scholarly journals A survey of moral distress in staff working in intensive care in the UK

2018 ◽  
Vol 20 (3) ◽  
pp. 196-203 ◽  
Author(s):  
GA Colville ◽  
D Dawson ◽  
S Rabinthiran ◽  
Z Chaudry-Daley ◽  
L Perkins-Porras
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Female Gender ◽  
Intention To Leave ◽  
Post Traumatic Stress ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Work Related ◽  
Distress Scale

Elevated rates of burnout and post-traumatic stress have been found in staff working in critical care settings, but the aspect of moral distress has been harder to quantify until a recent revision of a scale previously designed for nurses, was adapted for use with a range of health professionals, including physicians. In this cross-sectional survey, n = 171 nurses and physicians working in intensive care in the United Kingdom completed the Moral Distress Scale-Revised in relation to their experiences at work. Mean (SD) Moral Distress Scale-Revised score was 70.2 (39.6). Significant associations were found with female gender (female 74.1 (40.2) vs. male 55.5 (33.8), p = 0.010); depression ( r = 0.165, p = 0.035) and with intention to leave job (considering leaving 85.5 (42.4) vs. not considering leaving 67.2 (38.6), p = 0.040). These results highlight the importance of considering the moral impact of work-related issues when addressing staff wellbeing in critical care settings.

Psychological impact of working in paediatric intensive care. A UK-wide prevalence study

2019 ◽  
Vol 105 (5) ◽  
pp. 470-475 ◽  
Author(s):  
Gareth A L Jones ◽  
Gillian A Colville ◽  
Padmanabhan Ramnarayan ◽  
Kerry Woolfall ◽  
Yvonne Heward ◽  
...  
Keyword(s):  
Intensive Care ◽  
Moral Distress ◽  
Psychological Impact ◽  
Maslach Burnout Inventory ◽  
Paediatric Intensive Care ◽  
Junior Doctors ◽  
Post Traumatic Stress ◽  
Work Related ◽  
Transport Services ◽  
Distress Scale

ObjectiveTo determine the prevalence of work-related psychological distress in staff working in UK paediatric intensive care units (PICU).DesignOnline (Qualtrics) staff questionnaire, conducted April to May 2018.SettingStaff working in 29 PICUs and 10 PICU transport services were invited to participate.Participants1656 staff completed the survey: 1194 nurses, 270 physicians and 192 others. 234 (14%) respondents were male. Median age was 35 (IQR 28–44).Main outcome measuresThe Moral Distress Scale-Revised (MDS-R) was used to look at moral distress, the abbreviated Maslach Burnout Inventory to examine the depersonalisation and emotional exhaustion domains of burnout, and the Trauma Screening Questionnaire (TSQ) to assess risk of post-traumatic stress disorder (PTSD).Results435/1194 (36%) nurses, 48/270 (18%) physicians and 19/192 (10%) other staff scored above the study threshold for moral distress (≥90 on MDS-R) (χ2 test, p<0.00001). 594/1194 (50%) nurses, 99/270 (37%) physicians and 86/192 (45%) other staff had high burnout scores (χ2 test, p=0.0004). 366/1194 (31%) nurses, 42/270 (16%) physicians and 21/192 (11%) other staff scored at risk for PTSD (χ2 test, p<0.00001). Junior nurses were at highest risk of moral distress and PTSD, and junior doctors of burnout. Larger unit size was associated with higher MDS-R, burnout and TSQ scores.ConclusionsThese results suggest that UK PICU staff are experiencing work-related distress. Further studies are needed to understand causation and to develop strategies for prevention and treatment.

scholarly journals Work-related stress: the impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051326
Author(s):  
Janice Rattray ◽  
Louise McCallum ◽  
Alastair Hull ◽  
Pam Ramsay ◽  
Lisa Salisbury ◽  
...  
Keyword(s):  
Critical Care ◽  
Mixed Methods ◽  
Phase 1 ◽  
Mixed Methods Study ◽  
Burnout Syndrome ◽  
Post Traumatic Stress ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Work Related ◽  
The Impact

