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Oldenmenger WH, Berger E, Stoppelenburg A. The inner struggle of nurses, exploring moral distress among hospital nurses: A cross-sectional study. Int J Nurs Stud 2024; 158:104864. [PMID: 39094220 DOI: 10.1016/j.ijnurstu.2024.104864] [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: 02/09/2024] [Revised: 06/12/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND As frontline caregivers, nurses often find themselves at the crossroads of complex ethical decisions that can significantly impact patient outcomes and their own well-being. Identifying the areas of experienced moral dilemmas in the workplace and gaining insight into the prevalence of moral distress can lead to a healthier workplace environment. OBJECTIVE This study aims to examine the frequency, intensity and level of moral distress among nurses who work in a hospital, and to identify the variables associated with the level of moral distress. DESIGN Cross-sectional study. SETTING One university hospital and six general hospitals. PARTICIPANTS 654 of the 1095 nurses working on inpatient units filled out the questionnaire (response rate 60 %). METHODS The intensity and frequency of moral distress was assessed using the Moral Distress Scale-Revised (MDS-R). We also asked two additional questions about considering leaving their job, and if they could describe a distressing case and how moral distress was discussed. Multivariable regression analysis was conducted to identify the variables associated with the level of moral distress. RESULTS The overall mean MDS-R score of the 654 included nurses was low at 36.4 (SD 26). Nurses reported to have frequent dilemmas regarding organizational aspects and aspects of end-of-life care. The multivariable analyses showed that higher levels of moral distress were experienced by registered nurses, nurses working on a medical ward, and nurses who had ever left or considered leaving their job, or considering leaving their job at the moment. CONCLUSIONS Although nurses in our study experiences low levels of moral distress, they do experience moral dilemmas related to organizational topics and end of life care. We all need to pay attention to these dilemmas and how to discuss them in order to achieve a resilient nursing profession at a time of major nursing shortages. TWEETABLE ABSTRACT Caring for increasingly complex patients in a dynamic healthcare system is likely to continue to produce morally challenging scenarios.
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Affiliation(s)
- Wendy H Oldenmenger
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands.
| | - Elke Berger
- Franciscus Gasthuis & Vlietland, Franciscus Academy, Rotterdam, the Netherlands
| | - Arianne Stoppelenburg
- Erasmus MC, University Medical Center Rotterdam, Department Public Health, Rotterdam, the Netherlands
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Liguoro I, Mariani I, Iuorio A, Tirelli F, Massarotto M, Cardinale F, Parrino R, Dal Bo S, Rivellini S, Trobia GL, Valentino K, Sordelli S, Lubrano R, De Rosa G, Pandullo M, Di Stefano VA, Martucci V, Baltag V, Barbi E, Lazzerini M. Implementation of the WHO Standards to assess the quality of paediatric care using health workers as source of data: findings of a multicentre study (CHOICE) in Italy. BMJ Paediatr Open 2024; 8:e002612. [PMID: 39214556 DOI: 10.1136/bmjpo-2024-002612] [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: 03/18/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES There is little experience in implementing the WHO Standards for improving the quality of care (QOC) for children. We describe the use of 75 WHO-Standard based Quality Measures to assess paediatric QOC, using health workers (HWs) as data sources. DESIGN Cross-sectional study. SETTING 12 Italian hospitals. PARTICIPANTS The minimum target of 75% of HWs was reached in all facilities; answers from 598 HWs were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES 75 prioritised WHO Quality Measures were collected using a validated, and Italian-language questionnaire exploring views of HWs providing care to children. A QOC index was also calculated based on the assessed Quality Measures. RESULTS In both the domain of resources and work organisation, most Quality Measures showed a high overall frequency of reported 'need for improvement', with high variability across hospitals. Key needs for improvement included: availability of clear and complete protocols (eg, on paediatric emergencies: 44.6%; range 10.6%-92.6%); clear hospitalisation criteria for diarrhoea (50.5%; range 30.3%-71.7%); number of hand-washing stations (13.2%; range 3.4%-37.0%); equipped working rooms with computers for HWs (66.1%; range: 32.1%-97.0%); training (eg, on pain management: 43.5%; range 17.9%-76.7%), periodic discussion of clinical cases (43.5%; range 8.1%-83.7%) audits (48.8%; range 29.7%-76.7%); and all indicators related to system to improve QOC. Factors significantly associated with a lower QOC Index included HWs working in facilities in Southern Italy (p=0.001) and absence of a paediatric emergency department (p=0.011). CONCLUSIONS The use of the 75 prioritised Quality Measures, specific to HWs provide valuable data on paediatric QOC, which can be used to drive a quality improvement process.
