Distress morale e cure futili: indagine conoscitiva sulla percezione degli studenti infermieri

2016 ◽  
Vol 65 (5) ◽  
Author(s):  
Simone Conoci ◽  
Elena Cristofori ◽  
Caterina Galletti

Gli operatori sanitari, nell’esercizio professionale quotidiano, si avvalgono di un insieme di regole deontologiche che giustificano la moralità e irreprensibilità dell’atto assistenziale di cui sono garanti. Tuttavia l’iper-specializzazione del sapere e lo sviluppo di nuove tecnologie sottopongono costantemente i professionisti della salute all’impossibilità di conciliare sempre ciò che “è possibile fare” con ciò che “è doveroso” ed “eticamente lecito” fare per il paziente, condizione che potenzialmente genera nell’operatore distress morale. Gli infermieri che sperimentano Moral distress vivono una situazione di forte disagio, poiché riconoscono il comportamento da intraprendere più adeguato alla situazione clinica ma, per svariati motivi, non possono metterlo in pratica trovandosi quindi ad agire in modo contrario ai propri valori professionali. Le ricerche sul distress morale sono state condotte prevalentemente su infermieri. Nel presente studio sono state esaminate le situazioni che provocano conflitto morale nel vissuto degli studenti infermieri, in relazione a tutte quelle situazioni d’assistenza che si collocano al limite di una medicina etica e coscienziosa in termini di proporzionalità dei mezzi impiegati e di gravosità o beneficità dei trattamenti per il paziente. È stato svolto uno studio fenomenologico con interviste scritte semi-strutturate su un campione propositivo di studenti infermieri di una università romana. I testi delle interviste sono stati analizzati con il metodo Giorgi. I risultati hanno evidenziato che il Moral distress si manifesta nel vissuto esperienziale dello studente che è già in grado di delineare situazioni spiacevoli, cause, effetti e, in limitati casi, possibili strategie per rispondere al disagio vissuto nei setting clinici.During the professional practice of every day, caregivers use a set of ethical rules that warrant morality and irreproachability of welfare deed they are guarantors to. Nevertheless, hyperspecialization of knowledge and the development of new technologies, steadily submit professionals of wealth to inability to reconcile many times what “it is possible to do” to what “it is right to do” and “ethically correct” for patients, and that’s what potentially creates moral distress to the caregiver. Nurses who experience this moral distress, live a strong situation of discomfort, because they recognize the right behavior to have in a certain clinic situation but, due to several reasons, they can’t execute as they should, and they are incline to practice against their professional values. The most of surveys about moral distress are all conducted on nurses. This analysis inquires all situations that produce moral conflict in lived of nursing students, related to all those situations that lie on the border between an ethic and conscientious Medicine, about the proportionality in the use of means used and burdensomeness or beneficence of treatments for patients. It was carried out a phenomenological study by written semi-structured interviews on a purposeful sample of nursing students of a roman Campus. The texts of the interviews were analyzed with Giorgi’s method. The results showed that moral distress occurs in experiential lived of a student who is already able to outline unpleasant situations, causes, effects, and in few cases, possible strategies to respond to the distress experienced in clinical settings.

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 215
Author(s):  
Sunkyung Cha ◽  
Hyunjung Moon ◽  
Eunyoung Park

Nursing students have a more negative attitude toward psychiatric practice than other practices. In particular, Korean nursing students experience increased pressure during clinical practice in psychiatric nursing due to sociocultural and institutional influences, such as prejudices, fear, and anxiety towards mental illnesses. This study aimed to conduct an investigation on students’ first experiences of clinical practice in psychiatric nursing. Participants were 12 fourth year nursing students in South Korea. The data were collected through semi-structured interviews, and data analysis was done using Colaizzi’s phenomenological method. The students’ experiences of clinical practice in psychiatric nursing could be categorized into emotional fluctuation, burnout, transformation, and growth. The results of this study show that nursing students experienced emotional fluctuation and burnout at the beginning of their clinical practice in psychiatric nursing. At the end of the clinical practice, they experienced transformation and growth. The study suggests that nursing instructors and on-site staff need to interact with nursing students to understand the nature of these first experiences and support them through teaching and field guidance.


