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Liu Y, Ying L, Zhang Y, Jin J. The experiences of intensive care nurses coping with ethical conflict: a qualitative descriptive study. BMC Nurs 2023; 22:449. [PMID: 38037055 PMCID: PMC10687825 DOI: 10.1186/s12912-023-01612-2] [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: 05/28/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. AIMS This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. METHODS From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. RESULTS Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. CONCLUSION This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.
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Affiliation(s)
- Yuanfei Liu
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Liying Ying
- Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China.
- Changxing Branch Hospital of SAHZU, No.66 Taihu middle road, Changxing Country, Huzhou, 313100, Zhejiang, China.
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
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Salas-Bergües V, Lizarazu-Armendáriz E, Eraso-Pérez de Urabayen M, Mateo-Manrique P, Mendívil-Pérez M, Goñi-Viguria R. Levels of burnout and exposure to ethical conflict and assessment of the practice environment in nursing professionals of intensive care. ENFERMERIA INTENSIVA 2023; 34:195-204. [PMID: 37455225 DOI: 10.1016/j.enfie.2023.02.003] [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: 08/05/2022] [Accepted: 02/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nursing professionals working in Intensive Care Units (ICU) are at high risk of developing negative emotional responses as well as emotional and spiritual problems related to ethical issues. The design of effective strategies that improve these aspects is determined by knowing the levels of burnout and ethical conflict of these professionals, as well as the influence that the practice environment might have on them. OBJECTIVES To analyze the relationship between levels of burnout, the exposure to ethical conflicts and the perception of the practice environment among themselves and with sociodemographic variables of the different intensive care nursing professionals. METHODS Descriptive, correlational, cross-sectional, observational study in an ICU of a tertiary level university hospital. The level of burnout was evaluated with the Maslach Burnout Inventory Human Services Survey scale; the level of ethical conflict with the Ethical Conflict Questionnaire for Nurses and the perception of the environment with the Practice Environment Scale of the Nursing Work Index. Descriptive and inferential statistics were performed. The association between categorical variables was analyzed using Fisher's exact chi-square test (χ2) RESULTS: 31 nurses and 8 nursing assistants were evaluated, which meant a participation rate of 82,93%. 31,10% of the nursing professionals presented signs of burnout, 14,89% considered that they work in an unfavorable environment and 87,23% presented a medium-high index of exposure to ethical conflict. The educational level (χ2=11.084, p=0.011) and the professional category (χ2=5.007, p=0.025) influenced the level of burnout: nursing assistants presented higher levels of this. When comparing the level of burnout with the environment and the index of ethical conflict, there were no statistically significant differences. CONCLUSIONS The absence of association found in the study between Burnout and ethical conflict with the perception of the practice environment suggests that personal factors may influence its development.
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Affiliation(s)
- V Salas-Bergües
- Enfermería, Área de Investigación, Clínica Universidad de Navarra, Pamplona, Spain
| | - E Lizarazu-Armendáriz
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - P Mateo-Manrique
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain.
| | - M Mendívil-Pérez
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Goñi-Viguria
- Enfermería, Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Spain
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Foster MW, McKellar L, Fleet JA, Sweet L. Moral distress in midwifery practice: A Delphi study. Women Birth 2023; 36:e544-e555. [PMID: 37164777 DOI: 10.1016/j.wombi.2023.04.005] [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: 02/23/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Moral distress is a psychological concept that describes the harm associated with actions or inactions that oppose an individuals' moral beliefs. Moral distress is linked to moral compromise in the workplace that may negatively impact mental wellbeing. Current tools available to assess moral distress are not specific for the Australian health care system or midwifery practice. AIM The aim of this study was to develop a list of situational and outcome statements associated with moral compromise and levels of moral distress in midwifery to inform the development of a tool to measure levels of moral distress in midwives. METHODS This e-Delphi study was the third stage of a sequential exploratory mixed-methods study. Using an online strategy, three iterative rounds of e-Delphi were collected and analysed for consensus on situations leading to moral distress and the associated psychological outcomes. FINDINGS Twenty participants contributed across the three rounds. Consensus was met in 40 morally compromising situation statements. The highest level of consensus related to excessive workloads and the associated negative impact of this on women and families. Consensus on outcomes following exposure to morally distressing situations led to the development of a continuum scale from moral frustration to moral injury. DISCUSSION/CONCLUSION This is the first study to use a consensus method to establish different levels of moral compromise, frustration, distress, and injury in midwifery practice. The findings of this study contribute to a growing body of literature that supports the concept of moral distress occurring across a continuum.