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Affiliation(s)
- Ilaria Liguoro
- Division of Paediatrics, Department of Medicine DMED, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Iuorio
- Department of Pediatric Emergency Medicine, IRCCS Meyer Children's University Hospital, Florence, Italy
| | - Francesca Tirelli
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | - Roberta Parrino
- Department of Pediatrics, Pediatric Emergency Unit, Children's Hospital 'G. Di Cristina', ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Sara Dal Bo
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Sara Rivellini
- Division of Paediatrics, Department of Medicine DMED, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Gian Luca Trobia
- CA Pediatric and Pediatric Emergency Room Unit "Cannizzaro" Emergency Hospital, Catania, Italy
| | - Kevin Valentino
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Silvia Sordelli
- Department of Pediatrics, "Carlo Poma" Hospital, Mantova, Italy
| | - Riccardo Lubrano
- Department of Pediatrics Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppina De Rosa
- Department of Pediatrics, Pediatric Emergency Unit, Children's Hospital 'G. Di Cristina', ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Michela Pandullo
- Division of Paediatrics, Department of Medicine DMED, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | | | - Vanessa Martucci
- Department of Pediatrics Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Egidio Barbi
- Department of Paediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- Maternal Adolescent Reproductive and Child Health Care Centre, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Mercante A, Zanin A, Vecchi L, De Tommasi V, Benini F. Virtual reality intervention as support to paediatric palliative care providers: A pilot study. Acta Paediatr 2024; 113:833-834. [PMID: 38186210 DOI: 10.1111/apa.17099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Anna Mercante
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Zanin
- Pediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Valentina De Tommasi
- Pediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Franca Benini
- Pediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
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Fischer-Grönlund C, Brännström M, Isaksson U. Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Med Ethics 2023; 24:35. [PMID: 37254086 DOI: 10.1186/s12910-023-00916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). METHODS Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole. RESULTS The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912). CONCLUSIONS We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.
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Affiliation(s)
| | - Margareta Brännström
- Department of Nursing, Umeå University, Campus Skellefteå, 93187, Skellefteå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Linnaeus v 9, 90736, Umeå, Sweden
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Hinzmann D, Schütte-Nütgen K, Büssing A, Boenisch O, Busch HJ, Dodt C, Friederich P, Kochanek M, Michels G, Frick E. Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:333. [PMID: 36612657 PMCID: PMC9819312 DOI: 10.3390/ijerph20010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.
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Affiliation(s)
- Dominik Hinzmann
- Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 München, Germany
| | | | - Arndt Büssing
- Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Boenisch
- Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Christoph Dodt
- Emergency Department, München Klinik, 81925 Munich, Germany
| | | | - Matthias Kochanek
- Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
| | - Guido Michels
- Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
| | - Eckhard Frick
- School of Medicine, Technical University of Munich, 80333 München, Germany
- Spiritual Care and Psychosomatic Health, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, 80539 Munich, Germany
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Maffoni M, Fiabane E, Setti I, Martelli S, Pistarini C, Sommovigo V. Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9682. [PMID: 35955032 PMCID: PMC9367750 DOI: 10.3390/ijerph19159682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
During the COVID-19 health emergency, healthcare professionals faced several ethical demanding job stressors, becoming at particular risk of moral distress. To date, only a few scales have been developed to evaluate moral distress among frontline professionals working in contact with COVID-19 patients. Moreover, although many healthcare professionals from various disciplines were converted to COVID-19 patient care, no study has yet analyzed whether the resulting change in duties might represent a risk factor for moral distress. Thus, this study aimed to investigate how and when the change in duties during the emergency would be related to healthcare professionals' psycho-physical malaise. To this aim, a first Italian adaptation of the Stress of Conscience Questionnaire (SCQ) was provided. In total, 272 Italian healthcare professionals participated in this cross-sectional study. Healthcare professionals who had to perform tasks outside their usual clinical duties were more likely to experience moral distress and then psycho-physical malaise. This was particularly likely for those who were extremely concerned about becoming infected with the virus. The results also indicated that the Italian adaptation of the SCQ had a one-factor solution composed of six items. This study provides the first Italian adaptation of SCQ and practical suggestions on how supporting professionals' well-being during emergencies.
