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Koivisto T, Paavolainen M, Olin N, Korkiakangas E, Laitinen J. Strategies to mitigate moral distress as reported by eldercare professionals. Int J Qual Stud Health Well-being 2024; 19:2315635. [PMID: 38373153 PMCID: PMC10878340 DOI: 10.1080/17482631.2024.2315635] [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: 04/20/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
Eldercare workers experience higher levels of moral distress than other health and social care service workers. Moral distress is a psychological response to a morally challenging event. Very little is known about moral distress in the context of eldercare and about the mechanisms of preventing or mitigating moral distress. This qualitative study was conducted as part of the "Ensuring the availability of staff and the attractiveness of the sector in eldercareservices" project in Finland in 2021. The data were from 39 semi-structured interviews. This qualitative interview data were examined using two-stage content analysis. The key finding of this study, as reported by eldercare professionals, is that strategies to mitigate moral distress can be found at all organizational levels : organizational, workplace and individual. The tools that emerged from the interviews fell into four main categories:) organizational support and education 2) peer support 3) improving self-care and competence and 4) defending patients. The main identified categories confirmed the earlier findings but the qualitative, rich research interview data provided new insights into a little-studied topic: mitigating moral distress in eldercare. The main conclusion is that, in order to mitigate moral distress, ethical competence needs to be strengthened at all organizational levels.
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Affiliation(s)
- Tiina Koivisto
- CONTACT Tiina Koivisto Finnish Institute of Occupational Health, PO Box 40, Helsinki00032, Finland
| | | | - Nina Olin
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Jaana Laitinen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Miranda ACR, Fernandes SD, Ramos S, Nunes E, Fabri J, Caldeira S. Moral Distress of Nurses Working in Paediatric Healthcare Settings. Healthcare (Basel) 2024; 12:1364. [PMID: 38998898 DOI: 10.3390/healthcare12131364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Sílvia Ramos
- Nursing School Lisbon, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Elisabete Nunes
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, 1600-190 Lisbon, Portugal
| | - Janaína Fabri
- Faculty of Nursing, Universidade Estadual do Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
| | - Sílvia Caldeira
- Center for Interdisciplinary Research in Health, Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
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Rambod M, Pasyar N, Soltanian M. The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms. BMC Psychol 2024; 12:380. [PMID: 38978098 PMCID: PMC11232221 DOI: 10.1186/s40359-024-01881-9] [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: 05/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs). METHODS This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis. RESULTS 87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (β=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate. CONCLUSION The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.
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Affiliation(s)
- Masoume Rambod
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nilofar Pasyar
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Marzieh Soltanian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Zonneveld D, Conroy T, Lines L. Clinical supervision experience of nurses in or transitioning to advanced practice: A systematic review. J Adv Nurs 2024. [PMID: 38433321 DOI: 10.1111/jan.16126] [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: 11/25/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
AIMS To systematically explore the clinical supervision (CS) experience for nurses transitioning to advanced practice. DESIGN A qualitative systematic review using Joanna Briggs Institute meta-aggregation following an a priori protocol published on PROSPERO (CRD42023426658). DATA SOURCES Qualitative studies obtained from Medline, CINAHL, PsycINFO, Scopus, Emcare and ERIC databases and ProQuest dissertations and theses for peer-reviewed, published and unpublished studies from inception to July 2023. REVIEW METHODS Two authors conducted data screening and abstraction. Quality was appraised using the Critical Appraisal Skills Programme tool and reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist for systematic reviews. RESULTS Sixteen studies contributed to five synthesized findings: CS that is beneficial requires structure and commitment, trusting relationships are foundational for learning, lifting burdens and preventing burnout, learning through reflection, critical thinking and feedback and barriers to CS. CONCLUSIONS This review provides a meaningful exploration of CS to support nurses transitioning to advanced practice. Well-structured supervision offers a safe space to share work-related concerns and develop an advanced practitioner identity. Sharing experiences helps alleviate work-related burdens and reduce professional isolation and burnout. IMPLICATIONS FOR THE PROFESSION Peer-support networks are vital for successful transition to advanced practice. IMPACT This review highlighted the impact of effective supervisory relationships in forming professional identity and possible links with nursing retention. PUBLIC CONTRIBUTION No direct patient contributions are included as it forms part of a research degree.
