Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital

Department of Nursing, Mayo Clinic Hospital, Mayo Clinic, Phoenix, AZ 85054, USA.
Journal of Nursing Management (Impact Factor: 1.14). 05/2008; 16(3):360-73. DOI: 10.1111/j.1365-2834.2007.00798.x
Source: PubMed

ABSTRACT To determine the prevalence and contributing factors of moral distress in medical and surgical nurses.
Moral distress from ethical conflicts in the work environment is associated with burnout and job turnovers in nurses.
A prospective cross-sectional survey using the Moral Distress Scale tool was administered to medical and surgical nurses at an adult acute tertiary care hospital.
The survey was completed by 260 nurses (92% response rate). The intensity of moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies for situations associated with futile care and deceptions were particularly high. Encounter frequencies increased with years of nursing experience and caring for oncology and transplant patients.
Moral distress is common among nurses in acute medical and surgical units and can be elicited from different types of situations encountered in the work environment. Nursing experience exacerbated the intensity and frequency of moral distress.
Strategies aimed to minimize exposure to situations of moral distress and augment mechanisms mitigating its effect on nurses are necessary to enhance job satisfaction and retention.

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Available from: Joseph L Verheijde, Aug 03, 2015
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    • "Physical manifestations of stressinduced fatigue can include headaches (Nordam et al. 2005), increased illness (Cialdini et al. 2004; Edwards 1992), and sore muscles and tiredness (Ursin and Eriksen 2007). Emotional exhaustion is generally experienced as a feeling of being burned out or depleted (Jackson et al. 1987; Nordam et al. 2005; Pendry 2007; Rice et al. 2008) and can also lead to lower self-esteem and feelings of helplessness (Cordes and Dougherty 1993; Moore 2000). "
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    Journal of Business Ethics 10/2012; 110(3). DOI:10.1007/s10551-011-1197-y · 0.96 Impact Factor
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    • "Most previous research on moral distress concentrates on nurses in hospitals, working in acute care or critical care settings (e.g. [Corley et al., 2001], [Corley et al., 2005], [Elpern et al., 2005], [McClendon and Buckner, 2007], [Meltzer and Huckabay, 2004], [Mobley et al., 2007] and [Rice et al., 2008]). The second aim was to explore individual as well as job characteristics that influence moral distress. "
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    • "The experience of moral distress has been reported in nurses working in a range of acute, long-term care, and community settings and clinical areas (see Table 1). The sequelae of moral distress include a variety of biopsychosocial effects (Gutierrez, 2005), diminished job satisfaction (Rice et al., 2008), avoidance of the context or setting in which the distress occurred (Hanna, 2005), use of alcohol and drugs (Hanna, 2005), decreased capacity for caring (Nathaniel, 2006), symptoms of burnout and leaving the profession of nursing altogether (Aiken et al., 2002; Meltzer and Huckabay, 2004; Tiedje, 2000). Many of these authors alluded to a connection between moral distress and the challenges associated with nurse retention in the workforce. "
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