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Affiliation(s)
- Mrs Wendy Foster
- Clinical and Health Sciences, University of South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA 5000, Australia.
| | - Lois McKellar
- Clinical and Health Sciences, University of South Australia, Australia; School of Health and Social Care, Edinburgh Napier University, Scotland, UK
| | - Julie-Anne Fleet
- Clinical and Health Sciences, University of South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA 5000, Australia
| | - Linda Sweet
- School of Health and Social Care, Edinburgh Napier University, Scotland, UK; School of Nursing and Midwifery, Deakin University and Western Health Partnership, Australia
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Erden Melikoğlu S, Köktürk Dalcalı B, Aydoğan S. The Relationship of Intensive Care Nurses' Attitudes Towards Organ Donation With Their Attitudes Towards Euthanasia and Moral Sensitivity. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231199882. [PMID: 37650678 DOI: 10.1177/00302228231199882] [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: 09/01/2023]
Abstract
Determination of the relationship between nurses' attitudes towards issues, such as end-of-life care that is specific to intensive care, euthanasia, and organ donation and their moral sensitivity levels is one of the important points for working out ethical problems encountered in intensive care units and increasing the quality of care. This study was conducted to determine the relationship between the attitudes of intensive care nurses towards organ donation, euthanasia, and terminal patients and their moral sensitivity. The study was completed with 175 nurses who agreed to participate in the study. Informed consent of the participants was obtained. While nurses' attitudes towards euthanasia, death, and caring for the dying patient did not correlate with their moral sensitivities, their attitudes towards organ donation did.
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Affiliation(s)
- Seçil Erden Melikoğlu
- Department of Fundamentals of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Semine Aydoğan
- Anesthesiology and Resuscitation Department, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Abstract
While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals' moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change.
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Khanal A, Franco-Correia S, Mosteiro-Diaz MP. Ethical conflict among critical care nurses during the COVID-19 pandemic. Nurs Ethics 2022; 29:819-832. [PMID: 35085049 PMCID: PMC8795757 DOI: 10.1177/09697330211066574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical conflict is a problem with negative consequences, which can compromise the quality and ethical standards of the nursing profession and it is a source of stress for health care practitioners', especially for nurses. OBJECTIVES The main aim of this study was to analyze Spanish critical care nurses' level of exposure to ethical conflict and its association with sociodemographic, occupational, and COVID-19-related variables. Research Design, Participants, and Research context: This was a quantitative cross-sectional descriptive study conducted among 117 nurses working in critical care units. Data collection tools were sociodemographic, occupational, and COVID-19-related questionnaires and previously validated Spanish version of Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS We obtained permission from the Ethics Committee and participants' informed consent. FINDINGS Data indicates a moderate level of exposure to ethical conflicts. The most frequent ethical conflicts were related to situations about "treatment and clinical procedures." The most intensity of ethical conflicts was related to situations about "treatment and clinical procedures" and "dynamics of the service and working environment." No statistical significance was identified between the socio-demographic variables and level of exposure to ethical conflicts. However, for critical care nurses working in ICU, nurses with perceived worked stress had a higher level of exposure to ethical conflicts. Likewise, critical care nurses whose family/friends were infected with COVID-19 had a higher level of exposure. CONCLUSIONS Critical care nurses experience a moderate level of exposure to ethical conflicts which is consistent with the results of previous studies. A deeper understanding of ethical conflicts in conflictive situations allows recognition of the situations that occur in everyday clinical practice, identification of the ethical conflicts, and facilitation of the nurses working in the challenging clinical situation.
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Affiliation(s)
- Anjita Khanal
- International Postgraduate Centre of University of Oviedo, 16763University of Oviedo, Oviedo, Spain
| | - Sara Franco-Correia
- Faculty of Medicine and Health Sciences, 16763University of Oviedo, Oviedo, Spain
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Villa M, Balice-Bourgois C, Tolotti A, Falcó-Pegueroles A, Barello S, Luca EC, Clivio L, Biegger A, Valcarenghi D, Bonetti L. Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212012. [PMID: 34831768 PMCID: PMC8618535 DOI: 10.3390/ijerph182212012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022]
Abstract
Background: During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses’ ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. Methods: Design—Multicentre online survey. Setting—Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman’s rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses’ characteristics and outcome variables, and the Mann–Whitney/t-test to compare groups. Results: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low–moderate level of ethical conflict (median = 111.5 [76–152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96–13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56–9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. Conclusions: Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.
