Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available ...quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position. Further research is required to examine worksite strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress.
Health care professionals experience moral distress when they cannot act based on their moral beliefs because of perceived constraints. Moral distress prevalence is high among critical care (ICU) ...clinicians, but varies significantly between and within professions.
How can the interindividual variability in moral distress of Canadian ICU physicians be explained to inform future system-based interventions?
We analyzed 135 free-text comments written by 83 of the 225 ICU physicians who participated in an online cross-sectional wellness survey. An interdisciplinary team of five investigators completed the thematic analysis of anonymized survey comments according to published guidelines.
Physicians identified contextual and relational factors that contributed to moral distress and work-related stress. Combined sources of distress created high work-related demands that were not always matched by equally high resources or mitigated by work-related rewards. An imbalance between demands and rewards could lead to undesirable individual and collective consequences.
Moral distress is experienced variably by ICU physicians and is linked to contextual and relational factors. Future studies should evaluate modifiable factors such as team interactions and the role of professional rewards as mitigators of distress to bring new insights into strategies to improve ICU clinician wellness and patient care.
•A Moral Distress (MD) Consultation Service is an innovative intervention that identifies morally distressing sources and strategies to mitigate them in health-care organizations.•With the current ...workforce shortages, it is crucial to identify and mitigate MD to create a moral community and promote staff wellbeing.•Moral distress is common among nurses and needs to be acknowledged and addressed.
How Can I Survive This? Garros, Daniel; Austin, Wendy; Dodek, Peter
Chest,
April 2021, 2021-04-00, Volume:
159, Issue:
4
Journal Article
Peer reviewed
Open access
Worldwide, health-care professionals are experiencing unprecedented stress related to the coronavirus disease 2019 pandemic. Responding to a new virus for which there is no effective treatment yet ...and no vaccine is beyond challenging. Moral distress, which is experienced when clinicians are unable to act in the way that they believe they should, is often experienced when they are dealing with end-of-life care issues and insufficient resources. Both factors have been widespread during this pandemic, particularly when patients are dying alone and there is a lack of personal protection equipment that plagues many overburdened health-care systems. We explore here, guided by evidence, the concept and features of moral distress and individual resilience. Mitigation strategies involve individual and institutional responsibilities; the importance of solidarity, peer support, psychological first aid, and gratitude are highlighted.
Abstract Background Moral distress seriously affects professional nurses, and a number of instruments have been developed to measure the level of moral distress. The moral distress thermometer (MDT) ...is one of the commonly used instruments that can rapidly measure real-time moral distress; however, it remains unclear whether it is still useful in the Chinese cultural context. Aim This study aimed to adapt and validate the MDT among Chinese registered nurses. Research design An online, cross-sectional, survey study of adapting and validating Chinese version of MDT. Participants and research context A total of 182 registered nurses effectively finished this survey. The correlation between MDT score and the score of the moral distress scale-revised version (MDS-R) was used for evaluating convergent validity, and MDT scores of registered nurses who working in different departments and who made different actions to the final question of the MDS-R were compared by using one-way ANOVA to evaluate construct validity. Ethical considerations The Ethics Committee of Chongqing Traditional Chinese Medicine Hospital approved this study. Results The Chinese version of MDT was described as relevant to measure moral distress, with a reported item-level content validity index (I-CVI) and scale-level CVI (S-CVI) of 1. The mean MDT score and mean MDS-R score were 2.54 and 38.66, respectively, and the correlation between these two scores was significantly moderate ( r = 0.41). Nurses working different departments reported different levels of moral distress, and those working in intensive care unit reported the highest level of moral distress than those working in other departments ( p = 0.04). The MDT scores between nurses who presented different actions to their position were also significantly different, and those who had ever left and those who had considered leaving but did not leave reported significantly higher moral distress. Conclusion The MDT is a reliable, valid, and easy-to-use instrument to rapidly measure the real-time moral distress of registered nurses in China.
