The Relationship between Resilience and Moral Distress among Iranian Critical Care Nurses: A Cross-sectional Correlational Study

The association between psychological reactions, resilience, and work engagement among Palestinian critical care nurses in West Bank

AIM

This study aimed to assess the association between psychological reactions (e.g., stress, anxiety, and depression), resilience, and work engagement among Palestinian critical care nurses in the West Bank and examine the correlation of psychological reactions and resilience with work engagement.

BACKGROUND

Work engagement is associated with psychological reactions and resilience, particularly among critical care nurses. There is a lack of studies on work engagement and these factors in Palestine.

METHODS

A cross-sectional, descriptive correlational design was adopted. A convenience sample consisting of 273 critical care nurses from private and governmental hospitals was recruited to participate. Depression, Anxiety, Stress Scale-21 (DASS-21), Connor-Davidson Resilience Scale-25 (CDRS-25), Utrecht Work Engagement Scale-9 (UWES-9), and demographic data were used to collect data during the period from March 20 to May 20, 2023.

RESULTS

Findings demonstrated that 53.9% of the nurses reported mild-to-moderate levels of depression, 49.8% reported moderate-to-severe levels of anxiety, and 49.1% reported moderate-to-severe levels of stress. Additionally, 57.5% and 52.7% of them had low resilience and work engagement, respectively. Moreover, work engagement negatively correlated with depression (r = -0.796, P < 0.01), anxiety (r = -0.654, P < 0.01), and stress (r = -0.796, P < 0.01), while positively correlated with resilience (r = 0.42, P < 0.01) and gender (r = 0.121, P < 0.05). Depression, anxiety, stress, resilience, and gender were the main predictors of work engagement.

DISCUSSION

The majority of the nurses suffered from depression, anxiety, and stress. Additionally, more than half of the participants had low resilience and work engagement. Moreover, increased depression, anxiety, and stress were correlated with decreased work engagement, while high resilience and gender as being female positively correlated with high work engagement.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers and hospital administrators should develop interventions to improve critical care nurses' resilience and minimize psychological reactions, which have a significant influence on work engagement. Future studies should be conducted to examine the effectiveness of these interventions.

Resilience, compassion fatigue, moral distress and moral injury of nurses

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study.

Relationship between death anxiety and resilience among critical care nurses in Oman

BACKGROUND

Critical care nurses encounter numerous work-related stressors that might lead to depression and anxiety. Areas with higher patient mortality can lead to burnout, higher turnover and death anxiety. The possession of resilience and good attitudes towards mental health is of utmost importance for nurses, given their role as influential figures within society.

AIM

The aim of this study was to examine the relationship between death anxiety and resilience among critical care nurses in Oman.

STUDY DESIGN

This study employed a cross-sectional design with convenience sampling, sending 300 invitations via a URL link on a popular social media platform for critical care nurses in Oman. Out of 218 responses, the initial response rate was 72.7%. After data cleansing to remove incomplete and illegible submissions, the final sample consisted of 183 nurses who completed the Templer Death Anxiety Scale and the Connor-Davidson Resilience Scale (CD-RISC). The survey was conducted in December 2023.

RESULTS

The study found that the mean death anxiety and resilience scores were 38.23 (SD = 6.96) and 37.62 (SD = 5.32), respectively. Most of the participants exhibited a low level of death anxiety and a moderate level of resilience. The results of this study found a significant proportional correlation between death anxiety and resilience among critical care nurses in Oman (p = .000); nurses with a higher degree of resilience were shown to be significantly correlated with a lower level of death anxiety. The results showed that resilience explained 14.9% of the variation in death anxiety.

CONCLUSIONS

The research in Oman reveals that critical care nurses in the country experience moderate death fear. This anxiety stems from the demanding nature of their profession, which involves providing care for critically ill patients in high-pressure environments. Factors such as cultural and religious beliefs and educational attainment are also influencing this anxiety. Resilience is positively associated with the ability to confront challenges with courage, and a positive correlation exists between resilience and death anxiety. This suggests that nurses with higher resilience may also experience higher death anxiety because of their profession's inherent responsibilities and decision-making.

RELEVANCE TO CLINICAL PRACTICE

The study on critical care nurses in Oman highlights that workplace stress and high death anxiety negatively impact their well-being and patient care quality. Factors like job demands, cultural beliefs and education influence these experiences, with resilience playing a key role in coping. Enhancing resilience and coping strategies can improve care quality and reduce turnover in nursing.