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Affiliation(s)
- Michele Villa
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete 48, 6900 Lugano, Switzerland;
| | - Colette Balice-Bourgois
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland;
| | - Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland;
- Correspondence:
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, Consolidated Research Group SGR 269 Quantitative Psychology, University of Barcelona (Spain), Campus Bellvitge, Pavelló de Govern, 3a planta, Despatx 331, Feixa Llarga, s/n L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Serena Barello
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Department of Phychology, Università Cattolica del Sacro Cuore, Milano and Cremona, L.Go Gemelli 1, 20123 Milan, Italy;
| | - Elena Corina Luca
- Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 46, 6903 Lugano, Switzerland;
| | - Luca Clivio
- ICT Data Science & Research Unit, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland;
| | - Annette Biegger
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzonal, Switzerland;
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland;
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
- Department of Business Economics, University of Applied Sciences and Arts of Southern Switzerland, Health and Social Care, Via Violino, 11, 6928 Manno, Switzerland
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Liu Y, Cui N, Zhang Y, Wang X, Zhang H, Chen D, Sun S, Jin J. Psychometric properties of the ethical conflict in nursing questionnaire critical care version among Chinese nurses: a cross-sectional study. BMC Nurs 2021; 20:133. [PMID: 34320972 PMCID: PMC8316889 DOI: 10.1186/s12912-021-00651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results The ECNQ-CCV-C achieved Cronbach’s alphas 0.902 and McDonald’s omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. Conclusions The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00651-x.
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Affiliation(s)
- Yuanfei Liu
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Nianqi Cui
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Yuping Zhang
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shunxia Sun
- Department of Nursing, The General Hospital of Chongqing, Chongqing, China
| | - Jingfen Jin
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China. .,Changxing Branch Hospital of SAHZU, No.66 Taihu middle road, Changxing Country, Huzhou, 313100, Zhejiang, China.
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Tal R, Yakov G, Lorber A. When answers cannot be found in the textbook: Making ethical decisions regarding children with profound disabilities. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2020.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Falcó-Pegueroles A, Zuriguel-Pérez E, Via-Clavero G, Bosch-Alcaraz A, Bonetti L. Ethical conflict during COVID-19 pandemic: the case of Spanish and Italian intensive care units. Int Nurs Rev 2020; 68:181-188. [PMID: 33615479 DOI: 10.1111/inr.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. BACKGROUND During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. SOURCES OF EVIDENCE Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. DISCUSSION The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. CONCLUSIONS Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. IMPLICATIONS FOR NURSING PRACTICE AND POLICY Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.
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Affiliation(s)
- Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences. Quantitative Psychology Research Group (SGR 269), University of Barcelona, Barcelona, Spain
| | | | - Gemma Via-Clavero
- Critical Care Unit, Hospital Universitari de Bellvitge, Nursing Research Group (GRIN-IDIBELL), Barcelona, Spain.,Pediatric Critical Care Unit, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Alejandro Bosch-Alcaraz
- Pediatric Critical Care Unit, Sant Joan de Deu Hospital, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University de Barcelona, Barcelona, Spain
| | - Loris Bonetti
- Clinical Expert in Nursing Research, Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.,University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Abstract
BACKGROUND Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit. There is a gap in our understanding of nurses' perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. RESEARCH QUESTION/OBJECTIVES/METHODS The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. PARTICIPANTS AND RESEARCH CONTEXT Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. ETHICAL CONSIDERATIONS This study was approved by the Institutional Review Board at the organization where the study took place. FINDINGS Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. DISCUSSION Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. CONCLUSION These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA; Froedtert & the Medical College of Wisconsin, USA
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Roszkowski MJ, Thomas MM, Conroy JW, Ivy C, Gravitt GW. An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities. J Nurs Meas 2020; 28:JNM-D-18-00088. [PMID: 32179718 DOI: 10.1891/jnm-d-18-00088] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The Health Risk Screening Tool (HRST) is a 22-item instrument specifically designed to assess the health risk of persons with developmental disabilities. The predictive validity of the HRST was investigated by examining its ability to predict mortality. METHODS The sample consisted of 12,582 people with an intellectual or developmental disability residing in Georgia (U.S.). Data were analyzed using survival analysis (Kaplan-Meier estimate and Cox regression) and a binary logistic regression. RESULTS All models supported the prognostic value of the six-level health risk classification. The Kaplan-Meier procedure showed clear separation among functions. The Cox proportional hazard regression revealed that hazard is inversely related to the health risk level, even after controlling for potential confounding by gender, ethnicity, and race. CONCLUSIONS The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.