Background and aims: Moral distress is a significant ethical problem in nursing. The aim of this study was to review the studies into nurses’ moral distress and its contributing factors. Methods: ...This was a narrative review. Data were collected through searching several online Persian and English databases, namely Magiran, SID, IranMedex, PubMed, Scopus, and Google Scholar. Search keywords were "moral distress", "moral stress", "ethics", and "nurse". Eligibility criteria were publication in English or Persian, publication between 2010 and 2020, relevance to moral distress, and accessible full-text. Review studies were not included. Results: A total of 44 eligible articles were included. Nurses’ moral distress was at moderate level and its contributing factors were personal, psychological, and organizational factors as well as factors related to care quality. Conclusion: Nurses’ moral distress is moderate. Personal, psychological, and organizational factors as well as factors related to care quality contribute to moral distress among nurses. Effective management of these factors can prevent damage to nurses and patients and improve the quality of nursing care.
INTRODUCTIONMoral distress affects registered nurses' job dissatisfaction, and may ultimately be associated with higher rates of turnover. Nurse-physician relationships have been shown to affect ...moral distress in the intensive care unit setting, but no research has evaluated this impact on emergency nurses. The purpose of this study was to investigate the impact of nurse-physician relationships on the moral distress of emergency nurses.METHODSA quantitative correlational design was used to evaluate the study's aim. Point-of-care nurses currently working in an emergency department were asked to complete the Measure of Moral Distress Scale for Healthcare Professionals and the collegial nurse-physician relations domain of the Practice Environment Scale of the Nursing Work Index. Univariate and multivariate analyses were conducted to determine the impact of nurse-physician relationships on moral distress, controlling for demographic characteristics.RESULTSThirty-two participants completed the survey. Multivariate regression showed that nurse-physician relationships are associated with moral distress in emergency nurses. Years of experience and gender did not affect moral distress in univariate or multivariate analyses.DISCUSSIONGiven current staffing shortages and the need to retain expert nurses in high-acuity settings, strategies to improve nurse-physician collaboration opportunities should be explored in ED settings.
Purpose
The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the ...profession.
Methods
A descriptive, cross‐sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types and specialities (surgical, therapeutic, and intensive care), working in the five participating hospitals, 900 were randomly selected to be recruited for the study. Of the 900 surveys distributed, 612 questionnaires were completed, for a response rate of 68%. Depending on the hospital, the response rate ranged from 61% to 81%. Moral distress was measured using the Moral Distress Scale–Revised (MDS‐R). The MDS‐R is designed to measure nurses’ experiences of moral distress in 21 clinical situations. Each of the 21 items is scored using a Likert scale (0–4) in two dimensions: how often the situation arises (frequency) and how disturbing the situation is when it occurs (intensity). On the Likert scale, 0 correlates to situations that have never been experienced, and 4 correlates to situations that have occurred very often.
Results
Among the 612 participants, 206 (32.3%) nurses reported a low level of moral distress (mean score 1.09); 208 (33.9%) a moderate level of distress (mean score 2.53), and 207 (33.8%) a high level of distress (mean score 3.0). The most commonly experienced situations that resulted in moral distress were as follows: “Carrying out physician’s orders for what I consider to be unnecessary tests and treatments” (mean score 1.66); “Follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient” (mean score 1.31); and “Follow the physician’s request not to discuss the patient’s prognosis with the patient or family” (mean score 1.26). Nurses who had a high moral distress level were three times more likely to consider leaving their position compared with respondents who had a medium or low moral distress level (8.7% and 2.9%, respectively; p < .05).
Conclusions
Our findings provide evidence on the association between moral distress and intention to leave the profession. Situations that may lead health professionals to be in moral distress seem to be mainly related to the unethical work environment.
Clinical Relevance
The findings of this study reported that moral distress plays a role in both personal and organizational consequences, including negative emotional impacts upon employees.
•The overwhelming majority of participants agreed that their department medical director considers it important for staff to determine patients’ end-of- life preferences and that quality of life is ...of the highest value.•Most participants believed that death was considered a failure in their ward and that life should be saved at any cost.•High frequency of resuscitations performed in medical inpatient department affect the physicians and nursing staff causing high levels of moral distress intensity.
While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source.
to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments.
This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire.
64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (n = 228, 86.0 %) that their department medical director considers it important for staff to determine patients’ end-of-life preferences and that quality of life is of the highest value.
Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.
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