2013 ◽  
Vol 21 (4) ◽  
pp. 461-472 ◽  
Author(s):  
Elizabeth Peter ◽  
Shan Mohammed ◽  
Anne Simmonds

Background: While witnessing and providing aggressive care have been identified as predominant sources of moral distress, little is known about what nurses “know” to be the “right thing to do” in these situations. Research objectives: The purpose of this study was to explore what nurses’ moral knowledge is in situations of perceived overly aggressive medical care. Research design: A critical narrative approach was used. Participants: A total of 15 graduate nursing students from various practice areas participated. Findings: Four narrative types were identified, including “Wait and see: medical uncertainty,” “Deflected responsibilities to respond to dying, death, or futility,” “Divergent understandings, responsibilities, and temporalities,” and “Privileged medical understandings and responsibilities.” Discussion: The knowledge of differentially situated persons is acknowledged in dissimilar ways, the time required to determine that enough has been done is perceived differently, and how moral responsibilities are understood also varies. Conclusions: A better understanding of how social roles influence how time, knowledge, and responsibility are related to the provision of aggressive care is needed.


2020 ◽  
Author(s):  
Rhonda K. Rodgers ◽  
Vanessa L. Kettering ◽  
Jeremy P. Hunter

Organizational leaders and decision makers are searching for those who “do the right thing” regardless of moral complexities or cultural norms. Researchers have categorized these individuals as mindful, authentic, etc., and suggest their more attentive, and less reactive nature enables them to maintain unique ways of seeing, thinking, and acting in the world. Interest is building in secular adaptations (e.g., mindfulness training) of teachings from antiquity (e.g., Buddhist mindfulness), however scarce attention has been given to practitioners. To address this lack of understanding about contemplative experiences, a phenomenological study was undertaken to explore contemplative practice as experienced by American businesspeople. Semi-structured interviews were conducted with executives, managers, and career professionals (n = 29) who had an ongoing contemplative practice at the turn of the last century, and follow up interviews were conducted 15 years later to explore the trajectory of these individuals as professionals and contemplatives. At present (n = 7) of the original participants have been interviewed, and their experiences are the focus of this second wave of the study. The broad discovery is that over time, contemplative practice becomes an experiential framework for daily life, informing and influencing life choices in both personal and professional domains.


2020 ◽  
Author(s):  
Alireza Nikbakht Nasrabadi ◽  
Masoomeh Malek ◽  
Mahbobeh Shali ◽  
Haleh Jafari

Abstract Background: Simulation-based teaching skill is important for nurses who care for blind patients. Nurses should be able to understand their clients in order to provide them with better care. Also, better understanding of blindness enables nurses to take a more appropriate approach in dealing with blind patients and solving their problems. The aim of this study was to explore the experiences of blindness simulation among a group of nursing students.Methods: This qualitative study was conducted using an interpretive phenomenological method. Using purposeful sampling method, 8 participants were selected to share their experiences regarding blindness simulation through individual in-depth and semi-structured interviews. The transcribed interviews were analyzed by Diekelmann’s approach.Results: The results of data analysis resulted in three main categories and nine subcategories, which were conceptually named based on their nature. The main categories included; abandoned in the labyrinth of life, seeing with the eyes of heart, and personality alienation.Conclusions: The findings of this study provide a clear picture of students' experiences of blindness simulation. Understanding students' descriptions and perceptions of visually impaired patients in different aspects can provide valuable data in reducing and removing existing problems and planning to improve the quality of care. Therefore, improving and modifying care plan can guarantee the quality of professional services provided to patients.


2020 ◽  
Vol 29 (11) ◽  
pp. 618-626
Author(s):  
Lynn Craig ◽  
Alison Machin

Background: Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area. Aim: A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants. Method: Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used. Findings: Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the ‘model of self-efficacy in service improvement enablement’ was developed. Conclusion: This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.


2017 ◽  
Vol 31 (9) ◽  
pp. 853-860 ◽  
Author(s):  
Amanda Young ◽  
Katherine Froggatt ◽  
Sarah G Brearley

Background: Caring for dying people can contribute to moral distress experienced by healthcare professionals. Moral distress can occur when this caring is restricted by organisational processes, resources or the provision of futile care. These factors apply to end of life care in nursing homes but research is lacking. Aim: To describe how nursing home staff experience moral distress when caring for residents during and at the end of life. Methods: An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff. Data were analysed using a thematic analysis approach. Setting: Four nursing homes in one large metropolitan area. Participants: A total of 16 staff: 2 nurse managers, 4 nurses and 10 care assistants. Findings: Participants described holding ‘good dying’ values which influenced their practice. The four practice-orientated themes of advocating, caring, communicating and relating with residents were found to influence interactions with residents, relatives, general practitioners, and colleagues. These led staff to be able to ‘do the right thing’ or to experience ‘powerlessness’, which could in turn lead to staff perceiving a ‘bad death’ for residents. Conclusion: When there are incongruent values concerning care between staff and others involved in the care of residents, staff feel powerless to ‘do the right thing’ and unable to influence care decisions in order to avoid a ‘bad death’. This powerlessness is the nature of their moral distress.