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Affiliation(s)
- Debbie Zonneveld
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Lauren Lines
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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Hasanzadeh Moghadam M, Heshmati Nabavi F, Heydarian Miri H, Saleh Moghadam AR, Mirhosseini S. Participatory management effects on nurses' organizational support and moral distress. Nurs Ethics 2024; 31:202-212. [PMID: 37357944 DOI: 10.1177/09697330231177418] [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: 06/27/2023]
Abstract
RESEARCH QUESTION/AIM/OBJECTIVES Providing care for hospitalized children causes moral distress to nurses. Employee participation in discovering and solving the everyday problems of the workplace is one of the ways to hear the voices of nurses. This study aimed to evaluate the effect of participatory management programs on perceived organizational support and moral distress in pediatric nurses. RESEARCH DESIGN A quasi-experimental study. PARTICIPANTS AND RESEARCH CONTEXT The present study was conducted on 114 pediatric nurses in Iran. Data were collected using the Perceived Organizational Support Scale and the Moral Distress Scale of nurses. The intervention included implementing a participatory management program in three treatment departments that were randomly selected and it lasted 4 months. Participatory management was at the level of problem-solving with a focus on investigating, solving, and correcting issues and problems of work shifts and departments concerning the physical environment, equipment of the department, improvement of work processes, and team cooperation. In the control group, ordinary organizational approaches to problem-solving were used. ETHICAL CONSIDERATIONS This study was approved by the Ethics Committee of Mashhad School of Nursing and Midwifery. Informed consent was obtained from the study participants. FINDINGS/RESULTS Based on the results, both groups were homogenous before the intervention in terms of moral distress and perceived organizational support. The results showed that the moral distress mean scores in the intervention group decreased from 1.45 (0.52) to 1.03 (0.37) after the intervention. Also, the score of the perceived organizational support was 2.12 (1.2) increased after the intervention to 2.68 (1.10) in the intervention group. CONCLUSIONS It was found that the participation of nurses in the problem-solving process to solve daily workplace issues can be effective in increasing their perceived organizational support and reducing their moral distress.
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Affiliation(s)
| | - Fatemeh Heshmati Nabavi
- Public Health and Psychiatric Nursing Department, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Heydarian Miri
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Saleh Moghadam
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedmohammad Mirhosseini
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Mohammadi F, Naderi Z, Nikrouz L, Oshvandi K, Masoumi SZ, Sabetsarvestani P, Bijani M. Ethical challenges as perceived by nurses in pediatric oncology units. Nurs Ethics 2024; 31:268-280. [PMID: 37624231 DOI: 10.1177/09697330231191278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Providing care to children with cancer is one of the most challenging areas of ethical care for nurses. Few studies have addressed nurses' perception of the barriers to giving ethical care in oncology departments. Thus, it is essential that the ethical challenges in caregiving as perceived by oncology nurses be investigated. OBJECTIVE The present study was conducted to investigate the ethical challenges as perceived by nurses in pediatric oncology units in the south of Iran. RESEARCH DESIGN The present study is a qualitative work of research with a conventional content analysis design. Data were collected via individual semi-structured interviews. The collected data were analyzed using the qualitative content analysis method. PARTICIPANTS AND RESEARCH CONTEXT The participants were 21 nurses from pediatric oncology units in state hospitals who were selected by purposeful sampling. Sampling continued until the data were saturated. The study lasted from April to October 2022. FINDINGS Three main themes, promoting psychological safety in the children, respect for the dignity of the children, and expansion of support for families, and nine subthemes were extracted from the data. ETHICAL CONSIDERATIONS The study's protocol was approved by the Research Ethics Committee of the University of Medical Sciences and ethical principles were followed throughout the study. DISCUSSION AND CONCLUSION From the nurses' perspective, the major ethical challenges in providing ethical care in pediatric oncology units were reducing tension toward promoting the patients' psychological safety, showing respect for the identity and dignity of the children with cancer, and expanding support of the patients' families. By creating the right cultural and professional context and establishing proper protocols, healthcare policymakers and administrators can take effective steps toward eliminating the barriers to providing ethical care.
