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Liu Y, Zhang Y, Jin J. The experiences of ethical conflict among critical care professionals in China: A qualitative study. Nurs Crit Care 2024. [PMID: 38363045 DOI: 10.1111/nicc.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders. AIM This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China. STUDY DESIGN From December 2021 to February 2022, we performed semi-structured, face-to-face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data. RESULTS Five themes and 14 sub-themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth. CONCLUSIONS The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies. RELEVANCE TO CLINICAL PRACTICE The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice.
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Affiliation(s)
- Yuanfei Liu
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
- Changxing Branch Hospital of SAHZU, Huzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
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Tolotti A, Bonetti L, Luca CE, Villa M, Liptrott SJ, Steiner LM, Balice-Bourgois C, Biegger A, Valcarenghi D. Nurses Response to the Physical and Psycho-Social Care Needs of Patients with COVID-19: A Mixed-Methods Study. Healthcare (Basel) 2024; 12:114. [PMID: 38201019 PMCID: PMC10778578 DOI: 10.3390/healthcare12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
The COVID-19 pandemic heavily impacted nursing care. This study aimed to understand which nursing interventions were instrumental in responding to COVID-19 patients' needs by exploring the experiences of patients and nurses. In this mixed-method study with an explanatory sequential design, we involved nurses caring for COVID-19 patients in intensive and sub-intensive care units and patients. In the first phase, we collected data through a survey that assessed patients' needs from the perspective of nurses and patients, as well as patient satisfaction. In the second phase, qualitative data were collected through interviews with patients and nurses. In the third phase, we extracted quantitative data from patients' records. Our sample included 100 nurses, 59 patients, 15 patient records, and 31 interviews (15 patients, 16 nurses). The results from the first phase showed patients and nurses agreed on the most important difficulties: "breathing", "sleep/rest", and "communication". Nursing care was rated positively by 90% of the patients. In the second phase, four themes were identified through the patients' interviews: "my problems", "my emotions", "helpful factors", and "nursing care". Five themes were identified through the nurses' interviews: "the context", "nurses' experiences and emotions", "facilitators and barriers to patient care", "nursing care", and "the professional role". From the third phase, the analysis of the clinical documentation, it was not possible to understand the nursing care model used by the nurses. In conclusion, nurses adopted a reactive-adaptive approach, based on experience/knowledge, pursuing generalized objectives, and adapting their response to the clinical evolution. In difficult contexts, nursing care requires a constant competent technical-relational presence at the patient's bedside.
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Affiliation(s)
- Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland; (A.T.); (C.E.L.); (S.J.L.); (D.V.)
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
| | - Loris Bonetti
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
| | - Corina Elena Luca
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland; (A.T.); (C.E.L.); (S.J.L.); (D.V.)
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
- Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 46, 6903 Lugano, Switzerland
| | - Michele Villa
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Sarah Jayne Liptrott
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland; (A.T.); (C.E.L.); (S.J.L.); (D.V.)
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
- Ospedale Regionale di Bellinzona e Valli, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Laura Maria Steiner
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
| | - Colette Balice-Bourgois
- Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 46, 6903 Lugano, Switzerland;
| | - Annette Biegger
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland; (A.T.); (C.E.L.); (S.J.L.); (D.V.)
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; (M.V.); (L.M.S.)
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
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Beheshtaeen F, Torabizadeh C, Khaki S, Abshorshori N, Vizeshfar F. Moral distress among critical care nurses before and during the COVID-19 pandemic: A systematic review. Nurs Ethics 2023:9697330231221196. [PMID: 38116787 DOI: 10.1177/09697330231221196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic review. The findings indicate that personal, caring-related, and organizational factors can influence nurses' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses' age and work experience affect critical care nurses' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses' primary causes of moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care.
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de Oliveira Vargas MA, Cardozo DDO, Farias Brehmer LCD, Tomaschewski-Barlem JG, Souza Ramos FR, Schneider DG, Manoel MS. Development of the Patient Advocacy Scale for Intensive Care Nurses. J Nurs Meas 2023; 31:534-545. [PMID: 37848231 DOI: 10.1891/jnm-2021-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Background and Purpose: To describe the process of developing and validating the content of the Patient Advocacy Scale for Nurses in Intensive Care (EAPEnf-UTI). Methods: Methodological research. To achieve the elaboration objective, five stages were developed: (a) definition of the theme, (b) generation of the number of items, (c) determination of the measurement format, (d) validation of face and content, and (e) content adjustment. Results: The instrument elaborated from a survey and integrative literature review, and the measurement format chosen was the 5-point Likert scale. The validation of face and content was performed by expert judges and by pretest. The final instrument had 57 items. Conclusion: EAPEnf-UTI is a pioneering instrument built in the Brazilian context, whose future validation will allow the capturing of situations specific to intensive care units and the professional practice of intensive care nurses.
