Analytical study of care quality and moral distress in clinical situations and patient care

Objective: Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality.Methods: In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13.Results: Investigating moral distress domains(ignoring patient, decision-making power, and professional competence) and care quality domains(psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain(P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical(bodily), and communication domains of care quality.Conclusions: Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decisionmaking domains, improve the professional competence, and pay attention to patients.

The relationship between professional autonomy and moral distress among nurses working in children's units and pediatric intensive care wards

Background: Nurses serve as the primary source of care for minor patients in intensive care units. Even though they support both patients and their relatives, these nurses may experience moral distress from their profession. While managing their daily relationships with their patients, nurses must also be able to control their actions to feel that they are from a social unit and feel their competence in association with others.Objective: This study aimed to investigate the relationship between professional autonomy and moral distress among nurses working in children's units and pediatric intensive care wards. Methods: This descriptive/comparative cross-sectional study was conducted in 2015 using 120 nurses as subjects. Subjects were selected using the census method. The research tools used to gain measurable data were the Pankratznursing questionnaire(PNQ) and Corley'sMoral distress scale (MDS). In order to analyze the collected data, descriptive statistic tests such as the relative frequency distribution, mean, standard deviation and the Pearson correlation test, T-test, ANOVA, and regression were used. The SPSSv.20 software was also used to analyze the data obtained. Results: The relationship between professional autonomy and moral distress revealed that there was a significant positive relationship between professional autonomy and moral distress in the intensity (r=0.39;P<0.001) and the iteration (r=0.41;P<0.001). In addition, professional autonomy predicted 18% of changes in intensity of moral distress in total(MR = 0.42, R2 = 0.18) and also professional au-tonomy predicted 25% of iteration in moral distress in total(MR = 0.507, R2= 0.25). Conclusions: The results of this study revealed that there was a direct positive relationship between professional autonomy and moral distress.

Predictors of moral distress among nurses working in Jimma University Medical Center,South West Ethiopia

Background:Moral distress is characterized by biopsychosocial,cognitive,and behavioral effects experienced by clinicians when their values are compromised by internal or external constraints,which results in the inability to give the desired care to patients.Objective:To assess predictors of moral distress among nurses working in Jimma University Medical Center,South West Ethiopia.Methods:An institution-based cross-sectional study design was used.A simple random sampling technique was applied to select a total of 248 study participants.Data were collected using a structured self-administered questionnaire,which contains sociodemographic characteristics,Moral Distress Scale-Revised,personal factors,and organizational factors.The data were entered into Epi-data version 3.1 and analyzed by SPSS software version 20.Descriptive statistics,bivariate analysis,and multivariable logistic regression analysis were performed.Finally,P-value<0.05 was used to declare and include variables with statistically significant in predicting the outcome variable.Results:More than two-thirds of the study participants 170(68.5%)were females.The mean age of the respondents is 29 years.Among the study participants,174(70.16%)nurses had experienced a high level of moral distress.Sex,working hours,professional commitment,autonomy,and working environment were statistically significant predictors of moral distress.Conclusions:More than two-thirds of the nurses were experiencing a high level of moral distress.This will affect the nursing service quality,nurses,the nursing profession,and the organization as a whole.This finding is critical for the study since the problem is happening in the presence of low nurse to patient ratio and low nursing care quality.Sex,working hours per week,professional commitment,autonomy,and working environment were identified as predictors of moral distress.

A survey of moral distress in certified registered nurse anesthetists:A theoretical perspective for change in ethics education for advance practice nurses

Objective:The aim of this study was to examine the relationship between moral distress that may affect patient safety,and the clinical practice model,assessing ethical decision-making skills of certified registered nurse anesthetists(CRNAs).Methods:A survey using the Ethical Stress Scale(ESS)and the Ethical Assessment Skills Survey(EASS)was conducted with 134 CRNAs.Results:Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge[Wilks's lambda=0.952,F(6,256)=1.068,P=0.382,n^(2)=0.02].A statistically significant positive correlation existed between importance and skill(r=0.275,P=0.001).CRNAs felt skilled to manage the actions or activities they deemed important.Conclusion:CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress.Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

The Status Quo and Influencing Factors of the Moral Distress in Nurses in Tertiary Grade A Hospitals in Wuhan

Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing is considered to be an ethically important profession, and nurses aim to achieve ethical goals such as providing the best possible care to patients, achieving high quality outcomes, but it is common when there are insufficient numbers of staff, inadequately trained staff, and organizational policies and procedures that make it difficult, or even impossible, for nurses to meet the needs of patients and their families. This conflict results in moral distress for nurses, yet limited attention has been paid to this phenomenon. Objective: To explore the current phenomenon of moral distress and its triggering factors in nurses in tertiary grade A hospitals in Wuhan, by targeting root causes and understanding the interplay between nurses and settings where moral distress occurs, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care. Method: Totally 384 nurses from clinical departments in 2 tertiary Grade A hospitals in Wuhan were investigated with the Chinese version Moral Distress Scale-Revised (MDS-R). Result: The total score of moral distress was 47.41 ± 27.14, and the mean scores of moral distress frequency and intensity were 1.01 ± 0.53 and 1.19 ± 0.61, which were at a lower level. The main source of moral distress for nurses is related to end-of-life care and medical decision communication;Nurses’ moral distress scores were statistically significant (P Conclusion: Hospital facility leaders and nursing managers need to train nurses to develop competency development such as reflection, empathy, communication, positive thinking, and emotional intelligence to practice ethical dilemma response, and facilitate collaborative communication among healthcare members, so as to alleviate moral distress in nurses.

Characteristics of moral distress from nurses’perspectives:An integrative review

Objective:This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’perspectives in the literature.These insights will help update existing tools and create new ones to capture moral distress better,guiding the development and implementation of strategies to support nurses in addressing this challenge.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases(EBSCO Medline,CINAHL,and PubMed).Additionally,two journals,Bioethics and Nursing Ethics,were manually searched to reduce search bias.The included studies were primary resources published in English between 2018 and 2023,utilizing quantitative,qualitative,or mixed methods to examine moral distress’s characteristics,components,and definitions.All of identified studies were screened,extracted,and analyzed independently by two researchers.Results:Nineteen studies were included.The results were grouped into five themes shaping the main characteristics of moral distress:1)experiencing a moral situation,with five ethically conflicted situations identified,including treatment plans,professional and personal moral values,team dynamics,complex contexts,clinical practices,and patient-centered care;2)making a moral judgment,where nurses experience moral distress when they cannot act consistently with their values,ethical principles,and moral duties;3)the presence of constraints,categorized at three levels:individual factors related to the nurse,patient,and patient’s family;team factors related to the team or unit involved;and system factors,including institutional and policy elements;4)moral wrongdoing,which occurs when nurses are unable to perform the right moral action;and 5)moral suffering,with studies showing that moral distress impacts physical,emotional,and psychological well-being.Conclusion:The findings enhance the understanding of moral distress characteristics among nursing staff,highlighting the concept of the crescendo effect,which underscores the cumulative and escalating nature of unresolved moral distress,emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.

护士在造血干细胞移植患者照护中道德困扰的质性研究

目的了解护士在造血干细胞移植患者照护过程中遇到的道德困扰,为认识护理伦理问题并制定干预策略提供理论依据。方法采用目的抽样法,2022年5月至2023年12月选取6家三级甲等医院移植病房/血液科病房的18名护士为研究对象,采用描述性质性研究,用面对面访谈和在线访谈的方式收集资料,通过传统内容分析法进行资料分析、归纳及提炼主题。结果护士在造血干细胞移植患者照护中道德困扰可归纳为3个主题:治疗决策带来的困惑、无法提供最佳护理实践的困扰、维护患者权益相关的困扰。结论护士在照护造血干细胞移植患者过程中面临复杂的道德困扰,可以从建设支持性的工作环境等方面减少道德困扰带来的负面影响,调动护士工作积极性,增加职业价值感。

ICU护士道德困境质性研究的Meta整合

目的系统评价和整合有关ICU护士道德困境体验的质性研究,为临床制定减轻道德困境的干预策略提供参考。方法检索Web of Science、Embase、PubMed、EBSCOhost、中国知网、万方、维普、中国生物医学文献数据库中与ICU护士道德困境相关的质性研究,检索时限为建库至2023年7月,采用澳大利亚循证卫生保健中心质性研究质量评价标准评价纳入的文献,采用汇集性整合方法进行Meta整合。结果共纳入9篇研究,提炼出39个研究结果,归纳形成8个新类别,综合得出3个整合结果:造成ICU护士道德困境的因素、道德困境的感受、道德困境的应对方式。结论ICU护士道德困境的产生常与多种因素相关,道德困境会对ICU护士身心产生伤害,威胁护理安全。建议积极关注ICU护士的道德困境问题,并建立有针对性的支持系统,帮助护士积极应对道德困境。

