Impact of profession and wards on moral distress in a community hospital

2021 ◽  
pp. 096973302110153
Author(s):  
Karim Bayanzay ◽  
Behzad Amoozgar ◽  
Varun Kaushal ◽  
Alissa Holman ◽  
Valentina Som ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Community Hospital ◽  
Hospital Setting ◽  
Emergency Rooms ◽  
Institutional Review ◽  
Surgical Ward ◽  
The Mean ◽  
Nurses And Physicians

Background: Recently, a singular survey titled “Measure of Moral Distress—Healthcare Professionals,” which addresses shortcomings of previous instruments, has been validated. Aim: To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. Participant and research context: We distributed a self-administered, validated survey titled “Measure of Moral Distress—Healthcare Professionals” to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. Findings: A total of 101 surveys were included in the study. The mean Measure of Moral Distress—Healthcare Professionals score for all respondents was 143.0 (standard deviation = 79.8). The mean Measure of Moral Distress—Healthcare Professionals score was 1.75 greater for nurses than for physicians (92.5 vs 161.5, p < .001), and nurses were 2.52 times more likely to consider leaving their position due to moral distress (68% vs 27%). The mean Measure of Moral Distress—Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward (92.5, SD = 38.2) and highest in the telemetry ward (197.7, SD = 83.6). The intensive care unit ward had a mean Measure of Moral Distress—Healthcare Professionals score mildly greater than the emergency room. Ethical considerations: No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center’s Institutional Review Board. Discussion: This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. Conclusion: In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress—Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians.

Moral distress among healthcare professionals working in intensive care units in Spain

2021 ◽  
Author(s):  
E. Rodriguez-Ruiz ◽  
M. Campelo-Izquierdo ◽  
P.B. Veiras ◽  
M.M. Rodríguez ◽  
A. Estany-Gestal ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Healthcare Professionals ◽  
Moral Distress

scholarly journals Perception of the Futile Care and its Relationship With Moral Distress in Nurses of Intensive Care Units

2021 ◽  
Vol 31 (2) ◽  
pp. 85-92
Author(s):  
Somayeh Moaddaby ◽  
◽  
Masoomeh Adib ◽  
Sadra Ashrafi ◽  
Ehsan Kazemnezhad Leili ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Regression Model ◽  
Intensive Care Units ◽  
Work Experience ◽  
Logistic Regression Model ◽  
Moral Distress ◽  
Cross Sectional ◽  
Futile Care ◽  
The Mean

Introduction: The development of science and technology has provided more opportunities for patients to live and even receiving futile medical care or treatment with no hope of recovery. This process leads to awkward experiences and moral distress in nurses who frequently deliver with such care. Objective: This study aimed to determine the perception of futile care and its relationship with moral distress in nurses working in intensive care units Materials and Methods: This is a cross-sectional study conducted on 155 nurses working in Intensive Care Units (ICUs) employed in educational-therapeutic centers and hospitals of Guilan Province, Iran. They were selected by convenience sampling method. The study data were collected using the researcher-made questionnaire and Corley moral distress questionnaire. The obtained data were analyzed using descriptive statistics and inferential statistics the Kolmogorov-Smirnov test, nonparametric Mann-Whitney U, Kruskal-Wallis, Fisher exact and Backward logistic regression model. Results: The mean±SD age of the samples was 34.71±6.68 years; their mean±SD work experience was 10.24±5.63 years, and the mean±SD work experience in the ICU was 6.76±4.64 years. The results indicated that their mean±SD perception of futile care was 63±7, and their mean±SD moral distress was 92±54. The score of moral distress showed a low but significant and positive correlation with the legal and organizational aspects of futile care (r=0. 279, P=0.001) and the total score of perception futile care (r=0.2, P=0.012). In the multivariate analysis based on the logistic regression model of futile care, only the relationship between the legal and organizational score in care had a significant relationship with moral distress. So that by increasing one unit in the legal and organizational aspect of care, the chances of scoring above the mean of moral distress increases 1.2 times (P=0.0001, 95% CI; 1.077-1.324). Conclusion: Perhaps by familiarizing nurses with the legal and organizational nature of patient’s care, the moral distress of caring can be reduced.

