Determinants of moral distress in medical 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: 1.5). 05/2008; 16(3):360-73. DOI: 10.1111/j.1365-2834.2007.00798.x
Source: PubMed


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, Oct 05, 2015
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    • "MD has been demonstrated in nurses and physicians from different countries (Kälvemark et al., 2004; Førde and Aasland, 2008; Oh and Gastmans, 2013). Major sources of MD include aggressive treatment without perceived benefit for the patient, witnessing pain and suffering, depersonalization of patients, deception and also working with incompetent colleagues (Hanna, 2004; Catlin et al., 2008; Rice et al., 2008; Cavaliere et al., 2010). "
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    ABSTRACT: Background: Perceived constraints to providing patient care in their own morally justified way may cause moral distress (MD) in neonatal nurses and physicians. Negative long-term effects of MD include substandard patient care, burnout and leaving the profession. Aim: To assess the immediate impact of perceived inappropriate patient care on nurses' and physicians' MD intensity, and explore a possible moderating effect of ethical climate. Design: In a repeated measures design, after baseline assessment, each participant completed self-report questionnaires after five randomly selected shifts. Data were analysed with logistic and Tobit regression. Participants: Data were collected among 117 of 147 eligible nurses and physicians (80%) in a level-III neonatal intensive care unit in the Netherlands. Results: At baseline, overall MD was relatively low; in nurses, it was significantly higher than in physicians. Few morally distressing situations were reported in the repeated measurements, but distress could be intense in these cases; nurses' and physicians' scores were comparable. Physicians were significantly more likely than nurses to disagree with their patients' level of care (p = 0·02). Still, perceived overtreatment, but not undertreatment, was significantly related to distress intensity in both professional groups; ethical climate did not moderate this effect. Substandard patient care due to lack of continuity, poor communication and unsafe levels of staffing were rated as more important causes of MD than perceived inappropriate care. Conclusions: Although infrequently perceived, overtreatment of patients caused considerable distress in nurses and physicians. Our unit introduced multidisciplinary medical ethical decision making 5 years ago, which may partly explain the low MD at baseline. Relevance to clinical practice: MD might be prevented by improved continuity of care, safe levels of staffing and better team communication, along with other targeted interventions with demonstrated effectiveness, such as palliative care programs and facilitated ethics conversations.
    Nursing in Critical Care 09/2015; DOI:10.1111/nicc.12206 · 0.65 Impact Factor
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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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    ABSTRACT: Moral stress is an increasingly significant concept in business ethics and the workplace environment. This study compares the impact of moral stress with other job stressors on three important employee variables—fatigue, job satisfaction, and turnover intentions—by utilizing survey data from 305 customer-contact employees of a financial institution’s call center. Statistical analysis on the interaction of moral stress and the three employee variables was performed while controlling for other types of job stress as well as demographic variables. The results reveal that even after including the control variables in the statistical models, moral stress remains a statistically significant predictor of increased employee fatigue, decreased job satisfaction, and increased turnover intentions. Implications for future research and for organizations are discussed.
    Journal of Business Ethics 10/2012; 110(3). DOI:10.1007/s10551-011-1197-y · 1.33 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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    ABSTRACT: BACKGROUND: Moral distress is associated with job dissatisfaction, turnover and early retirement. Because of these negative consequences moral distress should be reduced. Little research has been done on what job factors contribute to whether or not a situation causes moral distress. OBJECTIVE: To identify individual and job characteristics associated with moral distress in nursing staff. DESIGN: This is a cross sectional correlational study. Nursing staff members completed two survey questionnaires with a time-interval of 3 months. In the first survey questions were asked about job characteristics and job satisfaction. Three months afterwards the respondents answered questions on moral distress. PARTICIPANTS: 365 nursing staff members employed in nursing homes, homes for the elderly, home care and acute care hospitals completed both questionnaires. RESULTS: High moral distress levels were related to lower job satisfaction. Moral distress is higher when nurses perceive less time available to give care to patients. If satisfaction with the consultation possibilities within the team is low and when an instrumental leadership style exists, nursing staff members are also more likely to experience moral distress. Nursing staff members working 30-40h per week experience less moral distress than colleagues working fewer hours per week. Multivariate analyses showed no relations with other individual characteristics measured. CONCLUSION: Job characteristics that contribute to moral distress should be an issue for managers because it is related to job satisfaction. Interventions to reduce moral distress should target at organisational issues. The way a team is supported can raise or decrease moral distress levels.
    International journal of nursing studies 09/2012; 50(1). DOI:10.1016/j.ijnurstu.2012.08.017 · 2.90 Impact Factor
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