Association between Moral Distress and Burnout Syndrome in university-hospital nurses

Sources of moral distress in nursing professionals: A scoping review

This article presents a scoping review aimed at mapping the main sources of moral distress among nursing professionals. The review was conducted according to the Arksey and O'Malley methodology, using the SPIDER framework to guide the systematic search in the BVS, PubMed, PsycArticles, Scielo, and Scopus databases. Initially, 2320 publications were identified. After the application of inclusion and exclusion criteria, 83 studies were selected for analysis in terms of their methodological characteristics, objectives, practice contexts, and various sources of moral distress identified. The analysis facilitated the grouping of these sources into specific situations, reflecting the challenges experienced by nurses under different practice settings. This review augments the knowledge of the causes of moral distress in nursing, highlighting the impact of this phenomenon on the physical and mental health of professionals, as well as on the quality of care provided.

Validation of the scale compassion fatigue inventory in health professional Spanish-speaking: a cross-sectional study

OBJECTIVES

To validate the Compassion Fatigue Inventory in Spanish-speaking health personnel, its psychometric properties were tested, and the influencing factors were investigated.

METHOD

This was a cross-sectional validation study. Information was collected through a survey of 733 nurses, physician and medical residents using the Compassion fatigue Inventory (CFI), Secondary Traumatic Stress Questionnaire (CETS), The physician burnout syndrome scale (PhBS), the quality-of-life index (SQL -sp) and the reduced Moral Stress Scale (MMDHPr). The psychometric properties of the CFI were tested via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and internal consistency analysis. The final version of the translated CFI was correlated with other scales.

RESULTS

An EFA was performed to evaluate the translated CFI, resulting in 15 items in three dimensions, as reported in the literature: reduced compassion, social life, and workplace. The CFA showed good fit indices and psychometric values (Cronbach´s alpha = 0.87, Omega = 0.87, Comparative Fit Index = 0.99, Tucker Lewis = 0.99, root mean square error of approximation = 0.045, Standardized Root Mean Square Residual = 0.05). The CFI had a negative correlation with the SQL-sp and a positive correlation with the other subscales. Work experience is predictive of a small reduction in CFI scores.

CONCLUSION

The adaptation of the CFI in a sample of Latino health professionals shows satisfactory psychometric indices in the evaluation of compassion fatigue and can be proposed as a specific inventory to differentiate compassion fatigue from other occupational syndromes.

Development of burnout and moral distress in intensive care nurses: An integrative literature review

AIMS

To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress.

METHODS

An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality.

RESULTS

Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress.

CONCLUSIONS

This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.

The Effect of Nursing Moral Distress on Intent to Leave Employment

OBJECTIVE

This study explored the impact of moral distress (MD) and respondent characteristics on intent to leave employment.

BACKGROUND

Managing patient care, within organizational constraints, may create physical discomfort or mental peace disturbances such as MD, negatively impacting RN retention.

METHODS

Responses from 948 RNs were collected using an anonymous online survey. The impact of MD on intent to leave employment was explored.

RESULTS

MD was significantly higher among RNs intending to leave employment. System-level and team-level integrity attributes were significant factors predicting intent to leave, controlling for potential confounders. The odds of intending to leave were 147% higher for new graduate RNs, 124% higher for direct care RNs, and 63% higher for 2nd-career RNs. Gender and race were not significant predictors.

CONCLUSION

Exploring root causes contributing to MD frequency and severity is critical to maintain a healthy work environment. Mitigating MD in the work environment may enhance nursing practice and improve patient care. Support for new graduate and 2nd-career RNs can be realized, further reducing turnover for these vulnerable populations of the nursing workforce.

