуть запобігати цьому. Для роботи ми обрали теми, які в названій терапії вважаються найефективнішими: поняття МТ, події, значення події для в житті людини, духовні ресурси, поняття провини та визнання провини, самопрощення, повага, духовне партнерство під час переживання МТ, посттравматичне зростання. Під час практичних занять здобувачі освіти розглядають практичні вправи для допомоги учням заспокоїтись, пережити травматичну ситуацію. Для щоденного використання ми пропонуємо використовувати вправи для контролю власних емоцій, спілкування з оточуючими, вирішення конфліктних ситуацій; техніки самодопомоги в екстремальних ситуаціях.
Висновки. Отримані знання зі спецкурсу «Моральна травма: діагностика та профілактика у майбутніх вчителів під час воєнного стану» є корисними, практичні навички можуть використовувати у професійній діяльності.
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Derblom K, Molin J, Gabrielsson S, Lindgren BM. Nursing Staff's Experiences of Caring for People with Mental Ill-Health in General Emergency Departments: A Qualitative Descriptive Study. Issues Ment Health Nurs 2022; 43:1145-1154. [PMID: 36383445 DOI: 10.1080/01612840.2022.2138653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While people with mental ill-health report unsatisfying experiences and poor treatment in general emergency departments, nursing staff report a lack of adequate knowledge and training. This study describes nursing staff's experiences caring for people with mental ill-health in general emergency departments. A qualitative descriptive design was used and 14 interviews were subjected to qualitative content analysis. Results show that nursing staff are dealing with uncertainty and competing priorities when caring for people with mental ill-health. Nursing staff must both take and be given the opportunity to maintain and develop confidence and independence and need support in promoting mental health recovery.
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Affiliation(s)
| | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Evaluation of the Moral Distress Intensity and Its Relationship with the Quality of Work Life among Nurses Working in Oncology Wards in Shiraz, Southwest of Iran. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7977039. [DOI: 10.1155/2022/7977039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
Background. Moral distress defined as an incident that prevents the appropriate functioning of individuals in spite of having the required knowledge. Nurses are commonly exposed to moral distress while doing their professional roles, which can influence the quality of their work life. The present study aimed to assess the relationship between the moral distress intensity and work life quality amongst nurses. Methods. In this descriptive-correlational study, 180 nurses working in oncology wards were selected through census based on inclusion criteria (associate or higher degrees, having at least six months of clinical work experience, and not suffering from anxiety disorders). The data were collected using Corley’s questionnaire (2001) and Brooks’ investigation of work life quality of nurses (2001). Then, the data were entered into the SPSS 22 software and were analyzed using the Independent Sample
-test, One-way ANOVA, and Pearson’s correlation coefficient. Results. The nurses’ mean scores of moral distress and work life quality were
and
, respectively. The results revealed a negative significant relationship between the nurses’ moral distress and work life quality (
) (
). There was also a significant difference between the nurses’ sex and work life quality (
). Conclusion. Identifying the moral distress intensity and work life quality of nurses and proper planning from the authorities can improve job satisfaction in nurses and resulting to higher quality of care.
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Tsubonouchi C, Kinoshita Y, Nomura N. The patient-authored medical record: A narrative path to a new tool in psychiatric nursing. Arch Psychiatr Nurs 2022; 39:46-53. [PMID: 35688543 DOI: 10.1016/j.apnu.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/14/2021] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
This paper describes preliminary research from Japan on developing a new tool for psychiatric nurses, the patient-authored medical record, a "prescription" written in ordinary language by the patient with the assistance of a nurse. The nurse asks the patient how to improve their illness and she types up the patient's story on site in the form of a first-person narrative. The patient checks it for accuracy before taking a copy home. Ten Japanese patients participated in this field-oriented ethnographic study, and the analysis of the qualitative data strongly suggested that the approach had therapeutic effects on each patient. This narrative-based prescription could be used as a tool, specifically by psychiatric nurses, in many cultures, and it is our hope that it contributes to their professional identity.