Moral distress and compassion fatigue among nursing interns: a cross-sectional study on the mediating roles of moral resilience and professional identity

BACKGROUND

Nursing interns often faced moral distress in clinical practice, similar to registered nurses, which can lead to compassion fatigue. The roles of moral resilience and professional identity in influencing the psychological well-being of nursing interns are recognized, but the interrelationships among moral distress, moral resilience, professional identity, and compassion fatigue in this group remain unclear.

OBJECTIVES

This study aimed to investigate the impact of moral distress on compassion fatigue among nursing interns and to explore the mediating role of moral resilience and professional identity.

METHODS

A quantitative cross-sectional study was conducted with 467 nursing interns. Data were collected using Compassion Fatigue Short Scale, Moral Distress Scale-revised, Rushton Moral Resilience Scale, and Professional Identity Scale. Data analyses were performed using SPSS 22.0 and Amos 21.0, adhering to the STROBE statement.

RESULTS

The mean scores for compassion fatigue, moral distress, moral resilience, and professional identity were 35.876, 44.887, 2.578, and 37.610, respectively. Moral distress was positively correlated with compassion fatigue. Structural equation modeling showed that moral resilience and professional identity partially mediated the relationship between moral distress and compassion fatigue (β = 0.448, P < 0.001).

CONCLUSION

The findings suggest that moral distress directly influences compassion fatigue among nursing interns and also exerts an indirect effect through moral resilience and professional identity. Interventions aimed at enhancing moral resilience and fostering a strong professional identity may help mitigate the adverse effects of moral distress on compassion fatigue among nursing interns.

Studying moral distress and moral injury among inpatient and outpatient healthcare professionals during the COVID-19 pandemic

Objective: COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). The purpose of this study was to examine MD and MI among inpatient and outpatient HCPs during March of 2022.The study sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on background characteristics.Methods: A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at two academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings.Results: A moderate association was found between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded eight sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability.Conclusions: While interrelated conceptually, MD and MI should be viewed as distinct constructs. Many HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by those in all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being, work satisfaction, and the quality of patient care.

Moral distress, moral resilience, and job embeddedness among pediatric nurses

BACKGROUND

Nurses often face ethical issues in their daily work that can have an impact on their level of job embeddedness. And positive job embeddedness is essential to reduce burnout among nurses and improve professional retention in the medical industry. However, few studies have focused on the relationship between moral distress, moral resilience, and job embeddedness.

OBJECTIVES

To investigate the relationship between moral distress, moral resilience, and job embeddedness, and explore the mediating role of moral resilience between moral distress and job embeddedness among nurses.

DESIGN

A quantitative, cross-sectional study.

METHODS

Nurses from a number of tertiary general hospitals in central China were surveyed and assessed using the Moral Distress Scale, the Nurse Moral Resilience Scale, and the nurse job embeddedness Scale from February to March 2023. The study was conducted in line with the 1964 Declaration of Helsinki.

ETHICAL CONSIDERATION

All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-313).

FINDINGS

Moral distress was positively correlated with moral resilience (β = 0.525, p < 0.01) and negatively correlated job embeddedness (β = -0.470, p < 0.01). Moral resilience partially mediated the relationship between moral distress with job embeddedness (β = -0.087, p < 0.01).

DISCUSSION

The findings reveal a relationship between moral distress, job embeddedness, and moral resilience among nurses.

CONCLUSION

Moral distress and moral resilience are important correlates of job embeddedness in nurses. Interventions to reduce moral distress and increase moral resilience may have potential benefits for improving nurses' job embeddedness. It is recommended that clinical nursing administrators create a favorable ethical atmosphere, educate nurses about ethics, and increase nurses' moral resilience.

The impact of resilience on clinical nurses' moral courage during COVID-19: A moderated mediation model of ethical climate and moral distress

AIM

The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID-19, and if moral distress faced by nurses is a moderating factor.

BACKGROUND

Resilience can help nurses maintain their personal health during COVID-19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear.

METHOD

A cross-sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor-Davidson Resilience Scale (CD-RISC), Moral Distress Scale-Revised (MDS-R), and Hospital Ethical Climate Scale (HECS).

RESULTS

Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress.

DISCUSSION

This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID-19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate.