Gender and the experience of moral distress in critical care nurses

2014 ◽  
Vol 22 (1) ◽  
pp. 32-42 ◽  
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.

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 Barriers and values of moral distress among critical care nurses

2016 ◽  
Author(s):  
◽  
Melissa A. Wilson
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Formal Analysis ◽  
Critical Care Nurses ◽  
Nursing Program ◽  
Review Of Literature ◽  
Effective Interventions ◽  
Doctor Of Philosophy ◽  
Distress Scale ◽  
The Impact

This dissertation explores the presence of moral distress and effective interventions to lessen its impact on critical care nurses. Manuscript one was completed prior to entering the doctor of philosophy in nursing program but was instrumental in building the foundation for successive work within this dissertation. An exploratory, descriptive designed study was used to examine moral distress and identify situations in which nurse's experienced high levels of moral distress. Nurses completed a 38-item moral distress scale, a coping questionnaire, and indicated their preferred methods for institutional support in managing distressing situations. Manuscript two includes a formal analysis of the Moral Distress Theory and identified limitations in the existing theoretical model based on a review of literature. Finally, manuscript three is a study identifying barriers and values during moral distress situations that can be used to potentially target interventions aimed at lessening the impact of moral distress.

Validation of the Greek version of the Revised Moral Distress Scale in critical care nurses

2016 ◽  
Vol 10 (2) ◽  
pp. 72-77 ◽  
Author(s):  
Stella Haikali ◽  
Maria NK Karanikola ◽  
Giannakopoulou Margarita ◽  
Mpouzika DA Meropi ◽  
Chrysoula Lemonidou ◽  
...  
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Critical Care Nurses ◽  
Greek Version ◽  
Distress Scale

Predictors of Moral Distress in a US Sample of Critical Care Nurses

2018 ◽  
Vol 27 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Catherine A. Hiler ◽  
Ronald L. Hickman ◽  
Andrew P. Reimer ◽  
Kimberly Wilson
Keyword(s):  
Job Satisfaction ◽  
Critical Care ◽  
Patient Safety ◽  
Moral Distress ◽  
Organizational Factors ◽  
National Sample ◽  
Critical Care Nurses ◽  
Practice Environment ◽  
Bivariate Correlation ◽  
Distress Scale

BackgroundMoral distress in registered nurses causes decreased job satisfaction, turnover in staffing, burnout, and heightened states of psychological distress. To date, investigation of modifiable factors, such as perceptions of the practice environment and patient safety, among a diverse sample of critical care nurses has been limited.ObjectiveTo explore the relationships among the severity of moral distress, the practice environment, and patient safety in a national sample of critical care nurses.MethodsCritical care nurses experienced in working with adults (&gt; 1 year of intensive care unit experience) and who were subscribers to the American Association of Critical-Care Nurses’ e-mail listserv and social media sites anonymously participated in this descriptive study. Participants completed a demographic questionnaire, the Moral Distress Scale–Revised, and the Practice Environment Scale of the Nursing Work Index. Descriptive statistics, bivariate correlation coefficients, and a hierarchical regression analysis were used to describe the sample characteristics and to assess relationships among the study variables.ResultsOf a national sample of 328 critical care nurses, 56% had less than 20 years of experience as a registered nurse. Moral distress was modestly associated with negative perceptions of the practice environment and patient safety. Job satisfaction, practice environment, and the participant’s age were statistically significant predictors of moral distress in this sample.ConclusionsModifications of organizational factors such as the development of healthy work environments that promote collegial relationships could reduce moral distress among critical care nurses.

CNE Article: Moral Distress and Psychological Empowerment in Critical Care Nurses Caring for Adults at end of Life

2013 ◽  
Vol 22 (2) ◽  
pp. 143-151 ◽  
Author(s):  
Annette M. Browning
Keyword(s):  
Critical Care ◽  
Regression Analysis ◽  
End Of Life ◽  
End Of Life Care ◽  
Moral Distress ◽  
Psychological Empowerment ◽  
Significant Negative Correlation ◽  
Critical Care Nurses ◽  
Life Care ◽  
Distress Scale

BackgroundCritical care nurses providing care for adults at the end of life may encounter moral distress when they cannot do what they believe is ethically correct. Psychological empowerment can decrease moral distress among critical care nurses.ObjectivesTo describe the relationships between moral distress, psychological empowerment, and demographics in critical care nurses caring for patients at the end of life.MethodA total of 277 critical care nurses were surveyed via the Moral Distress Scale and the Psychological Empowerment Instrument. Responses were scored on a Likert scale of 1 to 7.ResultsMoral distress intensity was high (mean 5.34, SD 1.32) and positively correlated with age (r = 0.179, P = .01). Moral distress frequency was moderate (mean 2.51, SD 0.87) and negatively correlated with nurses’ collaboration in end-of-life patient care conferences (r = −0.191, P = .007). Psychological empowerment scores (mean 5.31, SD 1.00) were high and positively correlated with age (r = 0.139, P = .03), years of experience (r = 0.165, P = .01), collaboration in end-of-life-care conferences (r = 0.163, P = .01), and end-of-life-care education (r = 0.221, P = .001) and were negatively correlated with moral distress frequency (r = −0.194, P = .01). Multiple regression analysis revealed that empowerment was a significant predictor of moral distress frequency (â = .222, P &lt; .01).ConclusionThe significant negative correlation between psychological empowerment and frequency of moral distress in these nurses indicated that nurses with higher perceived empowerment experience moral distress less often. This finding is of particular interest as interventions to decrease moral distress are sought. (American Journal of Critical Care. 2013;22:143–152)

scholarly journals Exploring the Presence of Moral Distress in Critical Care Nurses

