Development and evaluation of a moral distress scale

Background: Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints. Objectives: To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil. Method: Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil answering the scale. The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models. Ethical considerations: Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande. Findings: The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000). Conclusion: The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician.

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Researching moral distress among New Zealand nurses

Nursing Ethics ◽

10.1177/0969733014542679 ◽

2014 ◽

Vol 22 (1) ◽

pp. 117-130 ◽

Cited By ~ 29

Author(s):

Martin Woods ◽

Vivien Rodgers ◽

Andy Towers ◽

Steven La Grow

Keyword(s):

New Zealand ◽

Nurse Educators ◽

Moral Distress ◽

Response Rate ◽

Ethical Considerations ◽

Optimal Care ◽

Adequate Response ◽

Human Ethics ◽

Distress Scale ◽

Service Managers

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

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Gender and the experience of moral distress in critical care nurses

Nursing Ethics ◽

10.1177/0969733013513216 ◽

2014 ◽

Vol 22 (1) ◽

pp. 32-42 ◽

Cited By ~ 31

Author(s):

Christopher B O’Connell

Keyword(s):

Gender Differences ◽

Critical Care ◽

Gender Difference ◽

Intent To Leave ◽

Moral Distress ◽

Psychological Symptoms ◽

Research Question ◽

Critical Care Nurses ◽

Underrepresented Groups ◽

Distress Scale

Background: Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether. Research question: Do significant gender differences exist in the moral distress scores of critical care nurses? Research design: This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores. Participants and research context: Participants ( n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale–Revised online over a 5-day period in July 2013. Ethical considerations: Institutional review board review approved the study, and accessing and completing the survey implied informed consent. Findings: The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low. Discussion: The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress. Conclusion: Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups.

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Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers?

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.3102.2393 ◽

2014 ◽

Vol 22 (1) ◽

pp. 35-42 ◽

Cited By ~ 19

Author(s):

Graziele de Lima Dalmolin ◽

Valéria Lerch Lunardi ◽

Guilherme Lerch Lunardi ◽

Edison Luiz Devos Barlem ◽

Rosemary Silva da Silveira

Keyword(s):

Moral Distress ◽

Maslach Burnout Inventory ◽

Burnout Syndrome ◽

Bivariate Analysis ◽

Rio Grande Do Sul ◽

Weak Correlation ◽

Professional Performance ◽

Moderating Variables ◽

Professional Fulfillment ◽

Distress Scale

OBJECTIVE: to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. METHODS: this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbach's alpha. For the data analysis bivariate analysis using Pearson's correlation and multivariate analysis using multiple regression were performed. RESULTS: the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. CONCLUSION: the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.

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Moral distress among nurses working in Covid-19 wards: a cross-sectional study in 2021

10.21203/rs.3.rs-934292/v1 ◽

2021 ◽

Author(s):

Mina Pooresmaeil ◽

Masoumeh Aghamohammadi

Keyword(s):

Significant Relationship ◽

Work Experience ◽

Moral Distress ◽

Pearson Correlation ◽

Cross Sectional Study ◽

Moderate Level ◽

Related Factors ◽

Cross Sectional ◽

Experienced Nurses ◽

Distress Scale

Abstract Background Covid-19 is an emerging disease, which has confronted nurses with new moral distress. This study aims to determine the moral distress and its related factors among nurses working in the covid-19 wards of Ardabil city in Iran. Methods This cross-sectional descriptive study evaluated 159 nurses working in the covid-19 wards of Imam Khomeini hospital -as the only hospitalization center for the patients with covid-19 in Ardabil, 2021. The instruments used included a personal-occupational information form and Corley's moral distress scale. Data analysis was performed using descriptive and inferential statistics (Pearson correlation coefficient, independent t-test and one-way analysis of variance) in SPSS v22. Results The mean and standard deviation of the frequency and intensity of the nurses' moral distress were estimated 52.28 ± 5.24 and 51.54 ± 5.86, respectively, which indicated the moderate level of moral distress in the both dimensions. The item "I hesitate to tell the patient or the patient's family about his condition and treatment" (4.74 ± 0.75) showed the most moral distress based on the intensity and the phrase "too much work reduces the quality of my work” (4.81 ± 0.55) caused the most moral distress in the frequency dimension. The results indicated a significant relationship between the intensity and frequency of moral distress with the type of nurses' employment (P < 0.05). Moreover, a significant relationship was observed between the nurses’ position and the frequency (P = 0.04), and the nurses’ work experience and the intensity of moral distress (P = 0.02). Conclusions It seems that providing the necessary training for how to deal with the moral distress in new waves of the disease and using the experiences of the experienced nurses in this field are essential due to observing the moderate level of moral distress among nurses working in covid-19 wards.