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Affiliation(s)
- Chizuru Tsubonouchi
- School of Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya City, Japan; School of Nursing, Japanese Red Cross Toyota College of Nursing, Toyota City, Japan
| | | | - Naoki Nomura
- Graduate School of Humanities and Social Sciences, Nagoya City University, Nagoya City, Japan.
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Du J, Huang S, Lu Q, Ma L, Lai K, Li K. Influence of empathy and professional values on ethical decision-making of emergency nurses: A cross sectional study. Int Emerg Nurs 2022; 63:101186. [PMID: 35749969 DOI: 10.1016/j.ienj.2022.101186] [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: 11/11/2021] [Revised: 04/23/2022] [Accepted: 05/07/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Emergency nurses are likely to experience serious ethical dilemmas and conflicts because of the dangerous and unpredictable care situations. Nursing ethical decision-making ability is therefore a core competence. Empathy and professional values may be the important variables that influence ethical decision-making. However, for emergency nurses, there is a lack of empirical evidence to support presently. This study aimed to explore the influence of empathy and professional values on nursing ethical decision-making of emergency nurses. METHODS A convenience sample of 236 emergency nurses from 10 general hospitals in China were surveyed. Their ethical decision-making ability, empathy and professional values were measured using the Judgment About Nursing Decision scale, Jefferson Scale of Empathy-Health Professionals, and Nursing Professional Values Scale-Revised, respectively. Additionally, their sociodemographic data were collected. Univariate analysis, Pearson analysis, and multiple linear regression were performed. RESULTS The mean ethical decision-making score of emergency nurses was 295.06 ± 26.49, which was medium level. Their average ethical choice score was higher than that of ethical action (P < 0.001). The multiple linear regression results showed that professional values (Standardized coefficients (β) = 0.295, 95% confidence interval (CI): 0.618-1.618), empathy (β = 0.210, 95% CI: 0.620-1.613), job title (β = 0.253, 95% CI: 0.357-2.800) and number of forms of in-service training on ethical decision-making (β = 0.243, 95% CI: 0.254-3.942) were the independent factors significantly influencing the ethical decision-making ability. The multivariate linear regression model had an F statistic of 32.153 (P < 0.001) and an R2 = 0.588. CONCLUSIONS Strengthening nurses' empathy and professional values can help nurses make ethical decisions. More clinical experience and in-service training on ethical decision-making can help emergency nurses better handle ethical dilemmas and conflicts.
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Affiliation(s)
- Jingrong Du
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Sang Huang
- Emergency Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Qing Lu
- Emergency Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Lin Ma
- Phoenix International Medical Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kailan Lai
- Nursing Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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Jovarauskaite L, Murphy D, Truskauskaite-Kuneviciene I, Dumarkaite A, Andersson G, Kazlauskas E. Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study. BMJ Open 2022; 12:e056289. [PMID: 35534083 PMCID: PMC9086640 DOI: 10.1136/bmjopen-2021-056289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate how moral injury (MI), traumatic experiences and daily stressors were related to the symptoms of post-traumatic stress disorder (PTSD) and International Classification of Diseases 11th revision specific complex PTSD (CPTSD) symptoms of disturbances in self-organisation (DSO) in a treatment-seeking sample of nurses. DESIGN A cross-sectional study. SETTING Nurses from all regions of Lithuania participated in the study. The data were collected between April and May 2021. PARTICIPANTS A total of 206 nurses, mean age 42.34 years (SD=11.68), 97.1% women and with 65% >10 years of work experience. RESULTS The prevalence of PTSD and CPTSD in the treatment-seeking sample of nurses was 9.2% and 10.2%, respectively. The results of structural equation modelling indicated an acceptable model fit for the model regarding the links between trauma exposure, daily stressors, MI, PTSD and DSO symptoms, (χ2 (df)=219.718 (123), p<0.001, Comparative Fit Index/Tucker-Lewis Index=0.937/0.922, root mean square error of approximation (90% CI)=0.062 (0.048 to 0.075), standardised root mean square residual=0.049). MI had a large effect on DSO symptoms, β=0.667, p<0.001, and a medium effect on PTSD symptoms, β=0.394, p<0.001. Daily stress but not trauma exposure was significantly related to MI, β=0.618, p<0.001. CONCLUSIONS The prevalence of PTSD and CPTSD in a treatment-seeking sample of nurses inform healthcare administrators, policymakers and medical staff about the demand for psychosocial interventions for healthcare workers focused on stress management to address their daily stressors and mitigate effects on MI or trauma-focused treatments for PTSD/CPTSD. TRIAL REGISTRATION NUMBER NCT04817995; Pre-results.