scholarly journals Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1673
Author(s):  
Noemi Giannetta ◽  
Rebecca Sergi ◽  
Giulia Villa ◽  
Federico Pennestrì ◽  
Roberta Sala ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Hospital Setting ◽  
Community Setting ◽  
Cross Sectional Study ◽  
Community Settings ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ethical Approval

Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect.

scholarly journals Uses of high-flow nasal cannula on the community paediatric ward and risk factors for deterioration

2019 ◽  
Vol 25 (2) ◽  
pp. 102-106
Author(s):  
Diana De Santis ◽  
Falana Sheriff ◽  
Deborah Bester ◽  
Rabia Shahab ◽  
Carolyn Hutzal
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Community Hospital ◽  
Tertiary Care ◽  
Hospital Setting ◽  
High Flow ◽  
Inclusion Criteria ◽  
High Flow Nasal Cannula ◽  
Paediatric Ward ◽  
Respiratory Illnesses

Abstract Background High-flow nasal cannula (HFNC) is a form of noninvasive respiratory support used for paediatric acute respiratory illnesses. Past HFNC research has focused on its use in bronchiolitis and in intensive care units, but little is reported on its use in the community hospital setting. We aimed to investigate the paediatric population using HFNC, any adverse events, and risk factors for deterioration. Methods A retrospective chart review was performed on patients admitted to a community paediatric ward. Inclusion criteria were patients between 1 day and 17 years of age, admitted between September 2013 and April 2016, and treated with HFNC for at least 4 hours. Results A total of 85 children met inclusion criteria. The average age of patients in our study was 3.41 years with 39% of patients &gt;2 years of age. 46% of patients had an admitting diagnosis of bronchiolitis, 33% pneumonia, and 16% with asthma. Transfer rate to tertiary care centre paediatric intensive care unit was 18%. Patients transferred required greater FIO2 (odds ratio [OR] 1.04, P=0.018, confidence interval [CI] 1.007 to 1.082), and were 3.2 times more likely to be positive for respiratory syncytial virus (RSV) (P=0.081, CI 0.868–11.739). There were no adverse events attributed to HFNC in the population. Conclusion HFNC is being utilized in the community hospital setting for children of varied age and types of respiratory illnesses. Children requiring higher FIO2 are at risk of respiratory deterioration which may identify them earlier for transfer to tertiary care. Further research into the safety and efficacy of HFNC for different paediatric illnesses in the community is needed.

scholarly journals The effect of anger management program on perceived stress of healthcare professionals: a quasi-experimental study

2021 ◽  
Author(s):  
Rami Masa'deh ◽  
Omayma Mahmoud Masadeh ◽  
Aaliyah Momani ◽  
Samiha Jarrah ◽  
Samer Hussein Al Shabatat ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Perceived Stress ◽  
Healthcare Professionals ◽  
Management Program ◽  
Emergency Rooms ◽  
Intervention Level ◽  
Aggression Management ◽  
Stress Levels ◽  
Quasi Experimental

Background & Aim: Healthcare professionals working in Intensive Care Units and Emergency Rooms are at higher risk of violence from patients and their families compared to healthcare professionals working in other units. Healthcare professionals skilled in anger management may de-escalate the situation and stop violence from happening in the first place. This study aims to determine the effect of an aggression management program on perceived stress levels of physicians and nurses working in Intensive Care Units and Emergency Rooms. Methods & Materials: A quasi-experimental design with 158 physicians and 172 nurses recruited from nine hospitals in the three major cities in Jordan was used to assess perceived stress levels with the Arabic Version of Perceived Stress Scale (10-Items). Participants answered the questionnaires twice, before and after attending an aggression management program. Results: Results showed that female healthcare professionals had significantly higher stress levels than males (M=27.33±4.11, M=24.20±3.13; t (328) =2.11, p<0.001). Furthermore, healthcare professionals working in Emergency Rooms reported significantly higher stress levels than those working in Intensive Care Units (M=27.93±4.10, M=24.94±3.03; t (328)=2.04, p<0.001). Additionally, nurses reported significantly higher stress levels compared to physicians (M=28.17±3.92, M=25.20±3.13; t (328)=2.09, p<0.001). There was a strong significant positive relationship between increased stress levels and the number of violent attacks (r=0.73, p<0.001). Most importantly, perceived stress decreased significantly from the pre-intervention level (28.94±3.21) to the post-intervention level (24.20±3.01) (t (229) =2.03, p<0.001). Conclusion: Policymakers may need to consider offering aggression management programs for all healthcare professionals, especially those working in the Emergency Room. This program should decrease their perceived stress levels reflecting improved patient care, outcomes, and satisfaction.