Author(s):  
Dimitri Létourneau ◽  
Johanne Goudreau ◽  
Chantal Cara

AbstractObjectivesThis paper reports on nursing students’ and nurses’ lived experiences mediating their development of humanistic caring.MethodsUsing interpretive phenomenology, 26 participants were individually interviewed. A five-stage phenomenological analysis based on Benner’s (Benner, P. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: SAGE) method occurred simultaneously.ResultsThe analysis highlighted that the development of humanistic caring is affected by role models and counterexamples, environments in which humanistic caring is exalted or trivialized, communication-related courses, patient storytelling, and work overload.ConclusionsIt might be valuable to raise the awareness of nurse educators about their opportunity in shaping the development of students’ humanistic caring.


BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Alireza Nikbakht Nasrabadi ◽  
Ahmad Hasyim Wibisono ◽  
Kelly-Ann Allen ◽  
Ameneh Yaghoobzadeh ◽  
Yee Bit-Lian

Abstract Background Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study. Methods A qualitative, phenomenological study was conducted with 9 participants using in-depth semi-structured interviews. The purpose was to gain insight into the lived experiences and perceptions of moral distress among ICU nurses in hospitals affiliated with Tehran University of Medical Sciences during their long-term care of older adults. Results Five major themes are identified from the interviews: advocating, defense mechanisms, burden of care, relationships, and organizational issues. In addition, several subthemes emerged including respectful end of life care, symptom management, coping, spirituality, futile care, emotional work, powerlessness, relationships between patients and families, relationships with healthcare teams, relationships with institutions, inadequate staffing, inadequate training, preparedness, education/mentoring, workload, and support. Conclusions This qualitative study contributes to the limited knowledge and understanding of the challenges nurses face in the ICU. It also offers possible implications for implementing supportive interventions.


2020 ◽  
Vol 17 (3) ◽  
pp. 305-316
Author(s):  
D. Timóteo-Costa ◽  
V. Marinalva-de Barros ◽  
D.M. Rodrigues-da Silva ◽  
I.D. Lima-Cavalcanti ◽  
J.M. De Aquino ◽  
...  

Introduction: Assisted suicide is considered an action in which a patient, wishes to terminate his/her life due to the pain and suffering caused by a disease and requests the necessary help from the healthcare professionals. The right to decide about ending one’s own life and the impact attributed to the experienced suffering are the main questions regarding assisted suicide. Objective: Characterize the perceptions of nursing students about professional performance in the face of assisted suicide. Methods: The research comprised a descriptive analysis with a qualitative approach, based on the application of semi-structured interviews on nursing students enrolled in the curricular 9th period, during 2014, in the city of Recife-PE, Brazil. The sample consisted of 19 students. The data, were analyzed and categorized using the Collective Subject Discourse (CSD) method. Results and Discussion: The obtained data suggest that students consider assisted suicide as a way of preserving dignity in the face of procedures that will make the death an inevitably painful process. Indicate that euthanasia and assisted suicide should remain illegal, and they would not get involved professionally. But others assured their willingness to participate because they would be satisfying the patient's wishes, however, for its legalization it is necessary to create principles that would guide the execution of these procedures. Conclusion: The students consider, that the professional can eliminate real possibilities of treatment and recovery of the patient by accepting his request for suicide. However, some students are in favor of this procedure, arguing that the patient is free to conduct his own life.


2018 ◽  
Vol 26 (7-8) ◽  
pp. 1983-1991 ◽  
Author(s):  
Roghayeh Mehdipour Rabori ◽  
Mahlagha Dehghan ◽  
Monirosadat Nematollahi

Background: Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process. Objectives: This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran. Research design: This was a mixed-methods study with an exploratory sequential design. Participants and research context: A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively. Ethical considerations: The ethical committee of Kerman University of Medical Sciences, Iran, approved the protocol of the study. Findings: Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale. Discussion: The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges. Conclusion: Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences.


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