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Affiliation(s)
- Lina Jovarauskaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dominic Murphy
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- Combat Stress, Research Department, Tyrwhitt House, Leatherhead, Surrey, UK
| | | | - Austeja Dumarkaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Gerhard Andersson
- 4 Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Shehadeh J, Almaraira O, Hamdan-Mansour A. Determinants of Moral Distress Among Mental Health Professionals. Open Nurs J 2022. [DOI: 10.2174/18744346-v15-e2203030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.
Objectives:
To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.
Methods:
A cross-sectional descriptive design was used, employing self-administered questionnaire.
Results:
Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R2 = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R2 = .243.
Conclusion:
Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.
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Shehadeh J, Almaraira O, Hamdan-Mansour A. Determinants of Moral Distress Among Mental Health Professionals. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2203030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.
Objectives:
To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.
Methods:
A cross-sectional descriptive design was used, employing self-administered questionnaire.
Results:
Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R2 = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R2 = .243.
Conclusion:
Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.
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Oedegaard CH, Ruano AL, Blindheim A, Veseth M, Stige B, Davidson L, Engebretsen IMS. How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway. Int J Ment Health Syst 2022; 16:19. [PMID: 35379290 PMCID: PMC8978409 DOI: 10.1186/s13033-022-00529-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work. Trial registration: N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00529-8.
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Gabrielsson S, Karim H, Looi GME. Learning your limits: Nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Int J Ment Health Nurs 2022; 31:369-378. [PMID: 34913549 DOI: 10.1111/inm.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/13/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Young unaccompanied refugees come in contact with acute psychiatric care due to pre-existing mental health conditions as well as stressful and traumatic experiences before, during, and after migration. Previous research on nurses' experiences of caring for refugees has primarily reported on difficulties related to cultural differences and communication and how nurses might distrust refugees. This study aimed to describe registered nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Semi-structured interviews with ten nurses were analysed using a method for qualitative content analysis. Data were collected in Sweden during 2019 and 2020. Results describe nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care in one theme: learning your limits and three sub-themes: feeling powerless but doing what you can; taking a stance in a politicized environment; and being frustrated and in need of support. Findings highlight the potential and limitations of mental health nursing, the importance of reflection and peer support, and the importance of viewing the roles and responsibilities of mental health nurses and nursing in a societal context. These findings suggest that nurses can make a difference for young unaccompanied refugees in acute psychiatric care. However, in doing so, nurses need support in realizing what they can and cannot achieve. The study is reported in accordance with the COREQ guidelines.
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Affiliation(s)
- Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
| | - Hannan Karim
- Department of Psychiatry, Sunderby Hospital, Region Norrbotten, Lulea, Sweden
| | - Git-Marie Ejneborn Looi
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
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Jansen TL, Danbolt LJ, Hanssen I, Hem MH. How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study. BMC Psychiatry 2022; 22:212. [PMID: 35321674 PMCID: PMC8944013 DOI: 10.1186/s12888-022-03832-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. METHODS Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. RESULTS While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients' behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them. CONCLUSIONS Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat. Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.
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Affiliation(s)
- Trine-Lise Jansen
- Norway, MF Norwegian School of Theology, Religion and Society, Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway.