2016 ◽  
Author(s):  
Justina Gonzalez
Keyword(s):  
Critical Care ◽  
Ethical Climate ◽  
Moral Distress ◽  
Small Sample ◽  
Critical Care Nurses ◽  
Small Community ◽  
Convenience Sample ◽  
Difficult Situation ◽  
Frequent Event ◽  
Distress Scale

<p>With healthcare moving toward greater outpatient and preventative approaches, hospitalizations are increasingly intended for those who are critically ill. Frequently this requires the need for highly specialized nursing as well as resource utilization. Technological advances have aided in providing this type of intensive care but they have also compelled practitioners to make treatment decisions that did not previously exist. The conflict of maintaining one’s life without ascertaining whether there will be quality of life is just one example of a difficult situation that can lead to moral distress. The purpose of this study was to explore the effects of moral distress on critical care nurses. The project employed a survey design. After obtaining IRB approval, a convenience sample of 28 nurses was obtained from a small community hospital’s ICU and CCU. Each participant completed the Moral Distress Scale-Revised (MDS-R) measure and some demographic questions. Results confirmed that moral distress was present among the participants at low to moderate levels: 18 nurses (64%) scored low with seven nurses (25%) scoring in the moderate range. The most morally distressing experiences were related to end of life care. The most morally distressing and frequent event was that of “follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient”. There was no correlation between nurses’ age, level of experience and moral distress. Limitations included a small sample size and lack of diversity in age and experience. It is possible that the researcher’s affiliation with the unit could have affected participants’ responses regarding leaving their current position. The findings suggest that more research should be done on exploring the ethical climate and other factors that effect moral distress.</p>

Critical Care Nurses’ Perceptions of Futile Care and Its Effect on Burnout

2004 ◽  
Vol 13 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Lilia Susana Meltzer ◽  
Loucine Missak Huckabay
Keyword(s):  
Critical Care ◽  
Emotional Exhaustion ◽  
Moral Distress ◽  
Maslach Burnout Inventory ◽  
Critical Care Nurses ◽  
Full Time ◽  
Care Experience ◽  
Futile Care ◽  
Nurses Perceptions ◽  
Distress Scale

• Background Nurses’ perceptions of futile care may lead to emotional exhaustion. • Objectives To determine the relationship between critical care nurses’ perceptions of futile care and its effect on burnout. • Methods A descriptive survey design was used with 60 critical care nurses who worked full-time and had a minimum of 1 year of critical care experience at the 2 participating hospitals (350–470 beds). Subjects completed a survey on demographics, the Moral Distress Scale, and the Maslach Burnout Inventory. Six research questions were tested. The results of the following question are presented: Is there a relationship between frequency of moral distress situations involving futile care and emotional exhaustion? • Results A Pearson product moment correlational analysis indicated a significant positive correlation between the score on the emotional exhaustion subscale of the Maslach Burnout Inventory and the score on the frequency subscale of the Moral Distress Scale. Moral distress accounted for 10% of the variance in emotional exhaustion. Demographic variables of age, education, religion, and rotation between the critical care units were significantly related to the major variables. • Conclusions In critical care nurses, the frequency of moral distress situations that are perceived as futile or nonbeneficial to their patients has a significant relationship to the experience of emotional exhaustion, a main component of burnout.

scholarly journals Moral distress and avoidance behavior in nurses working in critical care and noncritical care units

2012 ◽  
Vol 20 (5) ◽  
pp. 589-603 ◽  
Author(s):  
Mary Jo De Villers ◽  
Holli A DeVon
Keyword(s):  
Critical Care ◽  
Avoidance Behavior ◽  
Moral Distress ◽  
Cross Sectional Study ◽  
Critical Care Nurses ◽  
Cross Sectional ◽  
Impact Of Event Scale ◽  
Event Scale ◽  
Avoidance Behaviors ◽  
Distress Scale

Nurses facing impediments to what they perceive as moral practice may experience moral distress. The purpose of this descriptive, cross-sectional study was to determine similarities and differences in moral distress and avoidance behavior between critical care nurses and non-critical care nurses. Sixty-eight critical care and 28 non-critical care nurses completed the Moral Distress Scale and Impact of Event Scale (IES). There were no differences in moral distress scores ( F = 0.892, p = 0.347) or impact of event scores ( F = 3.80, p = 0.054) between groups after adjusting for age. There was a small positive correlation between moral distress and avoidance behaviors for both the groups. Moral distress is present in both critical care and noncritical care nurses. It is important that nurses are provided with opportunities to cope with this distress and that retention strategies include ways to reduce suffering and mitigate the effects on professional practice.

Moral Distress of Staff Nurses in a Medical Intensive Care Unit

2005 ◽  
Vol 14 (6) ◽  
pp. 523-530 ◽  
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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