Dataset Information

What is 'moral distress' in nursing? A feminist empirical bioethics study.

ABSTRACT:

Background

The phenomenon of 'moral distress' has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.

Research aim

To explore the concept of moral distress in nursing both empirically and conceptually.

Methodology

Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen's six steps for data analysis.

Ethical considerations

The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.

Findings

The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants' narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.

Discussion

We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, 'moral-uncertainty distress'. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.

Conclusion

The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as 'moral distress'.

SUBMITTER: Morley G

PROVIDER: S-EPMC7406988 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

What is 'moral distress' in nursing? A feminist empirical bioethics study.

Morley Georgina G Bradbury-Jones Caroline C Ives Jonathan J

Nursing ethics 20190929 5

<h4>Background</h4>The phenomenon of 'moral distress' has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.<h4>Resear ...[more]

PMID: 31566094

Similar Datasets

Project description:BackgroundMoral distress is a far-reaching problem for nurses in different settings as it threatens their health.AimThis study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress.Research designA qualitative interview study with reflexive thematic analysis was used.Participants and research contextWe conducted semi-structured interviews with 20 home-care nurses in Germany.Ethical considerationsThe study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health.FindingsTwenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one's health, extended responsibility for the entire care arrangement, work-privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient's territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels.ConclusionsIn cases of tension between the service and billing system and the understanding of these nurses' care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients' quality of care.

Project description:BackgroundHigh levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention.Aim"Positive Attitudes Striving to Rejuvenate You: PASTRY" was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses.Research designA Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric's Moral Distress Scale-Revised (MDS-R.) This program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving "false hope" to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices.ParticipantsClinical nurses working on an adult leukemia/lymphoma unit.Ethical considerationsThis was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution's Ethics Committee oversaw PASTRY's implementation.FindingsWhile improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit's moral distress, led to enhanced camaraderie, and improved nurses' coping skills.DiscussionMeasurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions.ConclusionThis QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created.

Project description:Background:Metaphors are often used within the context of ethics and healthcare but have hardly been explored in relation to moral reasoning.Objective:To describe a central set of metaphors in one case and to explore their contribution to moral reasoning.Method:Semi-structured interviews were conducted with 16 parents of a child suffering from the neurodegenerative disease CLN3. The interviews were recorded, transcribed, and metaphors were analyzed. The researchers wrote memos and discussed about their analyses until they reached consensus.Ethical considerations:Participants gave oral and written consent and their confidentiality and anonymity were respected.Findings:A central set of metaphors referred to the semantic field of the hands and arms and consisted of two central metaphors that existed in a dialectical relationship: grasping versus letting go. Participants used these metaphors to describe their child's experiences, who had to "let go" of abilities, while "clinging" to structures and the relationship with their parent(s). They also used it to describe their own experiences: participants tried to "grab" the good moments with their child and had to "let go" of their child when (s)he approached death. Participants, in addition, "held" onto caring for their child while being confronted with the necessity to "let go" of this care, leaving it to professional caregivers.Discussion:The ethical analysis of the findings shows that thinking in terms of the dialectical relationship between "grasping" and "letting go" helps professional caregivers to critically think about images of good care for children with CLN3. It also helps them to bear witness to the vulnerable, dependent, and embodied nature of the moral self of children with CLN3 and their parents.Conclusion:Metaphorical reasoning may support the inclusion of marginalized perspectives in moral reasoning. Future studies should further explore the contribution of metaphorical reasoning to moral reasoning in other cases.

Project description:BackgroundMoral Distress (MD) is a unique form of distress that occurs when people believe they know the ethically correct action to take but are constrained from doing so. Limited clinical experience and insufficient ethical knowledge contribute to nursing students' MD, which can potentially cause negative outcomes. The aims of this study are: (1) to describe the MD intensity of nursing students, and (2) to analyze differences and associations between MD intensity and socio-demographic and academic variables.MethodsA cross-sectional study design with a convenience sample of the second, third, and delayed graduation students was included; only students willing to participate and who had attended their scheduled internships in the last six months were eligible for inclusion. To measure the level of MD, we used the It-ESMEE. We collected socio-demographic and academic variables. The data collection occurred from January 2024 to March 2024.ResultsThe students who adhered to the collection were N = 344. The findings reveal that the students perceived a high level of MD in situations related to clinical internship and class. They perceived higher levels of MD when nursing was not their first career choice, were separated or divorced, did not have children, and were not an employed student. The overall MD score is statistically significantly lower among students who had nursing as their first career choice (β = -0.267, p < 0.05), have children (β = -0.470, p < 0.01), and are employed (β = -0.417, p < 0.01). In contrast, being separated or divorced (β = 0.274, p < 0.01) was associated with a higher MD score.ConclusionsThis study has some limitations: data reflect a local context, and the findings may not be generalizable to other regions or educational environments. Additionally, students' recollections of their experiences could be influenced by the passage of time, and there may be a selection bias since only students willing to participate were included. The findings suggest that nursing education programs should incorporate more robust training in ethical decision-making and stress management to better prepare students for the moral challenges in their professional practice.

Dataset Information

What is 'moral distress' in nursing? A feminist empirical bioethics study.

Background

Research aim

Methodology

Ethical considerations

Findings

Discussion

Conclusion

Publications

What is 'moral distress' in nursing? A feminist empirical bioethics study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets