Caring for victims of child maltreatment: Pediatric nurses' moral distress and burnout

Moral Distress of Nurses Working in Paediatric Healthcare Settings

This scoping review aims to map the evidence on moral distress of nurses working in paediatric healthcare settings from homecare to hospital. It was conducted according to the Joanna Briggs Institute. International databases were searched according to the specific thesaurus and free search terms. Independent screening and analysis were conducted using Rayyan QCRI. This review considered a total of 54 studies, including quantitative and qualitative studies, systematic reviews, and grey literature; English and Portuguese languages were included. Moral distress is a phenomenon discussed in nursing literature and in the paediatric context but is considered absent from discussion in clinical practice. It is caused by disproportionate care associated with overtreatment. Nurses can present a variety of symptoms, characterising moral distress as a highly subjective experience. The paediatric contexts of practice should promote a healthy ethical climate and work towards a moral community built with peer support, education, communication, leadership, and management involvement. Moral distress is still a complex and challenging multidimensional concept, and the aim should be to promote a culture of prevention of the devastating consequences of moral distress and work towards moral resilience.

Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review

Introduction

Healthcare clinicians are often at risk of psychological distress due to the nature of their occupation. Military healthcare providers are at risk for additional psychological suffering related to unique moral and ethical situations encountered in military service. This scoping review identifies key characteristics of moral distress and moral injury and how these concepts relate to the military healthcare clinician who is both a care provider and service member.

Methods

A scoping review of moral distress and moral injury literature as relates to the military healthcare clinician was conducted on the basis of the Joanna Briggs Institute scoping review framework. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid), PsycInfo, 2 U.S. Defense Department sources, conference papers index, and dissertation abstracts. Reference lists of all identified reports and articles were searched for additional studies.

Results

A total of 573 articles, published between the years 2009 and 2021, were retrieved to include a portion of the COVID-19 pandemic period. One hundred articles met the inclusion criteria for the final full-text review and analysis.

Discussion

This scoping review identified moral distress and moral injury literature to examine similarities, differences, and overlaps in the defining characteristics of the concepts and the associated implications for patients, healthcare clinicians, and organizations. This review included the unfolding influence of the COVID-19 pandemic on moral experiences in health care and the blurring of those lines between civilian and military healthcare clinicians. Future directions of moral injury and moral distress research, practice, and care are discussed.

Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future

OBJECTIVE

The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave.

BACKGROUND

Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed.

METHODS

This cross-sectional correlational study was conducted in a Magnet® hospital.

RESULTS

Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic.

CONCLUSIONS

Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.

An Exploration of Student Nurses' Experiences of Burnout during the COVID-19 Pandemic Using the Copenhagen Burnout Inventory (CBI)

Burnout amongst healthcare professionals has been a long-considered condition associated with the workplace environment. Student nurses studying at Sheffield Hallam University continued to engage in their training during the COVID-19 pandemic; however, the stressors of this experience were anecdotally highlighted to their academic staff. Furthermore, burnout can be linked to the ongoing difficulties with recruitment and retention of nursing staff within the NHS workforce. This work aimed to determine the burnout among nursing students experience by obtaining quantitative data to understand their experiences. The Copenhagen Burnout Inventory was used to gauge levels of burnout across the different fields of nursing students. Results identified that: (1) mental health students reported feeling tired significantly less often than child and adult field students (mean rating of 69% versus 91.7% and 84.0%, respectively); (2) students aged 30-39 feel tired significantly less often than both younger student age groups (mean rating 59.4% versus 82.8% and 90.6%); (3) there was a significant difference in how often different age groups felt "tired of working with clients" (F(4) = 2.68, p = 0.04) and that "they couldn't take it anymore" (F(4) = 2.53, p = 0.05); (4) child-field students reported generally higher levels of global burnout (mean CBI total = 57.9%) whilst mental health students reported lower levels (mean CBI total = 54.1%). Considering these results, it is imperative for both higher education institutions and potential employers to consider the impact of COVID-19 and burnout, and the levels of support offered to student nurses during their training and transition to practice as newly qualified nurses.

Estimation of moral distress among nurses: A systematic review and meta-analysis

BACKGROUND

Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction.

AIM

To estimate moral distress among nurses.

METHODS

This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis.

ETHICAL CONSIDERATION

The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773.

RESULTS

Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I²: 98.4%, Tau²:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance.

CONCLUSION

The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.

An Interprofessional Approach to Family-Centered Child Protective Services Referral: A Case Report

BACKGROUND

Members of the trauma team often find themselves in a uniquely challenging position wherein their role on the care team may necessitate developing a working relationship with alleged or confirmed perpetrators of abuse.

CASE PRESENTATION

A 9-week-old admitted to the hospital with hyponatremia and evaluation for suspected child physical abuse. Specific details of the case were a barrier to communication and interactions between the patient's mother and the trauma nurse. This report will provide a discussion of takeaway lessons to support communication with this patient population.

CONCLUSION

Peplau's Theory of Interpersonal Relations is utilized as a framework for engaging in therapeutic communication with a family that is part of a child protective services evaluation. The mnemonic, A-TEAM (Aware, Transparent, Empathetic, A nonjudgmental approach, and Managed by an interprofessional team), is introduced as a strategy for trauma nurses and other health care team members to engage in therapeutic communication with a family that is part of a child protective services evaluation during their admission.