Moral Distress in Critical Care Nurses: A Qualitative Study

BackgroundHealth care professionals find themselves participating in insignificant events in human existence such as birth, pain, and death which is a privilege but also poses challenges as this participation involves decisions that can be life-changing and having an effect on everyone involved. The study aimed to explore moral distress within the context of Saudi Arabia.MethodologyA simple qualitative design was used with a research paradigm of constructivism. Data collection included in-depth interviews with five critical care nurses who were purposively sampled. The setting for the study was the critical care units at King Abdul- Aziz Medical City- Jeddah. Data analysis included content analysis. Principles of academic rigor were followed.FindingsTwo themes emerged from this study with various subthemes. Theme 1: Turning away from nursing obligations: hands are tied, the burden of workload, no voice, not honoring oath; Theme 2: Bad practice: hierarchy in practice and feeling guilty.ConclusionsThis study highlights that moral distress within critical care units is a real problem that impacts on critical care nurses' physical and psychological stress. Health care institutions should mobilize resources to reduce these effects on critical care nurses and other health care professionals.

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Resilience as an Incomplete Strategy for Coping With Moral Distress in Critical Care Nurses

Critical Care Nurse ◽

10.4037/ccn2020873 ◽

2020 ◽

Vol 40 (6) ◽

pp. 62-66

Author(s):

Lucia D. Wocial

Keyword(s):

Health Care ◽

Critical Care ◽

Clinical Relevance ◽

Moral Distress ◽

Critical Care Nurses ◽

Negative Consequences ◽

Important Quality

Topic Moral distress is receiving increasing attention in health care. The theoretical value of resilience as a strategy for coping with moral distress is prominent in the literature. Clinical Relevance The potential negative consequences of moral distress for nurses are indisputable, driving a push to identify interventions to help nurses deal with the experience. The evidence that resilience is an important quality and skill for maintaining wellness is equally clear. Purpose To review moral distress and resilience and examine the evidence for the new focus on resilience. Content Covered The complexity of both moral distress and resilience suggests that resilience by itself is an incomplete strategy for coping with and addressing moral distress.

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Peer Review #1 of "Mucoactive agent use in adult UK Critical Care Units: a survey of health care professionals’ perception, pharmacists’ description of practice, and point prevalence of mucoactive use in invasively mechanically ventilated patients (v0.1)"

10.7287/peerj.8828v0.1/reviews/1 ◽

2020 ◽

Keyword(s):

Health Care ◽

Critical Care ◽

Peer Review ◽

Health Care Professionals ◽

Point Prevalence ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Critical Care Units ◽

Ventilated Patients

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Quality assurance: An introduction for health care professionals The declaration of Madrid on the preparation of critical care nurses

Intensive and Critical Care Nursing ◽

10.1016/0964-3397(93)90057-5 ◽

1993 ◽

Vol 9 (2) ◽

pp. 143

Author(s):

Gill Harvey

Keyword(s):

Health Care ◽

Quality Assurance ◽

Critical Care ◽

Health Care Professionals ◽

Critical Care Nurses

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Peer Review #2 of "Mucoactive agent use in adult UK Critical Care Units: a survey of health care professionals’ perception, pharmacists’ description of practice, and point prevalence of mucoactive use in invasively mechanically ventilated patients (v0.1)"

10.7287/peerj.8828v0.1/reviews/2 ◽

2020 ◽

Author(s):

K Thomas

Keyword(s):

Health Care ◽

Critical Care ◽

Peer Review ◽

Health Care Professionals ◽

Point Prevalence ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Critical Care Units ◽

Ventilated Patients

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Describing Family Needs within Adult Critical Care Units at a Military Hospital in Jeddah, Saudi Arabia

International Journal of Studies in Nursing ◽

10.20849/ijsn.v2i2.246 ◽

2017 ◽

Vol 2 (2) ◽

pp. 44

Author(s):

Jennifer De Beer ◽

Hend Alnajjar

Keyword(s):