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Affiliation(s)
| | - Michael M Thomas
- Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia
| | - James W Conroy
- The Center for Outcome Analysis, Havertown, Pennsylvania
| | - Catherine Ivy
- Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia
| | - Gwendell W Gravitt
- Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia
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Lluch-Canut T, Sequeira C, Falcó-Pegueroles A, Pinho JA, Rodrigues-Ferreira A, Olmos JG, Roldan-Merino J. Ethical conflicts and their characteristics among critical care nurses. Nurs Ethics 2019; 27:537-553. [PMID: 31303110 DOI: 10.1177/0969733019857785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. AIM The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version and, second, to analyse Portuguese critical care nurses' level of exposure to ethical conflict and its characteristics. METHODS A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. ETHICAL CONSIDERATIONS The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. FINDINGS The Portuguese version of the Ethical Conflict Nursing Questionnaire-Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources.
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Saberi Z, Shahriari M, Yazdannik AR. The relationship between ethical conflict and nurses' personal and organisational characteristics. Nurs Ethics 2018; 26:2427-2437. [PMID: 30134760 DOI: 10.1177/0969733018791350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict. AIM The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses. METHODS This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0). ETHICAL CONSIDERATIONS All participants were informed about the study's aim and were assured that participation in and withdrawal from the study would be voluntary. FINDINGS The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was "working with professionally incompetent nurses or nurse assistants." Married nurses, nurses with official employment, nurses with master's degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager's conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict. CONCLUSION Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses' exposure to ethical conflict.
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Hurtado-Pardos B, Casas I, Lluch-Canut T, Moreno-Arroyo C, Nebot-Bergua C, Roldán-Merino J. Psychometric evaluation of a new instrument in Spanish to measure the wellness of university nursing faculty. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 73:29-37. [PMID: 27763250 DOI: 10.1080/19338244.2016.1246411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/05/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to design and validate an instrument to measure the wellness among university nursing faculty. The study was performed in two phases. Phase I consisted of the development of the instrument with discussion groups and participant consensus. We designed an instrument including the 21 items or psychosocial risk factors identified and estimated an index by evaluating the frequency and intensity of each item. The items were grouped into 3 dimensions: teaching work demands, curricular demands, and organizational difficulties. Phase II, we evaluated the psychometric properties of the tool in a sample of 263 participants. Exploratory factor analysis showed a 3-factor structure that explained 53% of the total variance. The internal consistency of the instrument was 0.91 for the whole instrument. The results indicate that the tool developed is valid and reliable and may be a good instrument to monitor the wellness of university nursing faculty.
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Affiliation(s)
- Barbara Hurtado-Pardos
- a Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona , Barcelona , Spain
- b Research Group GRIN (Group Emergent 2014-664: Grupo de Recerca Infermeria Emergent) , Barcelona , Spain
- c Research Group GIESS (Grupo de investigación en Enfermería, Educación y Sociedad), Esplugues de Llobregat , Barcelona , Spain
| | - Irma Casas
- d Preventive Medicine Service, Hospital Germans Trias i Pujol. Badalona , Barcelona , Spain
- e Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Teresa Lluch-Canut
- f Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona , Barcelona , Spain
- g Research Group GEIMAC (Group Consolidat 2014-1139: Grupo de Estudios de Invarianza de los Instrumentos de Medida y Análisis del Cambio en los Ámbitos Social y de la Salud) , Barcelona , Spain
- h Research Group GIRISAME (International Researchers Group of Mental Health Nursing Care) , Barcelona , Spain
- i Research Group REICESMA (Red Española Investigación de Enfermería en Cuidados de Salud Mental y Adicciones) , Madrid , Spain
| | - Carmen Moreno-Arroyo
- j Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona , Barcelona , Spain
| | - Carlos Nebot-Bergua
- a Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona , Barcelona , Spain
- c Research Group GIESS (Grupo de investigación en Enfermería, Educación y Sociedad), Esplugues de Llobregat , Barcelona , Spain
| | - Juan Roldán-Merino
- a Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona , Barcelona , Spain
- c Research Group GIESS (Grupo de investigación en Enfermería, Educación y Sociedad), Esplugues de Llobregat , Barcelona , Spain
- e Universitat Autònoma de Barcelona , Barcelona , Spain
- g Research Group GEIMAC (Group Consolidat 2014-1139: Grupo de Estudios de Invarianza de los Instrumentos de Medida y Análisis del Cambio en los Ámbitos Social y de la Salud) , Barcelona , Spain
- h Research Group GIRISAME (International Researchers Group of Mental Health Nursing Care) , Barcelona , Spain
- i Research Group REICESMA (Red Española Investigación de Enfermería en Cuidados de Salud Mental y Adicciones) , Madrid , Spain