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Yu Q, Huang C, Yan J, Yue L, Tian Y, Yang J, Li X, Li Y, Qin Y. Ethical climate, moral resilience, and ethical competence of head nurses. Nurs Ethics 2024:9697330241230526. [PMID: 38317573 DOI: 10.1177/09697330241230526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual's ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them. OBJECTIVES To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses. DESIGN A quantitative, cross-sectional study. METHODS A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson's correlation and a structural equation model. ETHICAL CONSIDERATIONS This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146). RESULTS Head nurses' ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience. CONCLUSION This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuelan Qin
- The First Affiliated Hospital of Hunan Normal University
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Morley G, Sankary LR. Nurturing moral community: A novel moral distress peer support navigator tool. Nurs Ethics 2023:9697330231221220. [PMID: 38149497 DOI: 10.1177/09697330231221220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward "solution." Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, rather than evidencing identification of the "right" course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient's values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action.
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Affiliation(s)
- Georgina Morley
- Nursing Ethics Program, Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System
| | - Lauren R Sankary
- Neuroethics Program, Center for Bioethics, Neurological Institute, Cleveland Clinic Health System
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Yang Q, Zheng Z, Ge L, Huang BX, Liu J, Wang J, Lu K, Huang Y, Zhang J. The impact of resilience on clinical nurses' moral courage during COVID-19: A moderated mediation model of ethical climate and moral distress. Int Nurs Rev 2023; 70:518-526. [PMID: 37584307 DOI: 10.1111/inr.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/23/2023] [Indexed: 08/17/2023]
Abstract
AIM The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID-19, and if moral distress faced by nurses is a moderating factor. BACKGROUND Resilience can help nurses maintain their personal health during COVID-19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear. METHOD A cross-sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor-Davidson Resilience Scale (CD-RISC), Moral Distress Scale-Revised (MDS-R), and Hospital Ethical Climate Scale (HECS). RESULTS Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress. DISCUSSION This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID-19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate. IMPLICATIONS FOR NURSING AND HEALTH POLICY This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate.
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Affiliation(s)
- Qingqing Yang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Zhihui Zheng
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Li Ge
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Bi Xia Huang
- Department of Nursing, The Third People's Hospital of Fujian Province, Fujian, China
| | - Jujuan Liu
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Jie Wang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Kangyuan Lu
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Yufeng Huang
- Department of Neonatology, Xiamen Maternal and Child Health Hospital, Fujian, China
| | - Jiahui Zhang
- Department of Health Management, Fujian Vocational College of Bioengineering, Fujian, China
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Blixt C, Johansson E, Forsner M, Angelhoff C. Compassion fatigue and compassion satisfaction in pediatric and neonatal care nurses during the COVID-19 pandemic in Sweden. J Pediatr Nurs 2023; 73:e646-e651. [PMID: 37977972 DOI: 10.1016/j.pedn.2023.11.013] [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: 05/03/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Quality of care and the mental and physical health of nurses are interlinked. The COVID-19 pandemic has imposed an extremely high burden on health care. This study aimed to: 1) describe professional quality of life of registered nurses (RN) working in the pediatric and neonatal care units during the COVID-19 pandemic in Sweden, 2) compare professional quality of life between RNs with and without a Master's degree in specialist nursing pediatric care (MSc), and 3) compare differences in professional quality of life associated with the nursing experience (years). DESIGN AND METHODS This study adopted a cross-sectional survey design. The PROQoL®-5-questionnaire was administered as a web survey to 160 RNs at four pediatric wards and two neonatal units of two hospitals in Sweden. RESULTS Seventy-one RNs responded to the survey. Overall, they reported a sufficient professional quality of life. RNs with an MSc suffered significantly lower secondary traumatic stress levels. Experienced RNs reported significantly higher compassion satisfaction and lower occupational burnout. CONCLUSION Higher education and longer experience are beneficial for nurses' professional quality of life when working in pediatric care units. PRACTICAL IMPLICATIONS Results from this study highlights the importance of offering RN education in pediatric care at master level and supporting novice nurses, to prevent negative professional well-being outcomes in pediatric care, because the health of nurses is of utterly importance when crisis such as a pandemic hits the world. The findings also suggest that the conditions for professional quality of life could improve through activities such as self-care, time for reflection, better working hours, competence-adjusted salary, and educational opportunities.