| | | | - Ingrid Hanssen
- Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway
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Janatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC Nurs 2022; 21:59. [PMID: 35287687 PMCID: PMC8918588 DOI: 10.1186/s12912-022-00839-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Missed nursing care is a global challenge that can have many consequences. Knowing the experiences of clinical nurses can be helpful. Therefore, this study was conducted to explain the experiences of Iranian nurses regarding the consequences of missed nursing care. Methods This qualitative descriptive study was conducted with a content analysis approach. Sampling was done by the purposeful sampling method and continued until data saturation. Data were collected by in-depth semi-structured interviews. Data were analyzed using qualitative content analysis and Graneheim and Lundman’s method. MAXQDA version 10 software was used for data management. Results The participants included 14 nurses with a mean age of 38.7 ± 7.7 years. The data were classified into three categories: patient-related outcomes, nurse-related outcomes, and organization-related outcomes. These categories included nine subcategories entitled "moral distress", "job dissatisfaction", " decreased quality of nursing care "," patient dissatisfaction ","adverse events"," absenteeism ","intention to leave and subsequent turnover", "decreased hospital credit", and "increased hospital costs". Conclusion Missed nursing care can have adverse consequences for the patients, nurses, and organizations. Therefore, it is necessary to adopt management strategies such as providing sufficient manpower and increasing nurses' job satisfaction to reduce the amount of missed nursing care. Further studies are needed to explain the predictors of the missed nursing care consequences.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Söderberg A, Ejneborn Looi GM, Gabrielsson S. Constrained nursing: Nurses' and assistant nurses' experiences working in a child and adolescent psychiatric ward. Int J Ment Health Nurs 2022; 31:189-198. [PMID: 34723444 DOI: 10.1111/inm.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Abstract
The role of nurses and nursing in CAP inpatient care is unclear, and nurses are at risk of moral distress due to having to deal with complex demands while lacking organizational support. This study aimed to describe nurses' and assistant nurses' experiences working in child and adolescent psychiatric inpatient care. Eight nurses and seven assistant nurses working in a child and adolescent ward in Sweden participated in the study. Data were collected in 2019 using semi-structured qualitative interviews and subject to qualitative content analysis. Results describe nurses' and assistant nurses' experiences of child and adolescent psychiatric inpatient care in one theme, Constrained nursing, and four categories: Striving to be there for children and parents; Finding a way to manage work; Depending on others; Lacking nursing leadership. Findings suggest that good, person-centred and recovery-oriented nursing practice can exist in CAP inpatient care but remain unrecognized and lacking support due to unclear roles and responsibilities and lack of nursing leadership. This study is reported in accordance with the COREQ guidelines.
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Affiliation(s)
- Anja Söderberg
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Git-Marie Ejneborn Looi
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Giannetta N, Sergi R, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study. Healthcare (Basel) 2021; 9:healthcare9121673. [PMID: 34946401 PMCID: PMC8701919 DOI: 10.3390/healthcare9121673] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 12/25/2022] Open
Abstract
Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect.
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Affiliation(s)
- Noemi Giannetta
- Faculty of Philosophy, Vita-Salute San Raffaele University, 20132 Milan, Italy; (N.G.); (R.S.); (F.P.); (R.S.); (R.M.)
| | - Rebecca Sergi
- Faculty of Philosophy, Vita-Salute San Raffaele University, 20132 Milan, Italy; (N.G.); (R.S.); (F.P.); (R.S.); (R.M.)
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Correspondence: ; Tel.: +39-022-643-2522
| | - Federico Pennestrì
- Faculty of Philosophy, Vita-Salute San Raffaele University, 20132 Milan, Italy; (N.G.); (R.S.); (F.P.); (R.S.); (R.M.)
| | - Roberta Sala
- Faculty of Philosophy, Vita-Salute San Raffaele University, 20132 Milan, Italy; (N.G.); (R.S.); (F.P.); (R.S.); (R.M.)
| | - Roberto Mordacci
- Faculty of Philosophy, Vita-Salute San Raffaele University, 20132 Milan, Italy; (N.G.); (R.S.); (F.P.); (R.S.); (R.M.)
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy;
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McMillan K, Wright DK, McPherson CJ, Ma K, Bitzas V. Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic. Glob Qual Nurs Res 2021; 8:23333936211051702. [PMID: 34761076 PMCID: PMC8573617 DOI: 10.1177/23333936211051702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.