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Affiliation(s)
- Mara Ambrosina de Oliveira Vargas
- Nursing Department and the Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daniela de Oliveira Cardozo
- Nurse at the Polydoro Ernani of São Thiago, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Laura Cavalcanti de Farias Brehmer
- Nursing Department and the Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jamila Geri Tomaschewski-Barlem
- Nursing Department and the Post-Graduation Program in Nursing, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Flávia Regina Souza Ramos
- Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Dulcinéia Ghizoni Schneider
- Post-Graduation Program in Nursing, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Mayara Souza Manoel
- Nurse at Multiprofessional Residency in Family Health, Florianópolis, Santa Catarina, Brazil
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Taipale M, Herttalampi M, Muotka J, Mauno S, Feldt T. Stress of conscience in healthcare in turbulent times: A longitudinal study. Nurs Ethics 2023:9697330231204949. [PMID: 37888885 DOI: 10.1177/09697330231204949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Healthcare workers frequently face ethically demanding situations in their work, potentially leading to stress of conscience. Long-term work intensification (more and more effort demanded year after year), organizational change and COVID-19 may be risk factors concerning stress of conscience. AIMS The main aim was to investigate the relationship between long-term work intensification and stress of conscience among the personnel in a healthcare organization. Organizational change management was considered a mediator and COVID-19-related work stress a moderator in the association between work intensification and stress of conscience. RESEARCH DESIGN, PARTICIPANTS AND CONTEXT A total of 211 healthcare district employees participated in a longitudinal survey using questionnaires collected in 2019 (major organizational change in the planning stage) and 2021 (organizational change completed). ETHICAL CONSIDERATIONS The study was implemented according to the guidelines of the Finnish National Board on Research Integrity. The Finnish instructions were that no review by an ethics committee was necessary because participation was voluntary, informed consent was requested, participants were assured that they were free to withdraw from the longitudinal study at any time and no health data were collected. FINDINGS Long-term work intensification was associated with more severe stress of conscience. Long-term work intensification was partially mediated through change management to stress of conscience. High COVID-19 stress strengthened the association between long-term work intensification and stress of conscience. CONCLUSIONS Long-term work intensification must be addressed to reduce stress of conscience in healthcare, otherwise the healthcare system will be vulnerable to changes and crisis. Extra resources for personnel and management should be allocated because of work intensification during organizational change and health crises like the COVID-19 pandemic to alleviate stress of conscience.
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Affiliation(s)
| | | | | | - Saija Mauno
- University of Jyväskylä, Finland
- Tampere University, Finland
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Salas-Bergües V, Lizarazu-Armendáriz E, Eraso-Pérez de Urabayen M, Mateo-Manrique P, Mendívil-Pérez M, Goñi-Viguria R. Levels of burnout and exposure to ethical conflict and assessment of the practice environment in nursing professionals of intensive care. ENFERMERIA INTENSIVA 2023; 34:195-204. [PMID: 37455225 DOI: 10.1016/j.enfie.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nursing professionals working in Intensive Care Units (ICU) are at high risk of developing negative emotional responses as well as emotional and spiritual problems related to ethical issues. The design of effective strategies that improve these aspects is determined by knowing the levels of burnout and ethical conflict of these professionals, as well as the influence that the practice environment might have on them. OBJECTIVES To analyze the relationship between levels of burnout, the exposure to ethical conflicts and the perception of the practice environment among themselves and with sociodemographic variables of the different intensive care nursing professionals. METHODS Descriptive, correlational, cross-sectional, observational study in an ICU of a tertiary level university hospital. The level of burnout was evaluated with the Maslach Burnout Inventory Human Services Survey scale; the level of ethical conflict with the Ethical Conflict Questionnaire for Nurses and the perception of the environment with the Practice Environment Scale of the Nursing Work Index. Descriptive and inferential statistics were performed. The association between categorical variables was analyzed using Fisher's exact chi-square test (χ2) RESULTS: 31 nurses and 8 nursing assistants were evaluated, which meant a participation rate of 82,93%. 31,10% of the nursing professionals presented signs of burnout, 14,89% considered that they work in an unfavorable environment and 87,23% presented a medium-high index of exposure to ethical conflict. The educational level (χ2=11.084, p=0.011) and the professional category (χ2=5.007, p=0.025) influenced the level of burnout: nursing assistants presented higher levels of this. When comparing the level of burnout with the environment and the index of ethical conflict, there were no statistically significant differences. CONCLUSIONS The absence of association found in the study between Burnout and ethical conflict with the perception of the practice environment suggests that personal factors may influence its development.
