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 ‘She Can’t Support Me Because She’s so Old’: A Mixed-Methods Study of Support Experiences and Needs in Adult Child–Parent Dyads at the End of Life

2021 ◽  
pp. 003022282110087
Author(s):  
Franziska A. Herbst ◽  
Laura Gawinski ◽  
Nils Schneider ◽  
Stephanie Stiel
Keyword(s):  
Mixed Methods ◽  
End Of Life ◽  
Family Caregivers ◽  
Adult Children ◽  
Qualitative Interviews ◽  
Terminally Ill ◽  
Adult Child ◽  
Self Report ◽  
Children And Parents ◽  
Parent Caregivers

Little is known about support experiences and needs in the dyads of (1) terminally ill adult children and their parent caregivers and (2) terminally ill parents and their adult child caregivers. The current study aimed at investigating the experiences and needs of adult children and parents in end of life situations regarding their provision and receipt of support. The study employed a convergent parallel mixed-methods design, combining explorative qualitative interviews with the quantitative self-report Berlin Social Support Scales. Sixty-five patients (dyad 1: 19; dyad 2: 46) and 42 family caregivers (dyad 1: 13; dyad 2: 29) participated in the study (02/2018–11/2019). Results show that ill adult children felt less (well) supported than ill parents. Parent caregivers were often limited in the support they could provide, due to their age and health conditions. Hypotheses were deduced from patients’ and family caregivers’ notions to inform dyad-specific recommendations for support interventions.

scholarly journals “We don’t want to sedate him” - A qualitative interview study on intentions when administering sedative drugs at the end of life in nursing homes and hospitals

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophie Meesters ◽  
Bettina Grüne ◽  
Claudia Bausewein ◽  
Eva Schildmann
Keyword(s):  
Palliative Care ◽  
Nursing Homes ◽  
End Of Life ◽  
Side Effect ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Qualitative Interview Study ◽  
The Family ◽  
Framework Approach ◽  
Sedative Drugs

Abstract Background Previous data indicate major differences between countries and settings regarding the intention when administering sedative drugs at the end of life and the perception, which drugs are sedating. Therefore, we aimed to explore the concept of ‘sedative drugs’ and the intentions of German healthcare professionals in general palliative care when administering sedative drugs at the end of life. Methods Semi-structured qualitative interviews with physicians and nurses (n = 49). Recruitment took place via contact persons in five hospital departments (haematology/oncology (n = 2), neurology, geriatrics, gynaecology) and five nursing homes. We thematically analysed the transcripts by the Framework approach, using MAXQDA version 2018.2. Results Most interviewees referred to benzodiazepines, opioids, and antipsychotics. Some subsumed all into sedative drugs, others differentiated between sedative drugs, anxiolytics, and analgesics. In explaining their intention, interviewees particularly emphasized what they want to avoid when administering sedative drugs. We identified three main themes regarding (excluded) intentions: (1) use of sedative drugs to relieve the patient’s suffering with reduction of consciousness as side effect, (2) use of sedative drugs to relieve the situation for the team and/or the family, (3) distinction between intention and expectation regarding hastening death. Interviewees often equated the term ‘sedation’ with inducing a state of unconsciousness, which should be avoided. Conclusion German healthcare professionals in general palliative care seem to negatively connote the term ‘sedation’. Moreover, they see themselves in a more passive role by accepting a side effect rather than performing an intentional act. Critical reflection of indications and intentions in accordance with respective guidelines is needed.