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Affiliation(s)
- Cornelia Blixt
- Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elin Johansson
- Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Forsner
- Department of Nursing, Umeå University, Sweden; Department of Biosciences and Nutrition, Karolinska Institutet, Sweden
| | - Charlotte Angelhoff
- Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Allergy Center in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Lanes TC, Dalmolin GDL, Silva AMD, Bernardi CMS, Schutz TC, Tiguman GMB. Influence of the ethical climate on workers' health among healthcare professionals: a systematic review. Rev Gaucha Enferm 2023; 44:e20220247. [PMID: 37909511 DOI: 10.1590/1983-1447.2023.20220247.en] [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: 07/31/2022] [Accepted: 05/30/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To evaluate the influence of the ethical climate on workers' health among healthcare professionals. METHOD Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. RESULTS Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). CONCLUSION The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.
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Affiliation(s)
- Taís Carpes Lanes
- Universidade Federal de Santa Maria (UFSM). Programa de Pós-Graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Graziele de Lima Dalmolin
- Universidade Federal de Santa Maria (UFSM). Departamento de Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Augusto Maciel da Silva
- Universidade Federal de Santa Maria (UFSM). Departamento de Estatística. Santa Maria, Rio Grande do Sul, Brasil
| | - Camila Milene Soares Bernardi
- Universidade Federal de Santa Maria (UFSM). Programa de Pós-Graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Thaís Costa Schutz
- Universidade Federal de Santa Maria (UFSM). Programa de Pós-Graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
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Mathews N, Alodan K, Kuehne N, Widger K, Locke M, Fung K, Gandhi S, McLean J, Hossain A, Alexander S. Prevalence and Risk Factors for Moral Distress in Pediatric Oncology Health Care Professionals. JCO Oncol Pract 2023; 19:917-924. [PMID: 37625100 DOI: 10.1200/op.23.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE Moral distress (MoD) is prevalent among health care professionals (HCPs) in oncology and is associated with burnout. The objectives of this study were to quantify MoD among pediatric oncology healthcare professionals (HCPs) at a Canadian quaternary care hospital, identify root causes, and evaluate change over time. METHODS Eligible pediatric oncology HCPs were identified, and consenting participants completed the Measure of Moral Distress-Healthcare Professionals (MMD-HP) and MoD Thermometer (MDT) at baseline, followed by biweekly MDTs over 12 weeks. RESULTS A total of 139 HCPs participated. The mean MMD-HP score was 123 ± 57.0, range 9-288. Demographic risk factors identified for elevated MMD-HP scores were female sex (female 127.1 and male 83.6, P = .01) and nursing role (nurse 136.3 and most responsible physician 85.3, P = .02). Higher MMD-HP scores were found in HCPs who were currently considering resigning because of MoD compared with those who were not (169.9 v 115.4, P < .001). Situations involving administration of treatment to children with poor prognosis cancers that was perceived to be overly aggressive were ranked as the greatest environmental contributor to MoD. Baseline and mean MDT scores over time strongly correlated with MMD-HP scores (P < .0001 and P = .0003, respectively), with mean MDT scores showing no significant fluctuation over the 12-week period. CONCLUSION MoD was common among pediatric oncology HCPs. Risk factors for elevated levels of MoD included both demographic and environmental factors. Implementation of systems to improve team communication and decision making, especially in the care of patients with poor prognosis cancers, may affect HCP MoD.