肿瘤科护士伦理行为现状及影响因素分析

目的了解肿瘤科护士伦理行为现状,分析其影响因素,为制定针对性干预措施提供参考。方法便利抽取郑州市3所三级甲等医院肿瘤科护士552人,采用一般资料调查表、护士伦理行为量表、拉什顿道德复原力量表、医院伦理氛围量表进行调查。结果肿瘤科护士伦理行为得分为(75.85±10.75)分。多元线性回归分析结果显示,工作年限、道德韧性、医院伦理氛围是肿瘤科护士伦理行为的主要影响因素(均P<0.05),共解释总变异的50.0%。结论肿瘤科护士伦理行为处于中等偏上水平。护理管理者可通过提升肿瘤科护士道德韧性水平,营造良好的医院伦理氛围,从而改善肿瘤科护士伦理行为。

关怀伦理视域下医务人员的道德创伤与应对思考

临床实践中的道德困境是造成医务人员道德创伤的重要因素。关怀伦理的核心思想是强调关怀和被关怀是人类的基本需要,这对防治医务人员道德创伤具有重要指导意义。通过梳理关怀伦理理论的基本思想,对医务人员的道德创伤进行解释和分析,剖析造成创伤的主要原因为:医务人员个体具有脆弱性,自我关怀水平较低;不和谐的医患关系以及医患双方关怀关系的不对称;组织支持水平较低,缺乏关怀型伦理氛围。因此,以关怀为目标,通过提高医务人员的关怀素养和道德韧性,构建医患之间和谐的关怀关系,建立关怀环境、形成关怀型组织伦理氛围等途径能够缓解道德两难困境,这也是防治医务人员道德创伤及构建医患命运共同体的有益尝试。

道德伤害在临床护理中的研究进展

阐述了道德伤害的概念发展、测量工具、影响因素、对护士的影响及三级预防。提出应研制符合中国文化的道德伤害量表,重视组织支持,制定三级预防措施,以促进临床护士的心理健康,稳定护理队伍。

ICU护士工作投入与工作环境、道德困境关系的调查研究

目的:分析ICU护士工作环境、道德困境、工作投入现状,探讨三者的路径关系。方法:采用一般资料问卷、护理工作环境量表(PES)、道德困境量表(MDS)、工作投入量表(UWES)对长沙市4所三级甲等医院的413名ICU护士进行调查。结果:ICU护士工作环境得分为(90.61±13.53)分,道德困境总分中位数为47.00分,工作投入得分为(63.67±20.47)分;ICU护士的工作环境与工作投入呈正相关,道德困境与工作投入呈负相关(P<0.01);工作环境通过道德困境对工作投入的间接效应显著,道德困境的中介效应为0.076,占总效应的14.3%。结论:ICU护士工作环境、道德困境、工作投入现状仍需改善,建议护理管理者开展以ICU护士工作投入的影响路径为依据的干预策略,通过改善工作环境,减轻道德困境,最终提升ICU护士的工作投入水平。

重症监护病房护士道德勇气与道德困境相关性分析

为了解重症监护病房(ICU)护士道德勇气与道德困境现状,并探讨其相关性,便利选取山东省某省属三级甲等医院ICU护士208名作为研究对象,所有研究对象均采用护士道德勇气量表、护士道德困境量表进行评估。研究显示,ICU护士道德勇气和道德困境具有显著相关性,提示医院相关职能部门应对其现状重点关注,应用较高的道德敏感度引导其辨析显存的伦理情景,脱离道德困扰。

医务人员道德韧性研究进展

对国内外医务人员道德韧性的概念发展、特征、测量工具、影响因素、作用、培养进行综述。医务人员道德韧性的特征包括医务人员的个人诚信、医疗团队的关系诚信、医务人员的适应性、医务人员的自我调节、医务人员的自我管理、道德效能。医务人员道德韧性的影响因素包括医疗团队支持系统、医务人员个人品质、医务人员对事件的认知。道德韧性能促进医务人员的身心健康,有效应对道德创伤,减少医务人员职业倦怠及离职意愿,缓解医务人员的道德困境,提高医务人员抵抗道德困境的能力。