Processes toward the end of life and dialysis withdrawal Physicians’ and nurses’ perspectives

2019 ◽  
Vol 27 (2) ◽  
pp. 419-432
Author(s):  
Lena Axelsson ◽  
Eva Benzein ◽  
Jenny Lindberg ◽  
Carina Persson
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
End Of Life ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Qualitative Content Analysis ◽  
Family Members ◽  
Research Approach ◽  
End Stage Kidney Disease ◽  
End Stage

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.

scholarly journals Exploring Differential Perceptions and Barriers to Advance Care Planning in Dementia among Asian Patient–Caregiver Dyads—A Mixed-Methods Study

2021 ◽  
Vol 18 (13) ◽  
pp. 7150
Author(s):  
Noorhazlina Ali ◽  
Philomena Anthony ◽  
Wee Shiong Lim ◽  
Mei Sian Chong ◽  
Edward Wing Hong Poon ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Negative Impact ◽  
Qualitative Interviews ◽  
Asian Population ◽  
Cultural Factors ◽  
Mixed Methods Study ◽  
Related Factors ◽  
Advance Care ◽  
English Speaking

A parallel mixed-methods study on 20 patient–caregiver dyads in an Asian population was conducted to explore the differential perceptions and barriers to ACP in dementia. We recruited English-speaking patients with mild dementia and their caregivers. A trained ACP facilitator conducted ACP counseling. Patient–caregiver dyads completed pre–post surveys and participated in post-counseling qualitative interviews. We used mixed-methods analysis to corroborate the quantitative and qualitative data. Differential perceptions of ACP were reported among dyads, with caregivers less inclined for further ACP discussions. Post-ACP counseling, caregivers were significantly more likely to acknowledge barriers to ACP discussions than patients (57.9% versus 10.5%, p = 0.005). Thematic analysis of the interview transcripts revealed four themes around barriers to ACP: patient-related factors (transference of decision making, poor cognition and lack of understanding, and dis-inclination to plan for the future), caregiver-related factors (perceived negative impact on the patient, caregiver discomfort, and confidence in congruent decision making), socio-cultural factors (taboos, superstitions, and religious beliefs), and the inappropriate timing of discussions. In a collectivist Asian culture, socio-cultural factors pose important barriers, and a family-centric approach to initiation of ACP may be the first step towards engagement in the ACP process. For ACP in dementia to be effective for patients and caregivers, these discussions should be culturally tailored and address patient, caregiver, socio-cultural, and timing barriers.

scholarly journals A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

2020 ◽  
Vol 34 (6) ◽  
pp. 689-707
Author(s):  
Katie Greenfield ◽  
Simone Holley ◽  
Daniel E Schoth ◽  
Emily Harrop ◽  
Richard F Howard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Side Effects ◽  
End Of Life ◽  
Treatment Efficacy ◽  
Symptom Management ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Children And Young People ◽  
Treatment Side Effects

Background: Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions. Aim: To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life. Design: A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797). Data sources: The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis. Results: A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals’ attitudes, hospice care, home care, families’ symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals’ demographics, treatment side effects, specialist support, healthcare professionals’ training, health services delivery, home care). Only one study included patients’ views. Conclusion: There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients’ perspective.

scholarly journals Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study

2019 ◽  
Vol 16 (3) ◽  
pp. 499 ◽  
Author(s):  
Waleed Alluqmani ◽  
Mohammed Alotaibi ◽  
Waleed Almalki ◽  
Abdulrahman Althaqafi ◽  
Hamed Alawi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Mixed Methods ◽  
Healthcare Professionals ◽  
Diabetic Patients ◽  
Second Phase ◽  
Drug Related Problems ◽  
Related Factors ◽  
Excessive Sweating ◽  
Ramadan Fasting ◽  
Structured Education

This study aimed to identify any drug-related problems (DRPs) in diabetic patients during Ramadan fasting in Saudi Arabia. The study used a mixed-methods approach consisting of two phases and was conducted in Makkah, Saudi Arabia from December 2017 to March 2018. The first phase of the study involved qualitative semi-structured individual interviews with diabetic patients. A 13-item questionnaire was used in the second phase to further identify DRPs in the wider population. The data was mainly presented as frequencies and percentages. Inferential statistics was performed using Statistical Package for Social Sciences (SPSS) version 21 to compare relevant variables/questions using the chi-square test. Twenty patients (10 male, 10 female) attended face-to-face interviews during the first phase of the study while 95 (40 male, 55 female) completed the questionnaire in the second phase of the study. Two possible risk factors for DRPs were identified from the qualitative data: patient-related factors, including changes in their medicine intake during fasting, and healthcare professionals-related factors, including lack of advice from healthcare professionals regarding fasting. The quantitative results indicated that 52 (54%) of the 95 participants who observed fasting reported to have changed the way they were taking their medicines. Furthermore, 41% of the participants experienced general healthcare problems such as hypoglycemia, hyperglycemia, fatigue, excessive sweating, and gastrointestinal disturbances. Healthcare professionals need to educate patients who are at risk of DRPs by providing structured education and counseling.

