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

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.

Consequences of clinical situations that cause critical care nurses to experience moral distress

2012 ◽  
Vol 19 (4) ◽  
pp. 479-487 ◽  
Author(s):  
Debra L Wiegand ◽  
Marjorie Funk
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
Thematic Analysis ◽  
Moral Distress ◽  
Medical Center ◽  
Critical Care Nurses ◽  
Negative Consequences ◽  
Convenience Sample ◽  
Methodological Rigor ◽  
Descriptive Approach

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families.

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.

scholarly journals Moral Distress in Critical Care Nurses: A Qualitative Study

2019 ◽  
Vol 4 (4) ◽  
pp. 35
Author(s):  
Hawazen Rawas
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Health Care Professionals ◽  
Moral Distress ◽  
Critical Care Nurses ◽  
Real Problem ◽  
Research Paradigm ◽  
Critical Care Units ◽  
Medical City ◽  
Depth Interviews

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.

Gender and the experience of moral distress in critical care nurses

2014 ◽  
Vol 22 (1) ◽  
pp. 32-42 ◽  
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.

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

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.

Moral distress of critical care nurses

1995 ◽  
Vol 4 (4) ◽  
pp. 280-285 ◽  
Author(s):  
MC Corley
Keyword(s):  
Factor Analysis ◽  
Critical Care ◽  
Intensive Care ◽  
Private Hospital ◽  
Moral Distress ◽  
Medical Center ◽  
Critical Care Nurses ◽  
Moral Integrity ◽  
Healthcare Organizations ◽  
Aggressive Care

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

Impact of Workplace Climate on Burnout Among Critical Care Nurses in the Veterans Health Administration

2020 ◽  
Vol 29 (5) ◽  
pp. 380-389 ◽  
Author(s):  
Lakshmana Swamy ◽  
David Mohr ◽  
Amanda Blok ◽  
Ekaterina Anderson ◽  
Martin Charns ◽  
...  
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Health Care System ◽  
Critical Care Nurses ◽  
Common Method ◽  
Health Administration ◽  
Workplace Climate ◽  
Common Method Bias ◽  
Method Bias ◽  
Care System

Background Burnout is a maladaptive response to work-related stress that is associated with negative consequences for patients, clinicians, and the health care system. Critical care nurses are at especially high risk for burnout. Previous studies of burnout have used survey methods that simultaneously measure risk factors and outcomes of burnout, potentially introducing common method bias. Objectives To evaluate the frequency of burnout and individual and organizational characteristics associated with burnout among critical care nurses across a national integrated health care system using data from an annual survey and methods that avoid common method bias. Methods A 2017 survey of 2352 critical care nurses from 94 sites. Site-level workplace climate was assessed using 2016 survey data from 2191 critical care nurses. Results Overall, one-third of nurses reported burnout, which varied significantly across sites. In multilevel analysis, workplace climate was the strongest predictor of burnout (odds ratio [OR], 2.20; 95% CI, 1.50-3.22). Other significant variables were overall hospital quality (OR, 1.44; 95% CI, 1.05-1.99), urban location (OR, 1.93; 95% CI, 1.09-3.42), and nurse tenure (OR, 2.11; 95% CI, 1.44-3.10). In secondary multivariable analyses, workplace climate subthemes of perceptions of workload and staffing, supervisors and senior leadership, culture of teamwork, and patient experience were each significantly associated with burnout. Conclusions Drivers of burnout are varied, yet interventions frequently target only the individual. Results of this study suggest that in efforts to reduce burnout, emphasis should be placed on improving local workplace climate.

Nursing Leadership From the Bedside to the Boardroom

2013 ◽  
Vol 24 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Mary Frances D. Pate
Keyword(s):  
Health Care ◽  
Critical Care ◽  
New Age ◽  
Nursing Leadership ◽  
High Impact ◽  
Critical Care Nurses

Experienced acute and critical care nurses are poised to be high-impact leaders in the current, ever-changing health care landscape. These professionals need new skills to carry them to the next level, as they are called on to lead in a new age filled with increasing complexities. This article provides strategies for nurses to consider and reflect on throughout their leadership journey.

The Need for an Effective Process to Resolve Conflicts Over Medical Futility: A Case Study and Analysis

2016 ◽  
Vol 36 (6) ◽  
pp. 13-23 ◽  
Author(s):  
Jocelyn A. Olmstead ◽  
Michael D. Dahnke
Keyword(s):  
Critical Care ◽  
Policy Development ◽  
Moral Distress ◽  
Medical Model ◽  
Medical Futility ◽  
Critical Care Nurses ◽  
Practice Nurses ◽  
Court Proceedings ◽  
Court Intervention ◽  
The Right

The issue of medical futility requires a well-defined process in which both sides of the dispute can be heard and a resolution reached in a fair and ethical manner. Procedural approaches to medical futility cases provide all parties involved with a process-driven framework for resolving these disputes. Medical paternalism or the belief in the absolute rightness of the medical model will not serve to resolve these disputes. Although medical futility is first determined by medicine, in order for the determination to meet legal criteria, it must be subject to review. The hope is that through a review process that meets legal criteria, the issue can be resolved without the need for court proceedings. If resolution cannot be obtained through this process, surrogates still have the right to seek court intervention. This issue is of relevance and importance in critical care nursing because of the role and position of critical care nurses, who have direct contact with patients and patients’ families, the potential for moral distress in cases of possibly futile treatment, and the expanding roles of nurses, including critical care nurses and advanced practice nurses, in management and policy development.

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