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Peng M, Saito S, Guan H, Ma X. Moral distress, moral courage, and career identity among nurses: A cross-sectional study. Nurs Ethics 2022; 30:358-369. [PMID: 36545793 DOI: 10.1177/09697330221140512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity. Objectives To investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between moral distress and career identity among nurses. Design A quantitative, cross-sectional study. Methods A convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses’ Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement. Ethical consideration Research ethics approval was obtained from the researcher’s university and hospital where this study was conducted prior to data collection. Findings Moral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity ( β = −0.230 to −0.163, p < 0.01). Discussion The findings reveal a relationship between moral distress, moral courage, and career identity among nurses. Conclusion By paying attention to nurses’ moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses.
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Affiliation(s)
- Mengyun Peng
- Graduate School of Health Sciences, Okayama University, Japan
| | - Shinya Saito
- Graduate School of Health Sciences, Okayama University, Japan
| | - Hong Guan
- Department of Nursing, The Second Hospital of Dalian Medical University, China
| | - Xiaohuan Ma
- Department of Nursing, The Second People's Hospital of Dalian, China
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Faraco MM, Gelbcke FL, Brehmer LCDF, Ramos FRS, Schneider DG, Silveira LR. Moral distress and moral resilience of nurse managers. Nurs Ethics 2022; 29:1253-1265. [PMID: 35549481 DOI: 10.1177/09697330221085770] [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 Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience. AIM The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil. RESEARCH DESIGN The research design is the qualitative study with discursive textual analysis. PARTICIPANTS AND RESEARCH CONTEXT : 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions. ETHICAL CONSIDERATIONS The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity. FINDINGS Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation. CONCLUSION From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.
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Caram CS, Peter E, Ramos FR, Brito MJ. The process of moral distress development: A virtue ethics perspective. Nurs Ethics 2021; 29:402-412. [PMID: 34753341 DOI: 10.1177/09697330211033408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses' experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose (telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress.
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Dorman JD, Raffin Bouchal S. Moral distress and moral uncertainty in medical assistance in dying: A simultaneous evolutionary concept analysis. Nurs Forum 2020; 55:320-330. [PMID: 31957042 DOI: 10.1111/nuf.12431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To develop a simultaneous, evolutionary concept analysis of moral distress and moral uncertainty in the context of medical assistance in dying (MAiD). BACKGROUND Moral distress is well represented in nursing literature but disagreement persists in how the concept is defined and understood. Moral uncertainty has not been investigated in-depth. Further definition and conceptual clarity is required to understand these concepts within the context of MAiD. DESIGN Simultaneous concept analysis. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and PubMed databases were searched for articles in English. The final sample consisted of 44 documents published from 1984 to 2019. METHOD An adapted combination of Rodgers's Evolutionary Model and Haase et al's Simultaneous Concept Analysis method. RESULTS Despite the significant overlap, moral distress and moral uncertainty have subtle distinguishing differences. Attributes of moral distress in the context of MAiD focus on knowing the right course of action but being unable to act, especially when conflict or suffering occurs. Attributes of moral uncertainty center on an inability to decide on which course of action to take or knowing what outcome is preferable. CONCLUSION More research is required to bring further clarity to these concepts and develop interventions to support nurses who receive requests for or participate in MAiD.
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Ramos FRS, Barlen ELD, Brito MJM, Vargas MA, Schneider DG, de Farias Brehmer LC. Validation of the Brazilian Moral Distress Scale in Nurses. J Nurs Meas 2019; 27:335-357. [PMID: 31511413 DOI: 10.1891/1061-3749.27.2.335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and PurposeTo determine the psychometric properties of the Brazilian Moral Distress Scale in Nurses (MDSN-BR).DesignIn this methodological, cross-sectional study, the criterion, content, and construct validation stages were presented.MethodA 57-item questionnaire was applied to 1,227 brazilian nurses through an online form. The exploratory factor analyses revealed significant conceptual relations among its items in six constructs, expressing the consistency of the scale.ResultsThe validated version of the instrument consists of six constructs and 49 items—Cronbach's alpha .980 (instrument) and of constructs: (a) (.942) Acknowledgment, power, and professional identity; (b) (.961) Safe and qualified care; (c) (.924) Defense of values and rights; (d) (.944) Work conditions; (e) (.933) Ethical infractions; (f) (.914) Work teams.ConclusionThe results provide evidence supporting the reliability and trustworthiness of the scale in the selected population.