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Affiliation(s)
- Natalie Mathews
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Khalid Alodan
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Nathan Kuehne
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kimberley Widger
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Maria Locke
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen Fung
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Sheila Gandhi
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer McLean
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Alomgir Hossain
- Clinical Research Services, Hospital for Sick Children, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Alexander
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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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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14
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Deschenes S, Scott SD, Kunyk D. Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations. HEC Forum 2023:10.1007/s10730-023-09506-1. [PMID: 37140806 PMCID: PMC10158695 DOI: 10.1007/s10730-023-09506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) "I'm sorry, there's nothing else": increasing supports for patients and families; (2) "someone will commit suicide": improving supports for nurses: (3) "Everyone needs to be heard": improving patient care communication; and (4) "I didn't see it coming": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.
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Affiliation(s)
- Sadie Deschenes
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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15
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Goktas S, Aktug C, Gezginci E. Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic. Nurs Crit Care 2023; 28:261-271. [PMID: 35821613 PMCID: PMC9350110 DOI: 10.1111/nicc.12820] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems. AIM The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID-19 pandemic. DESIGN Descriptive cross-sectional survey. METHODS A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines. RESULTS In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = -.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001). CONCLUSION The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage. RELEVANCE TO CLINICAL PRACTICE The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.
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Affiliation(s)
- Sonay Goktas
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cemile Aktug
- Faculty of Health Sciences, Department of Nursing, Gümüşhane University, Gumushane, Turkey
| | - Elif Gezginci
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
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16
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Molinaro ML, Polzer J, Rudman DL, Savundranayagam M. "I can't be the nurse I want to be": Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving. Soc Sci Med 2023; 320:115677. [PMID: 36669283 DOI: 10.1016/j.socscimed.2023.115677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses' experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.
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Affiliation(s)
- Monica L Molinaro
- Health and Rehabilitation Sciences Graduate Program, The University of Western Ontario, 1151 Richmond Street, London, ON N6G 2V4, Canada; Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, Hamilton, ON L8P 1H6, Canada.
| | - Jessica Polzer
- Department of Gender, Sexuality & Women's Studies, The University of Western Ontario, 1151 Richmond Street London, ON N6A 5B8, Canada; School of Health Studies, The University of Western Ontario, 1151 Huron Drive, London, ON N6A 2K5, Canada
| | - Debbie Laliberte Rudman
- School of Occupational Therapy, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1, Canada
| | - Marie Savundranayagam
- School of Health Studies, The University of Western Ontario, 1151 Huron Drive, London, ON N6A 2K5, Canada
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17
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Alimoradi Z, Jafari E, Lin CY, Rajabi R, Marznaki ZH, Soodmand M, Potenza MN, Pakpour AH. Estimation of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics 2023; 30:334-357. [PMID: 36704986 PMCID: PMC9902807 DOI: 10.1177/09697330221135212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. AIM To estimate moral distress among nurses. METHODS This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. ETHICAL CONSIDERATION The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. RESULTS Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. CONCLUSION The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.
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Affiliation(s)
| | - Elahe Jafari
- 113106Qazvin University of Medical Sciences, Qazvin, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | | | | | | | - Marc N Potenza
- Yale University, USA; Connecticut Council on Problem Gambling, USA; Connecticut Mental Health Center, USA; Wu Tsai Institute, Yale University, USA
| | - Amir H Pakpour
- Jönköping University, Sweden; Qazvin University of Medical Sciences, Iran
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18
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Showalter BL, Malecha A, Cesario S, Clutter P. Moral distress in clinical research nurses. Nurs Ethics 2022; 29:1697-1708. [PMID: 35730358 DOI: 10.1177/09697330221090613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses.Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses.Research design: This was a descriptive quantitative study to measure moral distress in clinical research nurses using the Measure of Moral Distress - Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected.Participants and research context: Registered nurses working in the clinical research nurse role (N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson's correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables.Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman's University. A consent statement was included, and completion of the questionnaire was construed as consent.Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0-354. Moral distress scores were negatively correlated with clinical research nurse age (r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach's alpha of 0.93.Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally.