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Affiliation(s)
- V Salas-Bergües
- Enfermería, Área de Investigación, Clínica Universidad de Navarra, Pamplona, Spain
| | - E Lizarazu-Armendáriz
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - P Mateo-Manrique
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain.
| | - M Mendívil-Pérez
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Goñi-Viguria
- Enfermería, Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Spain
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Falcó-Pegueroles A, Viola E, Poveda-Moral S, Rodríguez-Martín D, Via-Clavero G, Barello S, Bosch-Alcaraz A, Bonetti L. Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study. J Clin Nurs 2023; 32:6677-6689. [PMID: 37190669 DOI: 10.1111/jocn.16754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
AIMS AND OBJECTIVES To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic. BACKGROUND The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences. DESIGN A qualitative design based on phenomenological approach. METHODS A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines. RESULTS One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. CONCLUSIONS Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis. RELEVANCE TO CLINICAL PRACTICE Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.
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Affiliation(s)
- Anna Falcó-Pegueroles
- Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Consolidated Research Group 325 Bioethics, Law and Society (BIOELSi), University of Barcelona, Barcelona, Spain
| | - Elena Viola
- Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Nursing and Health Doctoral Program, University of Barcelona, Barcelona, Spain
| | - Silvia Poveda-Moral
- University School of Nursing and Occupational Therapy, Terrassa, Barcelona, Spain
| | | | - Gemma Via-Clavero
- Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Loris Bonetti
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- University of Applied Sciences and Arts of Southerm Switzerland, Manno, Switzerland
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Varaei S, Caihong Z, Siqi Z, Mahmoodi P, Rezaee M, Rezveh AK, Mirbazegh SF. Analysis of the strategies used by iranian nurses for management of provided care for patients with COVID- 19: a qualitative study. BMC Nurs 2023; 22:93. [PMID: 37004063 PMCID: PMC10064591 DOI: 10.1186/s12912-023-01239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Nurses have been at the center of managing the COVID-19 outbreak through direct bedside care in respiratory, emergency and intensive care environments, managing hospital units, providing Covid-19 testing, vaccination and contact tracing. Thus, the present study aimed to analysis the strategies used by Iranian nurses for management of Provided Care for patients with COVID- 19. METHODS The present study was conducted based on the conventional content analysis method and Graneheim & Lundman approach. The participants included the nurses working in the COVID-19 wards and were recruited by purposeful sampling and based on inclusion criteria. The data were collected by conducting semi-structured, in-depth, one-to-one interviews until reaching data saturation. RESULTS In-depth interviews with 10 nurses represented four main categories and fifteen subcategories. Four main categories emerged in this study i.e. "justice in human resources management", "The art and science of comprehensive nursing care", "managers as agents of change in crisis" and "challenges and its management". CONCLUSION The nurses' experiences of management strategies showed that paying attention to the financial, psychological, educational, equipment needs of nurses and maintaining their safety make the suitable environment for providing high quality care for patients with covid-19.
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Affiliation(s)
- Shokoh Varaei
- Medical Surgical department, Nursing & midwifery school, Tehran University of medical sciences, Tehran, Iran
| | - Zhang Caihong
- International nursing school, Adult Nursing, Hainan Medical University, Hainan, China
| | - Zhang Siqi
- Hainan Medical University, Hainan, China
| | - Parvin Mahmoodi
- Clinical Care Research Center, Nursing and Midwifery School, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Mehdi Rezaee
- Tehran University of medical sciences, Tehran, Iran
| | - Ali Karimi Rezveh
- Medical Surgical department, Nursing & midwifery school, Tehran University of medical sciences, Tehran, Iran
| | - Seydeh Fatemeh Mirbazegh
- Seydeh fatemeh mirbazegh, Deputy of treatment, Tehran University of medical sciences, Tehran, Iran
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Liu Y, Wang X, Wang Z, Zhang Y, Jin J. Ethical conflict in nursing: A concept analysis. J Clin Nurs 2022. [DOI: 10.1111/jocn.16563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Yuanfei Liu
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU) Zhejiang University Hangzhou China
| | - Xueqing Wang
- Department of Nursing, Sir Run Run Shaw Hospital Zhejiang University School of Medicine Zhejiang University Hangzhou China
| | - Zhaochen Wang
- School of Public Health, School of Medicine Zhejiang University Hangzhou China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU) Zhejiang University Hangzhou China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU) Zhejiang University Hangzhou China
- Changxing Branch Hospital of SAHZU Huzhou China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province Hangzhou China
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Balice-Bourgois C, Bonetti L, Tolotti A, Liptrott SJ, Villa M, Luca CE, Steiner LM, Biegger A, Goncalves S, Moser L, Palermo A, Sari D, Valcarenghi D. Experiences and Needs of Patients, Caregivers and Nurses during the COVID-19 Pandemic: Study Protocol for a Mixed-Methods Multicentre Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912838. [PMID: 36232138 PMCID: PMC9566058 DOI: 10.3390/ijerph191912838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 06/02/2023]
Abstract
The COVID-19 pandemic is a major public health problem with millions of confirmed cases and deaths described. Nurses are among the health care professionals most involved at the front line, caring for those affected by COVID-19. Patients and families have been subjected to a high emotional burden of fear, anxiety, and uncertainty. The COVID-19 pandemic has had a significant impact on the approach to patients, the organisation of care, and communication with patients and their families, all requiring considerable adaptation on the part of nurses and health care professionals. The overall aim of this research was to find out the needs of patients with COVID-19, the nursing interventions provided and their outcomes, and to explore the experiences of the nurses, patients, and caregivers. A mixed method study will be performed with a convergent design. The study was divided into three phases. Quantitative methods involved nurses and patients affected by COVID-19 with a questionnaire. Qualitative methods involved nurses, patients, and caregivers with interviews and finally a quantitative analysis of the nursing documentation of the interviewed patients. We hope that this study will help us to understand and identify the main nursing and support needs expressed by patients and their families at different stages of their illness.