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Ramos FRS, Barth PO, Brito MJM, Caram C, Silveira LR, Brehmer LCDF, Dalmolin GDL, Caçador B. Aspectos sociodemográficos e laborais associados ao distresse moral em enfermeiros brasileiros. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar associações entre distresse moral e características sociodemográficas e laborais de enfermeiros brasileiros. Métodos Estudo transversal realizado em todo território brasileiro, no período de novembro de 2015 a maio de 2016, com uma amostra de 1227 enfermeiros, a partir da aplicação da Escala Brasileira de Distresse Moral em Enfermeiros (EDME-Br), por meio de questionário eletrônico. A análise empregou estatística descritiva e analítica. Resultados Associações estatisticamente significativas foram estabelecidas em todos os seis fatores, são eles: 1. Reconhecimento, poder e identidade pessoal; 2. Cuidado seguro e qualificado; 3. Defesa de valores e de direitos; 4. Condições de trabalho; 5. Infrações éticas; 6. Equipes de trabalho. As variáveis que apresentaram maior número de associações foram: carga horária; pós-graduação, natureza da atenção/complexidade do serviço, natureza, tipo e tempo do vínculo. Destacou-se o papel da experiência e da formação ampliada na maior percepção e/ou vivência do distresse moral. Conclusão A amplitude do estudo e a diversidade do contexto revelam especificidades quanto à ocorrência do distresse moral no cenário brasileiro, reforçando a necessidade de conhecer elementos que participam da experiência moral dos enfermeiros.
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de Barros AM, Ramos FRS, Barth PO, Brito MJM, Rennó HMS, Rocha JM. The moral deliberation process of college nursing professors in view of moral distress. NURSE EDUCATION TODAY 2019; 73:71-76. [PMID: 30530138 DOI: 10.1016/j.nedt.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/24/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
STUDY AIM To discover college nursing professors' deliberation and coping strategies in view of moral distress. DESIGN Qualitative study with a descriptive and exploratory design. SETTING AND PARTICIPANTS The participants were 12 college nursing professors who taught at three public universities in Brazil. METHODS The adapted Delphi method was applied. The data were collected in three phases with concomitant data collection and analysis. FINDINGS Moral distress in teaching can lead to the development of strategies that promote moral deliberation through individual and collective actions, including the defense of principles and dialogue. At the same time, it can produce compensatory mechanisms of preservation and no personal involvement, as well as perceptions of impotence and discouragement, which do not lead to the construction of alternatives of resistance and deliberation. There is no polarization between professor who deliberate or not, as these can be mobile positions taken at certain times and in certain situations, influenced by bonds and support conquered in the group, and not just by leadership and personal characteristics. CONCLUSION Dialogue is a fundamental tool for the practice of moral deliberation in the conflicts and challenges of teaching work. DESCRIPTORS Faculty, Nursing; Moral Development; Choice Behavior; Interpersonal Relations.
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Affiliation(s)
| | | | - Priscila Orlandi Barth
- Health Science Center, - Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | | | | | - Jéssica Mendes Rocha
- Health Science Center, - Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Caram CS, Peter E, Brito MJM. Invisibility of the self: Reaching for thetelosof nursing within a context of moral distress. Nurs Inq 2018; 26:e12269. [DOI: 10.1111/nin.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/16/2018] [Accepted: 09/23/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Carolina S Caram
- Nursing School; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Elizabeth Peter
- Faculty of Nursing; University of Toronto; Toronto Ontario Canada
| | - Maria JM Brito
- Nursing School; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
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Silveira LR, Ramos FRS, Schneider DG, Vargas MADO, Barlem ELD. Sofrimento moral em enfermeiros dos departamentos de fiscalização do Brasil. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar a frequência e a intensidade das causas de sofrimento moral vivenciado por enfermeiros nos departamentos de fiscalização do Brasil. Métodos Estudo transversal realizado com 28 profissionais de competência gerencial e 113 profissionais de competência fiscalizatória. A amostra foi intencional e não probabilística. Os dados foram obtidos por meio de questionário e submetidos à análise descritiva e bivariada. Resultados Os participantes revelaram causas do sofrimento moral em dois momentos: Primeiro associado ao processo de fiscalização lento por parte das instituições fiscalizadas e Corens; e insuficiência de recursos humanos. Segundo associado aos problemas éticos; condições de trabalho; e qualidade da assistência de enfermagem. Conclusão Refletir sobre as causas do sofrimento moral neste cenário é reconhecer a necessidade de algumas mudanças que devem acontecer na base que sustenta os preceitos éticos e condutas morais da profissão, para assim fortalecer a categoria.
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