scholarly journals What is ‘moral distress’ in nursing? A feminist empirical bioethics study

2019 ◽  
Vol 27 (5) ◽  
pp. 1297-1314 ◽  
Author(s):  
Georgina Morley ◽  
Caroline Bradbury-Jones ◽  
Jonathan Ives
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Psychological Distress ◽  
Moral Distress ◽  
Real Life ◽  
Moral Dilemmas ◽  
Critical Care Nurses ◽  
Moral Uncertainty ◽  
The United Kingdom ◽  
Conceptual Clarity

Background The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim To explore the concept of moral distress in nursing both empirically and conceptually. Methodology Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis. Ethical considerations The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom. Findings The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas. Discussion We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress. Conclusion The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’.

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.

scholarly journals Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique

2018 ◽  
Vol 20 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Paul Twose ◽  
Una Jones ◽  
Gareth Cornell
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Clinical Practice ◽  
Delphi Technique ◽  
Minimum Standard ◽  
Knowledge And Skills ◽  
Critical Care Units ◽  
Modified Delphi ◽  
The United Kingdom ◽  
Modified Delphi Technique

Introduction Across the United Kingdom, physiotherapy for critical care patients is provided 24 h a day, 7 days per week. There is a national drive to standardise the knowledge and skills of physiotherapists which will support training and reduce variability in clinical practice. Methods A modified Delphi technique using a questionnaire was used. The questionnaire, originally containing 214 items, was completed over three rounds. Items with no consensus were included in later rounds along with any additional items suggested. Results In all, 114 physiotherapists from across the United Kingdom participated in the first round, with 102 and 92 completing rounds 2 and 3, respectively. In total, 224 items were included: 107 were deemed essential as a minimum standard of clinical practice; 83 were not essential and consensus was not reached for 34 items. Analysis/Conclusion This study identified 107 items of knowledge and skills that are essential as a minimum standard for clinical practice by physiotherapists working in United Kingdom critical care units.

scholarly journals Heterogeneous Mental Health Development During the COVID-19 Pandemic in the United Kingdom

2021 ◽  
Author(s):  
Lea Ellwardt ◽  
Patrick Praeg
Keyword(s):  
United Kingdom ◽  
Psychological Distress ◽  
Latent Class ◽  
Mitigation Measures ◽  
Social Lives ◽  
The United Kingdom ◽  
Policy Measures ◽  
Nationally Representative ◽  
The Uk

Aim. The COVID-19 pandemic and the mitigation measures by governments have upended the economic and social lives of many, leading to widespread psychological distress. However, how distress developed during the pandemic and who was most affected is poorly understood. We explore heterogeneity in trajectories of psychological distress during the first six months of the pandemic in the United Kingdom and relate this heterogeneity to socio-demographic and health factors. Subjects and Methods. We analyze six waves of longitudinal, nationally representative survey data from the UK Household Longitudinal Study (N = 15,218), covering the first lockdown in 2020. First, latent class mixture modelling (LCCM) is used to identify trajectories of psychological distress. Second, associations of the trajectories with covariates are tested with multinomial logistic regressions. Results. We find four different trajectories of distress: continuously low, continuously moderate, temporarily elevated, and continuously elevated distress. One-fifth of the population experienced severely elevated risks of distress. Long-term exposure was highest among younger people, women, those who lost income, and those with previous health conditions or COVID-19 symptoms. Conclusion. Given the threat of persistent stress on health, policy measures should be sensitized to the unintended yet far-reaching consequences of non-pharmaceutical interventions.

Moral distress of critical care nurses

1995 ◽  
Vol 4 (4) ◽  
pp. 280-285 ◽  
Author(s):  
MC Corley
Keyword(s):  
Factor Analysis ◽  
Critical Care ◽  
Intensive Care ◽  
Private Hospital ◽  
Moral Distress ◽  
Medical Center ◽  
Critical Care Nurses ◽  
Moral Integrity ◽  
Healthcare Organizations ◽  
Aggressive Care

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

scholarly journals What is ‘moral distress’? A narrative synthesis of the literature

2017 ◽  
Vol 26 (3) ◽  
pp. 646-662 ◽  
Author(s):  
Georgina Morley ◽  
Jonathan Ives ◽  
Caroline Bradbury-Jones ◽  
Fiona Irvine
Keyword(s):  
Moral Distress ◽  
Causal Relation ◽  
Sufficient Conditions ◽  
Moral Dilemmas ◽  
Moral Judgement ◽  
Necessary And Sufficient Conditions ◽  
Narrative Synthesis ◽  
Moral Integrity ◽  
Conceptual Clarity ◽  
Necessary And Sufficient

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress.

scholarly journals The United Kingdom Critical Care Trials Forum

2010 ◽  
Vol 11 (1) ◽  
pp. 73-76
Author(s):  
Iain Mackenzie ◽  
Gavin Perkins ◽  
Julian Bion ◽  
Fang Gao
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
The United Kingdom

PTU-102 Critical Care Nutrition in the United Kingdom – A Survey of Current Practice

Gut ◽  
2016 ◽  
Vol 65 (Suppl 1) ◽  
pp. A105.1-A105
Author(s):  
M FitzPatrick ◽  
MA Stroud ◽  
A De Silva
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Current Practice ◽  
The United Kingdom

The Need for an Effective Process to Resolve Conflicts Over Medical Futility: A Case Study and Analysis

2016 ◽  
Vol 36 (6) ◽  
pp. 13-23 ◽  
Author(s):  
Jocelyn A. Olmstead ◽  
Michael D. Dahnke
Keyword(s):  
Critical Care ◽  
Policy Development ◽  
Moral Distress ◽  
Medical Model ◽  
Medical Futility ◽  
Critical Care Nurses ◽  
Practice Nurses ◽  
Court Proceedings ◽  
Court Intervention ◽  
The Right

The issue of medical futility requires a well-defined process in which both sides of the dispute can be heard and a resolution reached in a fair and ethical manner. Procedural approaches to medical futility cases provide all parties involved with a process-driven framework for resolving these disputes. Medical paternalism or the belief in the absolute rightness of the medical model will not serve to resolve these disputes. Although medical futility is first determined by medicine, in order for the determination to meet legal criteria, it must be subject to review. The hope is that through a review process that meets legal criteria, the issue can be resolved without the need for court proceedings. If resolution cannot be obtained through this process, surrogates still have the right to seek court intervention. This issue is of relevance and importance in critical care nursing because of the role and position of critical care nurses, who have direct contact with patients and patients’ families, the potential for moral distress in cases of possibly futile treatment, and the expanding roles of nurses, including critical care nurses and advanced practice nurses, in management and policy development.

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