Moral distress among nurses: A mixed-methods study

2021 ◽  
pp. 096973302199602
Author(s):  
Chuleeporn Prompahakul ◽  
Jessica Keim-Malpass ◽  
Virginia LeBaron ◽  
Guofen Yan ◽  
Elizabeth G Epstein
Keyword(s):  
Mixed Methods ◽  
End Of Life ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Qualitative Interviews ◽  
Tertiary Care ◽  
System Level ◽  
Institutional Review Boards ◽  
Related Factors ◽  
Institutional Review

Background: Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. Objective: This study aims to describe the experience of moral distress and related factors among Thai nurses. Design: A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated. Participants: Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand. Ethical considerations: This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151. Results: A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress. Discussion: Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored. Conclusions: Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context.

scholarly journals Analysis of Suicidal Patients Admitted to The Emergency Rooms and Their Intensive Care Requirements, A Double-Center Study in Turkey

2019 ◽  
Author(s):  
Kocamer Şimşek Betul ◽  
Kocamer Şahin Şengül
Keyword(s):  
Emergency Department ◽  
Domestic Violence ◽  
Intensive Care ◽  
Suicide Attempt ◽  
Suicide Attempts ◽  
Demographic Data ◽  
Acute Poisoning ◽  
Emergency Rooms ◽  
Family Issues ◽  
The Mean

AbstractPurposeIn the present study, the clinical and socio-demographic data of the patients who admitted to the emergency department due to suicide attempt, the duration at the emergency department, and hospitalizations are examined. Requirement of intensive care and duration of hospitalization are investigated in the patients with suicide attempt.MethodsPatients who were admitted to the emergency department of the hospitals after suicide attempts between 2015 and 2017 and earlier 2018 were included in the retrospective study. Reason for suicide, suicide modality, duration between the suicide attempt and arrival to the emergency department, suicide time, first treatment at the emergency department, hospitalization, mortality, and the levels at the intensive care unit (ICU) were retrospectively reviewed and analyzed.ResultsIn the present study, 428 patients were included. Ratio of the female to male patients was 319/109. The mean age of the patients was 29.18±10.48. Most of the patients were single. The patients were mostly unemployed. Ninety-four (22.87%) patients were diagnosed with a psychiatric disorder. Four hundred twenty-two (98.59%) of the patients were attempted suicide with drugs/toxics. One hundred ninety-seven patients (49.75%) reported domestic violence and family issues reasons for suicide. Mean duration between the time of suicide and the time to arrive to the emergency department was 100.53±91.82 minutes. One hundred thirty (30.5%) patients were transferred to ICU, and 45 (10.5%) patients were followed in clinical departments. One hundred twenty (92.3%) patients hospitalized in the first-level ICU, 4 (3%) in the second-level ICU, and 6 (4.6%) in the third-level ICU. The mean ICU stay was 2.37±1.48 days.ConclusionThe suicide attempts were prominent in acute poisoning cases. Majority of the patients stated domestic violence and family issues as a reason of suicide. They were discharged mostly from the emergency department and 10.5% of the patients were kept under surveillance in the departments. When the suicide attempts were evaluated in terms of their time, they were observed during day time at a higher rate.

scholarly journals Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series

2021 ◽  
pp. 089719002110023
Author(s):  
Matt G. McKenzie ◽  
Yeunju (Michelle) Lee ◽  
Julin Mathew ◽  
Megan Anderson ◽  
Alison T. Vo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Community Hospital ◽  
Hospital Setting ◽  
Case Series ◽  
Community Hospitals ◽  
Retrospective Case ◽  
The Mean ◽  
Present On Admission

Objective: To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19. Design: A retrospective case series Setting: Five community hospitals within 1 urban health system Patients: Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19. Interventions: None. Measurements and Main Results Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 – 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient. Conclusions: Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.

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