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Intensity and frequency of moral distress in Brazilian nurses

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2018020703578 ◽

2020 ◽

Vol 54 ◽

Author(s):

Flavia Regina Souza Ramos ◽

Priscila Orlandi Barth ◽

Laura Cavalcanti de Farias Brehmer ◽

Graziele de Lima Dalmolin ◽

Mara Ambrosina Vargas ◽

...

Keyword(s):

Professional Identity ◽

Moral Distress ◽

Work Teams ◽

Cross Sectional Study ◽

Work Environments ◽

Sectional Study ◽

Cross Sectional ◽

Nurses Role ◽

Distress Scale ◽

Descriptive Statistical Analysis

Abstract Objective: To evaluate the frequency and intensity of moral distress in Brazilian nurses. Method: Cross-sectional study performed with nurses from 27 Brazilian states through application of the Brazilian Moral Distress Scale in Nurses (Portuguese acronym: EDME-Br) and descriptive statistical analysis. Results: Participation of 1,226 Brazilian nurses in the study. The intensity and frequency of overall moral distress were rated as moderate level, with averages of 3.08 (± 1.45) and 2.94 (± 1.37), respectively. Specifically, the highest intensity and frequency was related to the factors Acknowledgement, power and professional identity and Work teams, while the lowest was related to the factor Defense of values and rights. Conclusion: Moral distress occurs in precarious work environments, with little expressiveness of the nurses’ role. One highlights the importance of the problem in terms of its amplitude and multicausality, reaching professionals acting in different work contexts.

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Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses

American Journal of Critical Care ◽

10.4037/ajcc2018252 ◽

2018 ◽

Vol 27 (4) ◽

pp. 295-302 ◽

Cited By ~ 15

Author(s):

Krista Wolcott Altaker ◽

Jill Howie-Esquivel ◽

Janine K. Cataldo

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Ethical Climate ◽

Moral Distress ◽

Care Delivery ◽

National Database ◽

Palliative Care Teams ◽

Intensive Care Unit Nurses ◽

Distress Scale

Background Intensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance. Objectives To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. Methods Intensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale–Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed. Results Of 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor’s degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r = −0.145; P = .02) and ethical climate scores (r = −0.354; P < .001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores. Conclusions Poor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress. The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.

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Moral Distress Scale--Modified

PsycTESTS Dataset ◽

10.1037/t37283-000 ◽

2007 ◽

Author(s):

Patti Rager Zuzelo

Keyword(s):

Moral Distress ◽

Distress Scale

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Moral Distress Scale for Psychiatric Nurses

PsycTESTS Dataset ◽

10.1037/t44063-000 ◽

2010 ◽

Author(s):

Kayoko Ohnishi ◽

Yasuko Ohgushi ◽

Masataka Nakano ◽

Hirohide Fujii ◽

Hiromi Tanaka ◽

...

Keyword(s):

Moral Distress ◽

Psychiatric Nurses ◽

Distress Scale

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Moral Distress of Staff Nurses in a Medical Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2005.14.6.523 ◽

2005 ◽

Vol 14 (6) ◽

pp. 523-530 ◽

Cited By ~ 257

Author(s):

Ellen H. Elpern ◽

Barbara Covert ◽

Ruth Kleinpell

Keyword(s):

Job Satisfaction ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Moral Distress ◽

Medical Intensive Care Unit ◽

Well Being ◽

Individual Characteristics ◽

Medical Intensive Care ◽

Distress Scale

• Background Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.• Objectives To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.• Methods A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.• Results Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.• Conclusions Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

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