Ethical climate and moral distress in paediatric oncology nursing

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

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Important situations that capture moral distress in paediatric oncology

BMC Medical Ethics ◽

10.1186/s12910-020-0447-x ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Margareta af Sandeberg ◽

Cecilia Bartholdson ◽

Pernilla Pergert

Keyword(s):

Internal Consistency ◽

Moral Distress ◽

Paediatric Oncology ◽

Nursing Assistants ◽

Ethical Review ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Professional Groups ◽

Good Internal Consistency ◽

Distress Scale

Abstract Background The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents’ unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology. Methods In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach’s alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. Results Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22–25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21. Conclusion In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.

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Moral distress in paediatric oncology: Contributing factors and group differences

Nursing Ethics ◽

10.1177/0969733018809806 ◽

2018 ◽

Vol 26 (7-8) ◽

pp. 2351-2363 ◽

Cited By ~ 3

Author(s):

Pernilla Pergert ◽

Cecilia Bartholdson ◽

Klas Blomgren ◽

Margareta af Sandeberg

Keyword(s):

Healthcare Professionals ◽

Moral Distress ◽

Ethical Issues ◽

Paediatric Oncology ◽

National Study ◽

Ethical Review ◽

Contributing Factors ◽

High Turnover ◽

Scale Scores ◽

Distress Scale

Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care.

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The relationships between moral distress and quality of nursing care in oncology nurses

The Journal of Korean Academic Society of Nursing Education ◽

10.5977/jkasne.2020.26.4.366 ◽

2020 ◽

Vol 26 (4) ◽

pp. 366-373

Author(s):

Sae Mi Kim ◽

Yong Soon Shin

Keyword(s):

Nursing Care ◽

Moral Distress ◽

Correlation Study ◽

Oncology Nursing ◽

Cross Sectional ◽

Factors Affecting ◽

Distress Scale ◽

The Relationship ◽

Quality Of Nursing

Purpose: The study aimed to investigate the relationship between moral distress and the quality of nursing care.Methods: This cross-sectional correlation study included nurses working at oncology nursing units of two secondary general hospitals in Seoul and Gyeonggi-do, Korea. A total of 207 nurses participated. Moral distress was measured by the Moral Distress Scale-Revised Nurse Questionnaire and quality of nursing care was evaluated by the Quality of Oncology Nursing Care Scale. Data were collected from October 5 to 31, 2018. Data analysis included descriptive statistics, independent t-test, ANOVA, Pearson’s correlation coefficient and multiple regression analysis.Results: The quality of oncology nursing care showed a negative correlation with moral distress (r=-.19, p=.007). The factors affecting the quality of oncology nursing care were religion (β=-.22, p=.001), clinical experience in oncology units (β=.27, p=.007), and moral distress (β=-.16, p=.018). Moral distress showed a statistically significant predictive power of 13% in the regression model (F=8.70, p=<.001).Conclusion: The findings of this study suggest that management of moral distress is important to increase the quality of oncology nursing care.

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Moral distress in nurses in oncology and haematology units

Nursing Ethics ◽

10.1177/0969733011416840 ◽

2012 ◽

Vol 19 (2) ◽

pp. 183-195 ◽

Cited By ~ 45

Author(s):

Michela Lazzarin ◽

Andrea Biondi ◽

Stefania Di Mauro

Keyword(s):

Moral Distress ◽

Ethical Issues ◽

Paediatric Oncology ◽

Small Scale ◽

Mean Intensity ◽

Original Language ◽

Nursing Competence ◽

Almost All ◽

Distress Scale ◽

Conventional Sample

One of the difficulties nurses experience in clinical practice in relation to ethical issues in connection with young oncology patients is moral distress. In this descriptive correlational study, the Moral Distress Scale-Paediatric Version (MDS-PV) was translated from the original language and tested on a conventional sample of nurses working in paediatric oncology and haematology wards, in six north paediatric hospitals of Italy. 13.7% of the total respondents claimed that they had changed unit or hospital due to moral distress. The items with the highest mean intensity in the sample were almost all connected with medical and nursing competence and have considerably higher values than frequency. The instrument was found to be reliable. The results confirmed the validity of the MDS-PV (Cronbach’s alpha = 0.959). This study represents the first small-scale attempt to validate MDS-PV for use in paediatric oncology-ematology nurses in Italy.