Prevalence and factors associated with burnout among health professionals of a public hospital network during the COVID-19 pandemic

Burnout is most commonly defined as a syndrome characterized by emotional exhaustion, cynicism, and ineffectiveness, which occurs in response to chronic stressors at work. It can adversely affect health workers' physical and mental health, and the quality of care provided. The COVID-19 pandemic increased stressors and could impact burnout prevalence in this group. There is a lack of information regarding the prevalence of burnout among hospital health workers in Brazil. A newer definition of burnout has been proposed that considers three different clinical profiles: the frenetic, underchallenged and worn-out subtypes. This differentiation could lead to interventions tailored for each subtype. The present study aimed to estimate the prevalence of burnout, its subtypes, and associated factors in workers of a public hospital network in Brazil, during the pandemic. A total of 143 randomly selected participants answered an online form that included sociodemographic and occupational items, and the Burnout Clinical Subtypes Questionnaire, a summarized version. This questionnaire evaluates three burnout dimensions (overload, lack of development, neglect) that can be used to discriminate the three burnout subtypes (frenetic, underchallenged, worn-out, respectively); higher scores indicate higher burnout levels. The prevalence of burnout was high (53.85%), similar to other studies during the pandemic. The most common subtypes were 'frenetic' (34.97%), characterized by increased efforts to meet work demands, to the point of neglecting personal needs, and 'lack of development' (23.78%), characterized by a sense that work is uninteresting and does not contribute to personal development, and a perfunctory behavior towards tasks. Age was associated with burnout: workers with less than 51 years presented higher levels of burnout. These findings indicate the need for effective interventions to prevent and/or treat burnout. The assessment of burnout subtypes can allow managers to better understand the processes affecting employees, and inform actions to improve workforce health.

Moral distress, psychological capital, and burnout in registered nurses

AIMS

This study aimed to explore the relationship among moral distress, psychological capital, and burnout in registered nurses.

ETHICAL CONSIDERATION

The study was approved by the Ethics Committee of the School of Nursing, Hangzhou Normal University (Approval no. 2022001).

METHODS

A cross-sectional descriptive survey was conducted with a convenience sample of 397 nurses from three Grade-A tertiary hospitals in Zhejiang Province, China. Participants completed demographic information, the Nurses' Moral Distress Scale, the Nurses' Psychological Capital Scale, and the Maslach Burnout Inventory Scale. The data were analyzed using Pearson's correlation analysis, structural equation modeling, and hierarchical multiple regression analysis.

RESULTS

The study found that moral distress and burnout are positively correlated, while psychological capital is negatively correlated with both moral distress and burnout. The path analysis in structural equation modeling revealed that moral distress has a significant direct effect on psychological capital, while psychological capital has a significant direct effect on burnout. In addition, moral distress also had a significant indirect effect on burnout through psychological capital. Moreover, both the direct effect of moral distress on burnout and the total effect of moral distress on burnout were significant.

CONCLUSION

The findings suggest that psychological capital plays an important role in the relationship between moral distress and burnout. Promoting psychological capital among nurses may be a promising strategy for preventing moral distress and burnout in the workplace.

Burnout symptoms among physicians and nurses before, during and after COVID-19 care

OBJECTIVE

this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care.

METHOD

a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used.

RESULTS

280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff.

CONCLUSION

the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

Positive and negative aspects of psychological stress in clinical education in nursing: A scoping review

BACKGROUND

Even though clinical practice is crucial for nursing students' personal and professional development, it is recurrently associated with stress. However, stressful situations may not only elicit negative responses, but positive responses as well, and such aspects should be further investigated.

AIM

To explore the literature addressing the positive and negative aspects of stress experienced by nursing students during clinical practicum.

DESIGN

This scoping review followed the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines.

DATA SOURCES

CINAHL, MEDLINE/PubMed, PsycINFO, Web of Science, IBECS, LILACS, BDENF and two theses and dissertations repositories.

REVIEW METHODS

Searches were conducted from June to August 2022. Studies addressing the positive and negative aspects of stress experienced by nursing students during clinical practice were included regardless of the method adopted.

RESULTS

This review included 32 studies published between 1999 and 2022 in 25 countries across four continents: Africa, America, Asia, and Europe. Stress can positively influence academic performance, especially in mobilizing a search for learning and professional development and in integrating theoretical knowledge and improving clinical skills and competencies. Negatively, stress can cause biopsychosocial symptoms that compromise a student's academic performance and can cause doubts and uncertainties about the construction of their professional identity.

CONCLUSIONS

Although the negative aspects stand out over the positive ones, it is evident that both are present in the clinical practice environment. When considering stress of nursing students, educators should conduct the teaching-learning process in order to reduce the negative impact and promote the positive side of stressful situations.