scholarly journals Understanding ethical climate, moral distress, and burnout: a novel tool and a conceptual framework

2018 ◽  
Vol 27 (10) ◽  
pp. 766-770 ◽  
Author(s):  
Elizabeth Dzeng ◽  
J Randall Curtis
Keyword(s):  
Conceptual Framework ◽  
Ethical Climate ◽  
Moral Distress

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

2018 ◽  
Vol 27 (4) ◽  
pp. 295-302 ◽  
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.

Moral distress and ethical climate in a Swedish nursing context: perceptions and instrument usability

2011 ◽  
Vol 20 (23-24) ◽  
pp. 3483-3493 ◽  
Author(s):  
Marit Silén ◽  
Mia Svantesson ◽  
Sofia Kjellström ◽  
Birgitta Sidenvall ◽  
Lennart Christensson
Keyword(s):  
Ethical Climate ◽  
Moral Distress

Nurses’ perceptions of and responses to morally distressing situations

2012 ◽  
Vol 19 (4) ◽  
pp. 488-500 ◽  
Author(s):  
Colleen Varcoe ◽  
Bernie Pauly ◽  
Jan Storch ◽  
Lorelei Newton ◽  
Kara Makaroff
Keyword(s):  
Ethical Climate ◽  
Moral Distress ◽  
System Level ◽  
Institutional Constraints ◽  
Limited Attention ◽  
Considerable Effort ◽  
Effect Change ◽  
Course Of Action ◽  
Nurses Perceptions ◽  
Conceptual Work

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change.

When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates

2016 ◽  
Vol 22 (1) ◽  
pp. 51-67 ◽  
Author(s):  
Giulia Lamiani ◽  
Lidia Borghi ◽  
Piergiorgio Argentero
Keyword(s):  
Ethical Climate ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Psychological Empowerment ◽  
Empirical Studies ◽  
Psychological Characteristics ◽  
Job Retention ◽  
Preventive Interventions ◽  
The Right ◽  
Do The Right Thing

Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians’ wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.

Relationship between moral distress and ethical climate with job satisfaction in nurses

2017 ◽  
Vol 26 (2) ◽  
pp. 346-356 ◽  
Author(s):  
Sharareh Asgari ◽  
Vida Shafipour ◽  
Zohreh Taraghi ◽  
Jamshid Yazdani-Charati
Keyword(s):  
Job Satisfaction ◽  
Critical Care ◽  
Social Security ◽  
Ethical Climate ◽  
Moral Distress ◽  
Correlation Study ◽  
Critical Care Nurses ◽  
Quality Of Work Life ◽  
Distress Scale ◽  
The Relationship

Background: Moral distress and ethical climate are important issues in the workplace that appear to affect people’s quality of work life. Objectives: This study was conducted to determine the relationship of moral distress and ethical climate to job satisfaction in critical care nurses. Materials and methods: This descriptive-correlation study was conducted on 142 critical care nurses, selected from five social security hospitals in north Iran through census sampling. Data were collected using a demographic questionnaire, the Moral Distress Scale–Revised, the Olson’s Hospital Ethical Climate Survey, and the Brayfield and Rothe Job Satisfaction index. Ethical considerations: The research project was approved by the Ethics Committee of Mazandaran University of Medical Sciences and the Medical Deputy of the Social Security Organization. Findings: The mean scores obtained by the critical care nurses for moral distress, ethical climate, and job satisfaction were 87.02 ± 44.56, 3.51 ± 0.53, and 62.64 ± 9.39, respectively. Although no significant relationships were observed between moral distress and job satisfaction, the relationship between ethical climate and job satisfaction was statistically significant (p < 0.05). Conclusion: Identifying ethical stressors in the workplace and giving proper feedback to the authorities to eliminate these factors and improve the ethical climate in these workplaces can help enhance job satisfaction in nurses and lead to higher quality care.

scholarly journals The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian Social Security Organization

2019 ◽  
Author(s):  
Mina Bayat ◽  
Mohsen Shahriari ◽  
Mahrokh Keshvari
Keyword(s):  
Social Security ◽  
Ethical Climate ◽  
Moral Distress ◽  
Reverse Correlation ◽  
Moral Issues ◽  
The Mean ◽  
Convenience Sampling ◽  
Spss Software ◽  
Professional Interventions ◽  
The Relationship