IntroductionWe need to understand the impact of COVID-19 on critical care nurses (CCNs) and redeployed nurses and National Health Service (NHS) organisations.Methods and analysisThis is a mixed-methods study (QUANT-QUAL), underpinned by a theoretical model of occupational stress, the Job Demand-Resources Model (JD-R). Participants are critical care and redeployed nurses from Scottish and three large English units.Phase 1 is a cross-sectional survey in part replicating a pre-COVID-19 study and results will be compared with this data. Linear and logistic regression analysis will examine the relationship between antecedent, demographic and professional variables on health impairment (burnout syndrome, mental health, post-traumatic stress symptoms), motivation (work engagement, commitment) and organisational outcomes (intention to remain in critical care nursing and quality of care). We will also assess the usefulness of a range of resources provided by the NHS and professional organisations.To allow in-depth exploration of individual experiences, phase 2 will be one-to-one semistructured interviews with 25 CCNs and 10 redeployed nurses. The JD-R model will provide the initial coding framework to which the interview data will be mapped. The remaining content will be analysed inductively to identify and chart content that is not captured by the model. In this way, the adequacy of the JD-R model is examined robustly and its expression in this context will be detailed.Ethics and disseminationEthics approval was granted from the University of Aberdeen CERB2020101993. We plan to disseminate findings at stakeholder events, publish in peer-reviewed journals and at present at national and international conferences.

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.

Moral distress and intention to leave intensive care units: A correlational study

2020 ◽  
pp. 147775092097709
Author(s):  
Abbas Naboureh ◽  
Masoomeh Imanipour ◽  
Tahmine Salehi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Pearson Correlation ◽  
Intention To Leave ◽  
Critical Care Nurses ◽  
Self Report ◽  
Correlational Study ◽  
Negative Consequences ◽  
High Exposure

Moral distress is a fundamental problem in the nursing profession that affects nurses. Critical care nurses are more susceptible to this problem due to the nature of their work. Moral distress may, in turn, lead to several undesirable consequences. This study aimed to determine the relationship between moral distress and intention to leave the ward among critical care nurses. This descriptive-correlational study was conducted by census method on all eligible nurses who worked in Coronary Care Unit (CCU) and Intensive Care Unit (ICU) of AhVaz hospitals, Iran. Data was collected by Corley’s moral distress questionnaire and a researcher-made questionnaire to investigate the intention to leave the ward. Questionnaires were completed through self-report and data were analyzed using a t-test and Pearson correlation coefficient. The results showed that there was a direct association between moral distress and intension to leave the ward in critical care nurses (P < 0.05). Also, the intensity of moral distress (P = 0.03) and the intention to leave the ward (P = 0.007) were significantly higher in ICU nurses. Given the high exposure of critical care nurses with moral distress and its association with leaving the ward, it seems that devising strategies to reduce or control moral distress and its negative consequences are necessary, particularly in ICU nurses.

Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study

2017 ◽  
Vol 34 (4) ◽  
pp. 311-322 ◽  
Author(s):  
Amir Vahedian-Azimi ◽  
Mohammadreza Hajiesmaeili ◽  
Mari Kangasniemi ◽  
Joana Fornés-Vives ◽  
Rita L. Hunsucker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Peer Collaboration ◽  
Burnout Syndrome ◽  
Survey Method ◽  
Post Traumatic Stress ◽  
Cross Sectional ◽  
Stress Levels

Background: Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future. Methods: We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey. Results: We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse–patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels. Conclusion: As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

scholarly journals Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study

2021 ◽  
pp. bmjqs-2020-012239
Author(s):  
Niek Kok ◽  
Jelle Van Gurp ◽  
Johannes G van der Hoeven ◽  
Malaika Fuchs ◽  
Cornelia Hoedemaekers ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emotional Exhaustion ◽  
Moral Distress ◽  
Maslach Burnout Inventory ◽  
Personal Accomplishment ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Root Cause ◽  
Distress Scale

BackgroundBurnout threatens intensive care unit (ICU) professionals’ capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work–life balance and culture. This study aimed to disentangle the associations of ICU professionals’ moral distress and other risk factors with the components of burnout—emotional exhaustion, depersonalisation and personal accomplishment—suggesting informed burnout prevention strategies.MethodsCross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work–home balance (Survey Work–Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out.Results251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27).ConclusionsUnderstanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work–home imbalance. Interventions that support individual coping with moral distress and a work–home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.

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