scholarly journals Barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in infants, children and young people at end-of-life: a mixed methods systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030566 ◽  
Author(s):  
Katie Greenfield ◽  
Simone Holley ◽  
Daniel Eric Schoth ◽  
Emily Harrop ◽  
Richard Howard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Young People ◽  
End Of Life ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Synthesis Methods ◽  
Children And Young People

IntroductionThis protocol describes the objective and methods of a systematic review of barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in infants, children and young people (ICYP) at end-of-life.Methods and analysisThe Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey will be electronically searched. Reference screening of relevant articles and inquiries to researchers in the field will be undertaken. Studies will be selected if they apply qualitative, quantitative or mixed-methods designs to explore barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in ICYP at end-of-life.Articles will be screened by title and abstract by one reviewer with a second reviewer assessing 10% of the articles. Both reviewers will read and screen all remaining potentially relevant articles. For included articles, one reviewer will extract study characteristics and one will check this.Both reviewers will undertake independent quality assessments of included studies using established and appropriate checklists including The Critical Appraisal Skills Programme Qualitative Checklist; The evaluative criteria of credibility, transferability, dependability and confirmability; The Quality Assessment Tool for Quantitative Studies, and The Mixed Methods Appraisal Tool. Data synthesis methods will be decided after data extraction and assessment.Ethics and disseminationThis review will inform our understanding of symptom management in ICYP at end-of-life. The findings will be reported in a peer-reviewed journal and presented at conferences. The study raises no ethical issues.PROSPERO registration numberCRD42019124797

scholarly journals Knowledge, attitudes, and practice towards COVID-19 among multi-ethnic elderly Asian residents in Singapore: a mixed methods study

2021 ◽  
Author(s):  
A Aravindhan ◽  
ATL Gan ◽  
EPX Lee ◽  
P Gupta ◽  
R Man ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preventive Measures ◽  
Healthy Lifestyle ◽  
Qualitative Interviews ◽  
Positive Association ◽  
Population Based ◽  
Mixed Methods Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Attitudes And Practices

Introduction: We investigated knowledge, attitudes, and practice (KAP) about COVID-19 and related preventive measures in Singaporeans aged > 60 years. Methods: This was a population-based, cross-sectional, mixed-methods study (13 May 2020–9 June 2020) of participants aged >60 years. Self-reported KAP about ten COVID-19 symptoms and six government-endorsed preventive measures were evaluated. Multivariable regression models identified sociodemographic and health-related factors associated with knowledge, attitudes and practices in our sample. Associations between knowledge/attitude scores, and practice categories were determined using logistic regression. 78 participants were interviewed qualitatively about practice of additional preventive measures and data were analysed thematically. Results: Mean awareness score of the symptoms was 7.2/10. Fever (93.0%) and diarrhoea (33.5%) were the most- and least-known symptoms, respectively. Most knew all six preventive measures (90.4%), perceived them as effective (78.7%), and practiced ‘wear a mask’ (97.2%). Indians, Malays, and those in smaller housing had poorer mean knowledge of COVID-19 symptoms scores. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practicing 3/6 recommendations. A one-point increase in knowledge of and attitudes towards preventive measures score had higher odds of always practicing 3/6 and 2/6 measures, respectively. Qualitative interviews revealed use of other preventive measures, e.g. maintaining a healthy lifestyle. Conclusions: Elderly Singaporeans displayed high levels of KAP about COVID-19 and related preventive measures, with a positive association between levels of knowledge/attitude, and practice. However, important ethnic and socioeconomic disparities were evident, suggesting key vulnerabilities remain, requiring immediate attention.

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.

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