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Affiliation(s)
- Brandi L Showalter
- 53626University of Texas Health Science Center, Houston, TX, USA; Texas Woman's University, Houston, TX, USA
| | - Ann Malecha
- 53626University of Texas Health Science Center, Houston, TX, USA
| | - Sandra Cesario
- 53626University of Texas Health Science Center, Houston, TX, USA
| | - Paula Clutter
- 53626University of Texas Health Science Center, Houston, TX, USA
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Ventovaara P, Af Sandeberg M, Petersen G, Blomgren K, Pergert P. A cross-sectional survey of moral distress and ethical climate - Situations in paediatric oncology care that involve children's voices. Nurs Open 2022; 9:2108-2116. [PMID: 35441803 PMCID: PMC9190683 DOI: 10.1002/nop2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Abstract
Aim To assess experiences of morally distressing situations and perceptions of ethical climate in paediatric oncology care, with a focus on situations that involve children's voices. Design Cross‐sectional survey. Methods Registered Nurses at all four paediatric oncology centres in Denmark were asked to complete a web‐based questionnaire with Danish translations of the Swedish Moral Distress Scale‐Revised (MDS‐R) and the Swedish Hospital Ethical Climate Survey‐Shortened (HECS‐S). Data analysis included descriptive statistics and non‐parametric correlation tests. Results Nurses (n = 65) perceived morally distressing situations as rather uncommon, except for those that involved shortage of time, poor continuity of care and unsafe staffing levels. Most nurses (83%) found it disturbing to perform procedures on school‐aged children against their will, and 20% reported that they do this often. Perceptions of ethical climate were positive and healthcare professionals were perceived to be attentive to children's wishes.
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Affiliation(s)
- Päivi Ventovaara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Af Sandeberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gitte Petersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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20
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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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21
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Bartholdson C, Sandeberg MA, Molewijk B, Pergert P. Does participation in ethics discussions have an impact on ethics decision-making? A cross-sectional study among healthcare professionals in paediatric oncology. Eur J Oncol Nurs 2021; 52:101950. [PMID: 33862416 DOI: 10.1016/j.ejon.2021.101950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The overall aim of this study was to describe perceptions of the decision-making process in relation to participation/non-participation in ethics discussions among healthcare professionals in paediatric oncology. METHODS Healthcare professionals, working at three paediatric units where ethics discussions where performed answered a study-specific questionnaire focusing on perceptions of involvement, influence, responsibility and understanding of ethics decision-making. Statistical analyses included descriptive statistics, non-parametric paired t-tests and correlation tests. RESULTS Participation in ethics discussions was related to perceptions of greater involvement and the possibility of influencing decisions, as well as formal/shared responsibility for the ethics decisions related to patient care. Medical doctors and registered nurses perception of involvement in decisions, possibility to influence and responsibility decreased when they were not present during the ethics discussion or when no ethics discussion was conducted at all. Healthcare professionals had a generally good understanding of the ethical issues and the ethics decisions. The whole group considered medical doctors to be the most important participants in the ethics discussions, followed by patients/family. Healthcare professionals wanted more teamwork and viewed ethics discussions as very helpful for teamwork when dealing with ethical issues in paediatric oncology. CONCLUSIONS Ethics discussions in paediatric oncology practice increases the involvement within and the understanding of the decision-making process about ethical decisions. The understanding is not always dependent on participation, indicating a great trust in team members. Based on these findings the implementation of a structure for ethics support in paediatric oncology where patients/families are integrated is recommended.
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Affiliation(s)
- Cecilia Bartholdson
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Neurology and Musculokeletal Disorders and Homecare, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
| | - Margareta Af Sandeberg
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Bert Molewijk
- Dep. Ethics, Law & Humanities, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Centre for Medical Ethics, University of Oslo, Norway
| | - Pernilla Pergert
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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