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Affiliation(s)
- Marina Maffoni
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri, IRCCS, 27040 Montescano, Italy
| | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici Maugeri, 16167 Genova, Italy
| | - Ilaria Setti
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, 27100 Pavia, Italy
| | - Sara Martelli
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, 27100 Pavia, Italy
| | - Caterina Pistarini
- Department of Neurorehabilitation of Pavia Institute, Istituti Clinici Scientifici Maugeri, IRCCS, 27100 Pavia, Italy
| | - Valentina Sommovigo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
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Carletto S, Ariotti MC, Garelli G, Di Noto L, Berchialla P, Malandrone F, Guardione R, Boarino F, Campagnoli MF, Savant Levet P, Bertino E, Ostacoli L, Coscia A. Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148526. [PMID: 35886379 PMCID: PMC9323986 DOI: 10.3390/ijerph19148526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022]
Abstract
Moral distress (MD) in healthcare providers is widely recognized as a serious issue in critical care contexts. It has the potential to have negative impacts on both personal and professional wellbeing, the quality of care provided and staff turnover. The aim of this study was to investigate the relationship between MD and burnout among neonatal intensive care unit (NICU) healthcare professionals and identify the possible factors associated with its occurrence. Participants were asked to complete an online survey, which covered sociodemographic and professional information and included two self-report questionnaires (Italian Moral Distress Scale-Revised and Maslach Burnout Inventory). The sample comprised 115 healthcare providers (nurses and physiotherapists: 66.1%; physicians: 30.4%; healthcare assistants: 3.5%) working in four NICUs located within the province of Turin, Italy. The results revealed overall low levels of MD, with no significant differences between nurses/physiotherapists and physicians. Nurses/physiotherapists showed a statistically significant higher percentage of personal accomplishment burnout (32.9%) compared with physicians (8.6%; p = 0.012). MD was associated with the emotional exhaustion dimension of burnout. Spirituality and/or religiousness was shown to be a moderating variable. Further research is needed to deepen our understanding of the correlation between MD and burnout and the role of spirituality and/or religiousness as moderators.
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Affiliation(s)
- Sara Carletto
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, 10126 Turin, TO, Italy;
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
| | - Maria Chiara Ariotti
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| | - Giulia Garelli
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
| | - Ludovica Di Noto
- Formerly at the School of Medicine, University of Torino, 10126 Turin, TO, Italy;
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
| | - Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
- Correspondence:
| | - Roberta Guardione
- Neonatal Care Unit, City of Health and Science University Hospital of Torino, 10126 Turin, TO, Italy; (R.G.); (M.F.C.)
| | - Floriana Boarino
- Neonatal Care Unit, Santa Croce Hospital ASL TO5, 10024 Moncalieri, TO, Italy;
| | - Maria Francesca Campagnoli
- Neonatal Care Unit, City of Health and Science University Hospital of Torino, 10126 Turin, TO, Italy; (R.G.); (M.F.C.)
| | - Patrizia Savant Levet
- Neonatal Intensive Care Unit, Maria Vittoria Hospital, ASL Città di Torino, 10144 Turin, TO, Italy;
| | - Enrico Bertino
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
| | - Luca Ostacoli
- Clinical Psychology Unit, A.O.U. City of Health and Science of Torino, 10126 Turin, TO, Italy; (G.G.); (L.O.)
- Department of Clinical and Biological Sciences, University of Torino, 10043 Turin, TO, Italy;
| | - Alessandra Coscia
- Neonatal Intensive Care Unit of University of Torino, Sant’Anna Hospital, City of Health and Science, 10126 Turin, TO, Italy; (M.C.A.); (E.B.); (A.C.)
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