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Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review

Aquichan ◽

10.5294/aqui.2019.19.1.3 ◽

2019 ◽

Vol 19 (1) ◽

pp. 1-16 ◽

Cited By ~ 3

Author(s):

Ivonne Vargas Celis ◽

Camila Andrea Concha Méndez

Keyword(s):

Interpersonal Relationships ◽

Ethical Climate ◽

Moral Distress ◽

Ethical Issues ◽

Organizational Factors ◽

Oncology Nurses ◽

Oncology Nursing ◽

Ethical Problems ◽

Moral Agents ◽

Deliberation Process

Objective: To describe the factors that influence the emergence of moral distress in oncology nurses. Methodology: integrative review of the literature whose search will be performed in Web of Science databases, CINAHL (EBSCO), Scielo, Proquest, Pubmed and PsycInfo using the keywords moral distress and oncology nursing and their similes in Spanish, without restriction for years of publication until 2017. Results: The results of this review were grouped into three groups of factors each with subgroups: 1) Organizational factors: ethical climate, evasive culture and resources for ethics delivered by the organization. 2) Particular clinical situations: pain management, information delivery, futile treatment, and assistance to the patient and their family in the process of death, 3) Interpersonal relationships: poor communication, power relations, trust in the team’s competence. Conclusion: the three factors described are triggers of moral distress in oncology nurses. When there are ethical problems and the nurses do not participate in the deliberation process, these problems can be hidden and be normalized, which can diminish the moral sensitivity of the professionals, as well as the possibility of acting as moral agents.

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Moral distress in undergraduate nursing students

Nursing Ethics ◽

10.1177/0969733018814902 ◽

2019 ◽

Vol 26 (7-8) ◽

pp. 2325-2339 ◽

Cited By ~ 2

Author(s):

Simoní Saraiva Bordignon ◽

Valéria Lerch Lunardi ◽

Edison Luiz Devos Barlem ◽

Graziele de Lima Dalmolin ◽

Rosemary Silva da Silveira ◽

...

Keyword(s):

Nursing Students ◽

Undergraduate Students ◽

Moral Distress ◽

Intensity Level ◽

Linear Regression Models ◽

Design Data ◽

Cross Sectional ◽

Undergraduate Nursing Students ◽

Undergraduate Nursing ◽

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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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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Ethical climate in a Belgian psychiatric inpatient setting: relation with burnout and engagement in psychiatric nurses

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v1i2.685 ◽

2013 ◽

Vol 1 (2) ◽

pp. 443

Author(s):

Astrid Faelens ◽

Marleen Claeys ◽

Bernard Sabbe ◽

Didier Schrijvers ◽

Patrick Luyten

Keyword(s):

Job Satisfaction ◽

Turnover Intention ◽

Ethical Climate ◽

Ethical Issues ◽

Psychiatric Inpatient ◽

Psychiatric Nurses ◽

Inpatient Setting ◽

Cross Sectional ◽

Emotional Burden ◽

The Relationship

Research suggests a relation between the ethical climate – that is, the organisational conditions and practices that affect the way ethical issues with regard to patient care are discussed and decided - and job satisfaction of nurses. Yet no study to date has investigated the relationship between ethical climate and job satisfaction in psychiatric nurses. This study aimed to address this critical gap in our knowledge by investigating the relationships among ethical climate and features of both burnout and engagement based on the Job Demands-Resources Model (JD - R model) in a large cross-sectional study of 265 nurses working in a large psychiatric inpatient hospital in Flanders, Belgium. Correlational and multiple hierarchical regression analyses were used to investigate the relationship between ethical climate, burnout and engagement. In addition, based on the JD-R model, we also investigated whether engagement mediated the relationship between ethical climate on the one hand and job satisfaction and turnover intention on the other and whether ethical climate moderated the relationship between emotional burden and burnout. Results showed that a positive ethical climate was related to lower levels of emotional exhaustion and distancing and higher levels of engagement and job satisfaction. Furthermore, although ethical climate did not buffer against the effects of emotional burden on burnout, higher levels of engagement explained in part the relationship between ethical climate and job satisfaction.

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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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