- k Faculty of Nursing, Rovira i Virgili University of Tarragona , Tarragona , Spain
- l Research Group CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental) , Sant Boi de Llobregat, Barcelona , Spain
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Motaharifar F, Atashzadeh-Shoorideh F, Pishgooie AH, Falcó-Pegueroles A. Translation and psychometric properties of the "ethical conflict in nursing questionnaire: critical care version" in Iran. Electron Physician 2017; 9:3776-3785. [PMID: 28465806 PMCID: PMC5410905 DOI: 10.19082/3776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/15/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Ethical conflict is one of ICU nurses’ main problems, which rise for several reasons that must be measured. Unfortunately, there is no native instrument for measuring ethical conflicts for ICU nurses in Iran. One of the more suitable and new tools for the measurement of ethical conflict is called the “Ethical Conflict in Nursing Questionnaire: Critical Care Version (ECCNQ-CCV).” This study was aimed to translate and investigate psychometric properties of the ECCNQ-CCV in Iranian nurses. Methods In this methodological study, after translation and cultural adaptation, face validity, content validity, and construct validity were assessed. Then, internal consistency and stability were measured for reliability. Two software programs (SPSS version 20 and AMOS) were used for data analysis. Result Face and content validities were acceptable. Confirmatory factor analysis was not fitted. Thus, exploratory factor analysis was done, which showed five factors. However, some of the scenarios in a factor were not compatible with each other, and choosing the fit name for factors was not possible. Thus, all the scenarios were put into one factor, which has been proposed by the developer in the original version. The alpha Cronbach was 0.92 for the total scale. Conclusions Findings show that the one factor Persian version of the ECNQ-CCV has acceptable psychometric properties. It can be used to evaluate ethical conflicts in Iranian ICU nurses.
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Affiliation(s)
- Fatemeh Motaharifar
- M.Sc. Management Nursing Student, Department of Nursing Management, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Ph.D. in Nursing, Assistant Professor, Department of Nursing Management, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hosein Pishgooie
- Assistant Professor, Ph.D., M.Sc., B.Sc., RN., Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Anna Falcó-Pegueroles
- Ph.D. in Nursing, MHSc., RN, Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing., Faculty of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
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Astbury JL, Gallagher CT. Development and validation of a questionnaire to measure moral distress in community pharmacists. Int J Clin Pharm 2016; 39:156-164. [PMID: 28004238 PMCID: PMC5306186 DOI: 10.1007/s11096-016-0413-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/08/2016] [Indexed: 12/03/2022]
Abstract
Background Pharmacists work within a highly-regulated occupational sphere, and are bound by strict legal frameworks and codes of professional conduct. This regulatory environment creates the potential for moral distress to occur due to the limitations it places on acting in congruence with moral judgements. Very little research regarding this phenomenon has been undertaken in pharmacy: thus, prominent research gaps have arisen for the development of a robust tool to measure and quantify moral distress experienced in the profession. Objective The aim of this study was to develop an instrument to measure moral distress in community pharmacists. Setting Community pharmacies in the United Kingdom. Method This study adopted a three-phase exploratory sequential mixed-method design. Three semi-structured focus groups were then conducted to allow pharmacists to identify and explore scenarios that cause moral distress. Each of the identified scenarios were developed into a statement, which was paired with twin seven-point Likert scales to measure the frequency and intensity of the distress, respectively. Content validity, reliability, and construct validity were all tested, and the questionnaire was refined. Main outcome measure The successful development of the valid instrument for use in the United Kingdom. Results This research has led to the development of a valid and reliable instrument to measure moral distress in community pharmacists in the UK. The questionnaire has already been distributed to a large sample of community pharmacists. Conclusion Results from this distribution will be used to inform the formulation of coping strategies for dealing with moral distress.
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Affiliation(s)
- Jayne L Astbury
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, AL10 9AB, UK
| | - Cathal T Gallagher
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, AL10 9AB, UK.
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Falcó-Pegueroles A, Lluch-Canut T, Roldan-Merino J, Goberna-Tricas J, Guàrdia-Olmos J. Ethical conflict in critical care nursing: Correlation between exposure and types. Nurs Ethics 2014; 22:594-607. [PMID: 25335920 DOI: 10.1177/0969733014549883] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. OBJECTIVES The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. RESEARCH DESIGN This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. PARTICIPANTS AND RESEARCH CONTEXT A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. FINDINGS The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. DISCUSSION The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. CONCLUSION The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.
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