the present study was conducted to determine the relation between nurses’ moral distress and the ethical climate in selected hospitals of the Iranian Social Security Organization (ISSO). This descriptive-analytical correlational study was conducted in 6 hospitals under the coverage of the Iranian Social Security Organization in 2016. Three hundred nurses were selected by convenience sampling method. Data were gathered using Corley’s Standard Moral Distress and Olson’s Hospital Ethical Climate Scales. Data were analyzed using SPSS software version 19. The mean score of the nurses’ moral distress was 1.94 ± 0.66, which is considered moderate. The mean score of ethical climate was 88.97, indicating desirable ethical climate in these hospitals. The frequency score of moral distress had a unilateral reverse correlation with the total score of ethical climate as well as its dimensions, including colleagues, patients, hospitals and physicians. The score of the intensity of nurses’ moral distress also had a unilateral reverse correlation with the total score of ethical climate and the scores of the hospital and physicians dimensions. These results emphasized the importance of creating a positive ethical climate to decrease moral distress as well as the need for professional interventions to increase support in moral issues.

A study of nurses’ ethical climate perceptions

2015 ◽  
Vol 23 (3) ◽  
pp. 265-276 ◽  
Author(s):  
Anne Humphries ◽  
Martin Woods
Keyword(s):  
New Zealand ◽  
Registered Nurses ◽  
Nursing Staff ◽  
Ethical Climate ◽  
Moral Distress ◽  
Ethical Practice ◽  
Patient Throughput ◽  
Staffing Levels ◽  
Ethical Climates ◽  
The Impact

Background: Acting ethically, in accordance with professional and personal moral values, lies at the heart of nursing practice. However, contextual factors, or obstacles within the work environment, can constrain nurses in their ethical practice – hence the importance of the workplace ethical climate. Interest in nurse workplace ethical climates has snowballed in recent years because the ethical climate has emerged as a key variable in the experience of nurse moral distress. Significantly, this study appears to be the first of its kind carried out in New Zealand. Aim/objective: The purpose of this study was to explore and describe how registered nurses working on a medical ward in a New Zealand hospital perceive their workplace ethical climate. Research design/participants/context: This was a small, qualitative descriptive study. Seven registered nurses were interviewed in two focus group meetings. An inductive method of thematic data analysis was used for this research. Ethical considerations: Ethics approval for this study was granted by the New Zealand Ministry of Health’s Central Regional Health and Disability Ethics Committee on 14 June 2012. Findings: The themes identified in the data centred on three dominant elements that – together – shaped the prevailing ethical climate: staffing levels, patient throughput and the attitude of some managers towards nursing staff. Discussion: While findings from this study regarding staffing levels and the power dynamics between nurses and managers support those from other ethical climate studies, of note is the impact of patient throughput on local nurses’ ethical practice. This issue has not been singled out as having a detrimental influence on ethical climates elsewhere. Conclusion: Moral distress is inevitable in an ethical climate where the organisation’s main priorities are perceived by nursing staff to be budget and patient throughput, rather than patient safety and care.

The relationship between ethical climate and moral distress from the perspective of operating room staff: A correlational study

2021 ◽  
pp. 147775092110572
Author(s):  
Fatemeh Esmaelzadeh ◽  
Fatemeh Rajabdizavandi ◽  
Monirsadat Nematollahi
Keyword(s):  
Organizational Climate ◽  
Operating Room ◽  
Ethical Climate ◽  
Moral Distress ◽  
Medical Sciences ◽  
The Social ◽  
The Mean ◽  
Distress Scale ◽  
The Relationship ◽  
Operating Room Staff

Background The organizational climate in the operating room is special due to the specific conditions of the patient, and the ethical climate may affect moral distress of the operating room staff. Objective This study determined the relationship between ethical climate and moral distress from staff working in operating rooms of hospitals affiliated to Mashhad University of Medical Sciences. Method This analytical study was performed on 169 operating room staff in Mashhad, Iran. The operating room staff was selected using stratified random sampling. The data were collected via Olson's Hospital Ethical Climate Survey and the Corley Moral Distress Scale and analyzed with IBM Statistical Package for the Social Sciences (SPSS) software version 21. Results The results showed no relationship between the ethical climate, the frequency, and intensity of moral distress of the operating room staff ( p > 0.05). In addition, the mean score of the ethical climate was 3.32 ± 0.48, indicating the average ethical climate in the operating room. The mean frequency and intensity of moral distress were 36.36 ± 11.68 and 48.8 ± 15.92, showing a moderate rate. There was a significant inverse relationship between the dimensions of ethical climate, the relationship with physicians, and the intensity of moral distress ( p <0.05). A significant relationship was found between the intensity of moral distress, the level of education, and field of study ( p <0.05). Conclusion The results of the current study showed that interventional programs should be implemented to reduce moral distress and improve the ethical climate in the operating room.

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