重症监护室护士道德困境与职业倦怠的相关性研究

目的探讨重症监护室护士道德困境与职业倦怠现状及两者的相关性。方法采用自制一般情况调查表、中文版护士道德困境量表和护士职业倦怠问卷,于2013年6月和7月对南昌市4所三级甲等医院重症监护病房的105名护士进行问卷调查。结果护士道德困境总均分为43.03±10.72;护士职业倦怠总均分为60.59±17.86。护士道德困境与职业倦怠得分的相关系数为0.224(P<0.05)。道德困境与情感耗竭、去人格化、职业倦怠呈正相关,与个人成就感呈负相关。结论护士道德困境可导致临床护士情感耗竭、去人格化和职业倦怠,使个人成就感降低。护理管理者可采取多种途径且有针对性的教育方法,使其克服道德困境,远离职业倦怠,保证临床护理质量。

护士道德困境与工作满意度相关性分析

目的分析护士道德困境与工作满意度的相关性,旨在为护理管理者提供依据,提高护士工作满意度。方法采用中文版护士道德困境量表(MDS-R)和明尼苏达工作满意度问卷(MSQ),对济南市3所三级甲等医院的189名临床护士进行问卷调查。结果护士道德困境总分为(38.86±8.26)分,道德困境频率和强度条目平均得分分别为(1.07±0.45)分和(1.04±0.63)分,均处于较低水平;工作满意度总分为(51.95±10.73)分;工作满意度各维度与道德困境的总分呈负相关(均P<0.01)。结论护士道德困境与工作满意度关系密切,医院管理者应重视临床护士所面临的道德困境,提供各种支持措施,缓解道德困境给护士带来的工作压力,从而提高护士工作满意度。

护理人员经历的伦理问题及其影响因素分析

目的:描述护理人员经历的伦理问题,分析影响护理人员经历伦理问题的因素。方法:采用改良的Fry和Duffy的伦理问题量表(Ethical Issue Scale)对上海市7家不同等级医院的903名护士进行调查。结果:护理人员最常经历的伦理问题依次为人员配备不足对病人造成影响、对治疗的知情同意、保护病人的权利和尊严等。护理人员的教育程度、职位和所在医院等级是影响他们经历伦理问题的因素。结论:护理管理者应增加与护士的对话,发展支持系统,制定、修改护理人员配备政策,为临床护理人员营造有利的伦理氛围。

ICU护士道德困境对其职业认同感的影响

目的 :分析ICU护士道德困境对其职业认同感的影响。方法 :采用便利抽样法抽取温州市3所三级甲等医院的ICU护士198名进行问卷调查,了解ICU护士道德困境和职业认同感的现状,并分析两者之间的关系。结果 :ICU护士职业认同感总分为(32.58±6.47)分,ICU护士道德困境与其职业认同感呈负相关,回归分析显示,控制人口学变量之后,价值冲突、个体责任共可以解释职业认同感的28.6%。结论 :护理管理者应根据ICU护士道德困境的不足之处,制定针对性的干预措施,增进ICU护士的职业认同感。

急诊科护士道德困境的现状调查

目的探讨急诊科护士道德困境水平,为管理者改善护士道德困境提供参考。方法采用中文版护士道德困境量表,对湖州市3所三级医院182名急诊科护士进行问卷调查。结果急诊科护士道德困境总均分为(2.03±1.15)分,不同急诊护龄、急诊岗位、学历与用工性质的急诊科护士道德困境水平差异均具有统计学意义(P<0.01或P<0.05)。结论护理管理者应重视急诊科护士道德困境问题,通过提高急诊科护士的自我预防与应对能力,以降低其道德困境的发生。

急危重症护士工作环境对道德困境影响的研究

目的:调查急危重症护士工作环境和道德困境的现状,并分析护理工作环境对道德困境的影响。方法:采用便利抽样法选取长沙市4所三级甲等医院的急危重症护士457名作为研究对象,对其进行问卷调查。结果 :急危重症护士工作环境总分为(90.95±13.24)分,道德困境总分为(53.98±35.89)分;护理工作环境与道德困境呈负相关(P<0.01);控制人口学变量后,护理工作环境中的护士参与医院事务及充足的人力和物力维度可独立解释道德困境29.1%的变异。结论 :急危重症护士道德困境现状不容乐观,护理工作环境对道德困境有一定的预测性,护理管理者可通过改善工作环境来缓解急危重症护士道德困境水平。