Nursing (Ethical aspects)
Nurses (Ethical aspects)
|Publication:||Name: Journal of the New York State Nurses Association Publisher: New York State Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New York State Nurses Association ISSN: 0028-7644|
|Issue:||Date: Spring-Winter, 2011 Source Volume: 42 Source Issue: 1-2|
|Topic:||Event Code: 200 Management dynamics; 290 Public affairs; 310 Science & research Advertising Code: 91 Ethics|
|Product:||Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Rice, E. M., Rady, M. Y., Hamrick, A., Verheijde, J. L., &
Pendergast, D. K. (2008). Determinants of moral distress in medical and
surgical nurses at an adult acute tertiary care hospital. Journal of
Nursing Management, 16, 360-373.
Nurses in all clinical settings confront ethical issues that frequently lead to moral distress. Most studies on moral distress have been directed in the critical care environments, mostly due to the widespread use of advanced medical technology at the end of life. The aim of this study was to determine the prevalence and contributing factors of moral distress in medical surgical nurses in adult acute care units.
The study design was a prospective cross-sectional survey of nurses who cared for different patient populations including general medicine, surgical, cardiac, neurologic, and oncologic at an adult acute tertiary care hospital. The study used the moral distress scale, a validated survey instrument to measure moral distress. Institutional Review Board approval was obtained. The survey was administered to all medical and surgical nurses by the principal investigator, and consisted of 38 situations that can generate ethical conflicts and moral distress in customary hospital practice. The nurses were instructed to give consideration to experiences throughout their entire career when responding to the survey.
The moral distress scale measures perceptions of nurses on two dimensions of each situation: (1) intensity of moral distress and (2) frequency of the encounter of that particular situation using a 0-6 Likert scale. The survey situations were in six categories. Categorical variables were analyzed by the chi-squared test. The sum of moral distress and encounter frequency scores for each of the categories was examined with Wilcoxon/Kruskal-Wallis tests. Multiple regression analysis was used to identify independent predictors for the sum scores of encounter frequencies to different categories of situations. All statistical tests were two-tailed and statistical significance was accepted at P < 0.05.
In total, 260 nurses completed the survey for a 92% response rate. The main findings from the survey were: (1) the intensity of moral distress was uniformly high across the six categories of situations, (2) there was a variability of encounter frequencies among the different categories of situations, (3) futile care situations had the highest moral distress and encounters in the study cohort, and (4) years of nursing experience and caring for oncology patients were significantly associated with encounter frequencies of moral distress situations.
The study further identified inadequate pain control for the terminally ill and dying patients as an important cause of moral distress in medical and surgical nurses. Additionally, nurses who provided care to oncology patients had much higher exposures to situations causing moral distress than those who cared for patients with other illnesses. Lastly, the nurses' comfort level with staffing and competence of other nurses and physicians as healthcare providers was also cited as a potential contributor to moral distress.
The implications for this study are profound. Effective communication among healthcare providers, patients, and families must take place to achieve the desired goals of medical care, including sound patient-care decisions. Improved communication and collaboration among nurses and physicians can be crucial for providing moral support of nurses when encountering situations containing ethical conflict and distress. Patient-care conferences and open group discussion of issues surrounding ethical conflicts can be both educational and beneficial. Nurse administrators are encouraged to develop programs to facilitate communication, interdisciplinary collaboration, and discussions among pertinent disciplines and with adherence to palliative care principles.
Ann Cella, St. Francis Hospital Heart Center, Roslyn, NY
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