Saudi Arabia ◽

Critical Care ◽

Health Care Professionals ◽

Family Members ◽

Critical Care Nurses ◽

Military Hospital ◽

Family Needs ◽

Loved One ◽

Critical Care Units ◽

Important Family

Background: Family members have traumatic experiences when a loved one is admitted into critical care units as they are not psychological prepared for the sudden illness of a loved one. Attending to the needs of family members of critically ill patients is vital in providing appropriate holistic care for both the patient and the family.Methods: A cross sectional descriptive quantitative research design was used. The study was conducted in a military hospital in Jeddah, Saudi Arabia, within 10 critical care units. A total of 25 doctors, 66 critical care nurses and 38 family members were included in the study. Data was collected using the Critical Care Family Needs Inventory (CCFNI), a Likert tool developed by Jane Leske which has established reliability of 0.80-0.97.Findings: The most important need as perceived by doctors was “the “need to know the expected outcome’ regarding the patient’s condition, M= 3.72 (SD = 0.54), while critical care nurses’ perceived the most important family need as “To have explanations of the environment before going into the critical care unit for the first time, M= 3.65 (SD= 0.54). Further to this, family members’ perceived “To be assured that the best care possible is being given to the patient” as the most important family need M= 3.76 (SD= 0.54).Conclusion: Health care professionals have a responsibility towards meeting these needs in order to provide care that is holistic in nature that encompasses the basic tenets of patient-family centered care.

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Embodied Spatial Practices and the Power to Care

The Oxford Handbook of the Sociology of Body and Embodiment ◽

10.1093/oxfordhb/9780190842475.013.28 ◽

2019 ◽

pp. 360-377

Author(s):

Elise Paradis ◽

Warren Mark Liew ◽

Myles Leslie

Keyword(s):

Health Care ◽

Critical Care ◽

Health Care Delivery ◽

Care Delivery ◽

Ethnographic Study ◽

Spatial Practices ◽

Critical Care Units ◽

Interprofessional Care ◽

The Social

Drawing on an ethnographic study of teamwork in critical care units (CCUs), this chapter applies Henri Lefebvre’s ([1974] 1991) theoretical insights to an analysis of clinicians’ and patients’ embodied spatial practices. Lefebvre’s triadic framework of conceived, lived, and perceived spaces draws attention to the role of bodies in the production and negotiation of power relations among nurses, physicians, and patients within the CCU. Three ethnographic vignettes—“The Fight,” “The Parade,” and “The Plan”—explore how embodied spatial practices underlie the complexities of health care delivery, making visible the hidden narratives of conformity and resistance that characterize interprofessional care hierarchies. The social orderings of bodies in space are consequential: seeing them is the first step in redressing them.

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Hidden Tales of Ebola: Airing the Forgotten Voices of Ugandan “Ebola Nurses”

Journal of Transcultural Nursing ◽

10.1177/10436596211017968 ◽

2021 ◽

pp. 104365962110179

Author(s):

Isaac Okello Wonyima ◽

Susan Fowler-Kerry ◽

Grace Nambozi ◽

Charlotte Barry ◽

Jeanie Wills ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Access To Treatment ◽

Care Workers ◽

Free Health Care ◽

Control And Prevention ◽

Holistic Practice ◽

Phenomenological Design ◽

Depth Interviews ◽

Current Reality

Introduction According to the Centers for Disease Control and Prevention, Ebola has affected the lives of thousands, including health care workers. With few studies describing the experience of nurses who survived Ebola, the study aimed to describe Ugandan nurses’ experiences. Method Using a phenomenological design, in-depth interviews were conducted among five Ugandan nurses who contracted Ebola and survived. Result Thematic analysis revealed themes of expectations of dying, hopelessness, loneliness, and betrayal by family, community, and the health system. Discussion Results support the need for policies targeting holistic practice protocols to protect all health care professionals during future outbreaks. Last, nursing survivors should have access to government-guaranteed support programs, including free health care and financial stipends. These results and recommendations transcend to the current reality of living with COVID-19 (coronavirus disease 2019). Efficient practice protocols could protect all rights and privileges and contribute to access to treatment and stigma removal.

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Gender and the experience of moral distress in critical care nurses

Nursing Ethics ◽

10.1177/0969733013513216 ◽

2014 ◽

Vol 22 (1) ◽

pp. 32-42 ◽

Cited By ~ 31

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.

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Critical Care Nurses’ Physical and Mental Health, Worksite Wellness Support, and Medical Errors

American Journal of Critical Care ◽

10.4037/ajcc2021301 ◽

2021 ◽

Vol 30 (3) ◽

pp. 176-184

Author(s):

Bernadette Mazurek Melnyk ◽

Alai Tan ◽

Andreanna Pavan Hsieh ◽

Kate Gawlik ◽

Cynthia Arslanian-Engoren ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Critical Care ◽

Physical Health ◽

Medical Errors ◽

Odds Ratio ◽

Care Quality ◽

Critical Care Nurses ◽

Worksite Wellness ◽

Physical And Mental Health

Background Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses’ overall health affects the occurrence of medical errors. Objective To examine the associations among critical care nurses’ physical and mental health, perception of workplace wellness support, and self-reported medical errors. Methods This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors. Results A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%). Conclusion Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.

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