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Affiliation(s)
- Kim McMillan
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - David K Wright
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristina Ma
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Vasiliki Bitzas
- Clinical Administrative Coordinator, Geriatrics and Palliative Care, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada
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Fischer-Grönlund C, Brännström M. The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). BMC Med Ethics 2021; 22:151. [PMID: 34772400 PMCID: PMC8588668 DOI: 10.1186/s12910-021-00722-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one's convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context. METHODS The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0-4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts. RESULTS The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items' had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible. CONCLUSION The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context.
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Irmak H, Sagkal Midilli T. The relationship between psychiatric nurses' spiritual care practices, perceptions and their competency. Arch Psychiatr Nurs 2021; 35:511-518. [PMID: 34561067 DOI: 10.1016/j.apnu.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The research aimed to examine the relationship between psychiatric nurses' spiritual care practices, perceptions and competencies. METHODS This study was conducted as a descriptive -correlational study. The population of the study consisted of the nurses working at Manisa Mental Health Hospital (N =134). It was intended to contact the whole of the population, and so there was no selection process. Thus, the study sample consisted of 128 nurses, who accepted to participate in the research. Spirituality Spiritual Care Rating Scale used to determine nurses' perceptions spirituality and spiritual care. Spiritual Care Competence Scale was used to evaluate the nurses' spiritual care competence. RESULTS Spirituality and Spiritual Care Rating Scale of psychiatric nurses item score mean was 3.93 ± 0.49, the Spiritual Care Competence Scale of psychiatric nurses item score mean was 3.54 ± 0.63. There was no significant relationship between two scales (p > 0.05). As a result of multiple regression analysis, psychiatric nurses' which accounts for only 20.1% of spirituality and spiritual care perceptions of feel incompetent about spiritual care. CONCLUSION Psychiatric nurses' perceptions of spiritual and spiritual care were high, but their competence was at a moderete level. There was no a correlation between nurses' perceptions and competencies of spiritual care.
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Affiliation(s)
- Hatice Irmak
- Istanbul University- Cerrahpasa, Florence Nightingale Faculty of Nursing, Department of Psychiatric and Mental Health Nursing, Istanbul, Turkey.
| | - Tulay Sagkal Midilli
- Manisa Celal Bayar University Faculty of Health Sciences, Department of Fundamentals of Nursing, Manısa, Turkey.
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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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Jansen TL, Hem MH, Danbolt LJ, Hanssen I. Coping with moral distress on acute psychiatric wards: A qualitative study. Nurs Ethics 2021; 29:171-180. [PMID: 34486442 PMCID: PMC8866740 DOI: 10.1177/09697330211010246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Nurses working within acute psychiatric settings often face multifaceted
moral dilemmas and incompatible demands. Methods: Qualitative individual and focus group interviews were conducted. Ethical considerations: Approval was received from the Norwegian Social Science Data Services.
Ethical Research Guidelines were followed. Participants and research context: Thirty nurses working within acute psychiatric wards in two mental health
hospitals. Results: Various coping strategies were used: mentally sorting through their ethical
dilemmas or bringing them to the leadership, not ‘bringing problems home’
after work or loyally doing as told and trying to make oneself immune.
Colleagues and work climate were important for choice of coping
strategies. Discussion: Nurses’ coping strategies may influence both their clinical practice and
their private life. Not facing their moral distress seemed to come at a high
price. Conclusions: It seems essential for nurses working in acute psychiatric settings to come
to terms with distressing events and identify and address the moral issues
they face. As moral distress to a great extent is an organisational problem
experienced at a personal level, it is important that a work climate is
developed that is open for ethical discussions and nourishes adaptive coping
strategies and moral resilience.
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Affiliation(s)
- Trine-Lise Jansen
- Lovisenberg diakonale høgskole (Lovisenberg Diaconal University College), Norway.,MF Norwegian School of Theology, Religion and Society, Norway
| | | | | | - Ingrid Hanssen
- 155319Lovisenberg diakonale høgskole (Lovisenberg Diaconal University College), Norway
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Heikkilä M, Huhtala M, Mauno S, Feldt T. Intensified job demands, stress of conscience and nurses' experiences during organizational change. Nurs Ethics 2021; 29:217-230. [PMID: 34374305 PMCID: PMC8866741 DOI: 10.1177/09697330211006831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nurses frequently face ethically demanding situations in their work, and these may lead to stress of conscience. Working life is currently accelerating and job demands are intensifying. These intensified job demands include (1) work intensification, (2) intensified job-related planning demands, (3) intensified career-related planning demands, and (4) intensified learning demands. At the same time, many healthcare organizations are implementing major organizational changes that have an influence on personnel. AIM The aim of the study was to investigate the association between intensified job demands and stress of conscience, and whether their association is moderated by organizational change experiences among nurses. Experiences of organizational change may expose employees to stress of conscience or serve as a buffer because employees appraise, involve, and cope with changes differently. RESEARCH DESIGN Questionnaires measuring stress of conscience, intensified job demands, and organizational change experiences were completed by nurses (n = 511) in a healthcare district undergoing a major organizational change. ETHICAL CONSIDERATIONS Throughout, the study procedures were implemented according to the guidelines of the Finnish National Board on Research Integrity and the 1964 Helsinki Declaration and its later amendments. According to the Finnish regulations, because participation was voluntary, informed consent was requested, and participants were advised of their right to withdraw from the study at will. No permission from an ethics committee was necessary. FINDINGS Work intensification and personal worry considering organizational change were associated with more severe stress of conscience among nurses. Nurses' experiences of managements' competent handling of organizational change buffered the association between work intensification and stress of conscience. CONCLUSIONS During organizational changes, management may alleviate nurses' stress of conscience by proper communication and support procedures.
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Affiliation(s)
| | | | - Saija Mauno
- University of Jyväskylä, Finland; Tampere University, Finland
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Paradis-Gagné E, Pariseau-Legault P, Goulet MH, Jacob JD, Lessard-Deschênes C. Coercion in psychiatric and mental health nursing: A conceptual analysis. Int J Ment Health Nurs 2021; 30:590-609. [PMID: 33694266 DOI: 10.1111/inm.12855] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
The use of coercion in psychiatric and mental health nursing is a major challenge, which can lead to negative consequences for nurses and patients, including rupture in the therapeutic relationship and risk of injury and trauma. The concept of coercion is complex to define and is used in different ways throughout the nursing literature. This concept is defined broadly, referring to both formal (seclusion, restraint, and forced hospitalization), informal (persuasion, threat, and inducement), and perceived coercion, without fully addressing its evolving conceptualizations and use in nursing practice. We conducted a concept analysis of coercion using Rodgers' evolutionary method to identify its antecedents, attributes, and associated consequences. We identified five main attributes of the concept: different forms of coercion; the contexts in which coercion is exercised; nurses' justification of its use; the ethical issues raised by the presence of coercion; and power dynamics. Our conceptual analysis shows the need for more nursing research in the field of coercion to achieve a better understanding of the power dynamics and ethical issues that arise in the presence of coercion.
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Fernández-Hernández JL, Herranz-Hernández P, Segovia-Torres L. Refusal of Treatment for Anorexia Nervosa: Mental Health Professionals' Opinion on Willingness and Role Stress. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00046-9. [PMID: 33888305 DOI: 10.1016/j.rcp.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/27/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The hospitalisation of patients with anorexia nervosa poses an important bioethical quandary and can generate stress for the healthcare professionals. Our goal was to know and analyse the opinion of mental health professionals on some conditions for applying the involuntary hospitalisation of patients with anorexia nervosa. METHODS Cross-sectional descriptive observational study on a sample of 270 mental health professionals, using an ad hoc questionnaire with scores ranging from 0 to 10. RESULTS The professionals state that, in some cases, the patient accepts admission reluctantly: 7.74 (95% CI, 7.55-7.93). In the event of physical risk, it is difficult for them to combine respect for the patient's autonomy and the duty of care: 6.06 (95% CI, 5.70-6.41) and the relationship with the patient is largely oriented to convince them: 7.18 (95% CI, 6.91-7.46). They do not decide on the suitability of the participation of non-medical staff in the decision: 5.13 (95% CI, 4.75-5.52), or if the indication should correspond to someone other than the doctor in charge of their care: 4.79 (95% CI, 4.39-5.19). They reject the possibility of conscientious objection: 4.05 (95% CI, 3.68-4.41). CONCLUSIONS Mental health professionals are subject to ambiguous work demands, which affects their care dynamics.
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Musto L, Schreiber R, Rodney PP. Risking vulnerability: Enacting moral agency in the is/ought gap in mental health care. J Adv Nurs 2021; 77:2458-2471. [PMID: 33609062 DOI: 10.1111/jan.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/23/2020] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore how healthcare providers in acute care mental health settings navigate ethically challenging situations, enact moral agency, practice in congruence with ethical standards and mitigate moral distress (MD). DESIGN Grounded theory, a qualitative methodology. METHODS Over 18 months between 2015 and 2017, we reviewed documents, conducted observations and interviewed multidisciplinary participants (N = 27) from inpatient and emergency departments. Participants either provided direct care (N = 14) or were in leadership positions (N = 13). Data were analysed iteratively using constant comparison, coding, memoing and theorizing, which continued until saturation was reached in July 2016. FINDINGS The basic social process of how healthcare professionals enacted moral agency, Risking Vulnerability, occurred in the context of Systemic Inhumanity, a constant source of MD. Participants Risked Vulnerability, balancing professional obligations, clinical expertise and organizational processes with their own vulnerability in the system as they strove to practice ethically. Risking Vulnerability was composed of Pushing Back, Working Through Team Relationships and Struggling with Inhumanity. CONCLUSION Healthcare professionals' moral agency occurred at the nexus of structure (organizational constraints) and agency (persons). Given this, interventions for MD should be directed at all levels of healthcare to support moral agency, promote ethical practice and improve care. IMPACT Sociopolitical elements such as austerity measures undermined ethical practice at the level of direct care. Enactment of moral agency is dynamic, influencing experiences of MD: participants supported by leadership or colleagues to enact moral agency noted that they were not stuck in MD. Interventions supporting moral agency throughout the healthcare system are necessary to mitigate experiences of MD. Findings enhance our understanding of the role of action in the experience of MD.
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Affiliation(s)
- Lynn Musto
- School of Nursing, Trinity Western University, Langley, BC, Canada
| | - Rita Schreiber
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Patricia Paddy Rodney
- Faculty Associate, UBC Centre for Applied Ethics, School of Nursing, University of British Columbia (UBC), Vancouver, BC, Canada
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Jia Y, Chen O, Xiao Z, Xiao J, Bian J, Jia H. Nurses' ethical challenges caring for people with COVID-19: A qualitative study. Nurs Ethics 2020; 28:33-45. [PMID: 32856534 PMCID: PMC7653013 DOI: 10.1177/0969733020944453] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Ethical challenges are common in clinical nursing practice, and an infectious environment could put nurses under ethical challenges more easily, which may cause nurses to submit to negative emotions and psychological pressure, damaging their mental health. Purpose: To examine the ethical challenges encountered by nurses caring for patients with the novel coronavirus pneumonia (COVID-19) and to provide nurses with suggestions and support regarding promotion of their mental health. Research design and method: A qualitative study was carried out using a qualitative content analysis. The participants were 18 nurses who agreed to attend an interview and describe their own experiences of providing care to COVID-19 patients in China. They were purposively sampled, and structured, in-depth interviews were performed. Data were iteratively collected and analyzed from February to March 2020. Ethical considerations: The proposal was approved by the Research Ethics Committee of the Second Hospital of Shandong University, China. Findings: The findings revealed three main themes and 10 categories. The themes were the following: (1) ethical challenges (people with COVID-19, inequality, professional ethics, and job competency); (2) coping styles (active control and planning, seeking support as well as catharsis, and staying focused); and (3) impacts on career (specialized nursing skills, scientific research ability, and management skills). Conclusion: Nurses faced ethical challenges on multiple fronts in caring for COVID-19 patients. The results may help nurses with more safety, ethics, and humanistic care in nursing practice.
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Affiliation(s)
- Yuxiu Jia
- 531675The Second Hospital of Shandong University, China
| | - Ou Chen
- 531675Shandong University, China
| | | | | | | | - Hongying Jia
- 531675The Second Hospital of Shandong University, China
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