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Affiliation(s)
- Colette Balice-Bourgois
- Institute of Paediatrics of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
| | - Loris Bonetti
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino, 11, 6928 Manno, Switzerland
| | - Angela Tolotti
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Sarah Jayne Liptrott
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Michele Villa
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Corina Elena Luca
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
- Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 46, 6903 Lugano, Switzerland
| | - Laura Maria Steiner
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino, 11, 6928 Manno, Switzerland
| | - Annette Biegger
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
| | - Silvia Goncalves
- Ospedale Regionale di Locarno, Ente Ospedaliero Cantonale (EOC), Via all'Ospedale, 1, 6600 Locarno, Switzerland
| | - Laura Moser
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Antonio Palermo
- Ospedale Regionale di Bellinzona e Valli, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Davide Sari
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Dario Valcarenghi
- Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
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11
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Tarwade P. Intensive Care Unit Nurses and Ethical Attitudes. Indian J Crit Care Med 2022; 26:259-260. [PMID: 35519932 PMCID: PMC9015932 DOI: 10.5005/jp-journals-10071-24161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pritee Tarwade
- Pritee Tarwade, Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, United States of America, e-mail:
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12
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Czyż-Szypenbejl K, Mędrzycka-Dąbrowska W, Falcó-Pegueroles A, Lange S. Conflict Sources and Management in the ICU Setting before and during COVID-19: A Scoping Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031875. [PMID: 35162897 PMCID: PMC8835561 DOI: 10.3390/ijerph19031875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/26/2022] [Accepted: 02/05/2022] [Indexed: 02/01/2023]
Abstract
Introduction. Conflicts are an inherent part of work within any organisation. They can arise between members of an interdisciplinary team (or between teams representing different departments), between patients and team members/family members, and patients’ families and team members. Various conflict situations among employees may occur, therefore it is very important to identify their causes and take preventive or targeted corrective measures. The aim of this study was to review the available literature concerning conflicts arising in ICUs—their types, methods of expression as well as their management and mitigation. In addition, we reviewed the available literature on the impact of the pandemic on the ICU environment caring for COVID-19 patients. Methods. The databases were searched. Single key words or their combinations using AND or OR operators were entered. Eventually, 15 articles were included in our review, which included two identical papers. Results. Conflicts occurred occasionally or rarely; researchers describing ethical conflicts demonstrated a moderate level of exposure to conflicts. The pandemic created many challenges and ethical dilemmas that are a source of ethical conflict. Conclusions. As conflict by nature remains inevitable, adequate procedures in conflict management should be developed and the leadership of managing personnel should be reinforced, because team members frequently expect guidance from their supervisors. The importance of training in interpersonal communication and crisis situation management in healthcare should therefore be emphasised.
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Affiliation(s)
- Katarzyna Czyż-Szypenbejl
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland;
- Correspondence:
| | - Anna Falcó-Pegueroles
- Department of Fundamental Care and Medical-Surgital Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain;
| | - Sandra Lange
- Department of Internal and Pediatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland;
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Khanal A, Franco-Correia S, Mosteiro-Diaz MP. Ethical conflict among critical care nurses during the COVID-19 pandemic. Nurs Ethics 2022; 29:819-832. [PMID: 35085049 PMCID: PMC8795757 DOI: 10.1177/09697330211066574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical conflict is a problem with negative consequences, which can compromise the quality and ethical standards of the nursing profession and it is a source of stress for health care practitioners', especially for nurses. OBJECTIVES The main aim of this study was to analyze Spanish critical care nurses' level of exposure to ethical conflict and its association with sociodemographic, occupational, and COVID-19-related variables. Research Design, Participants, and Research context: This was a quantitative cross-sectional descriptive study conducted among 117 nurses working in critical care units. Data collection tools were sociodemographic, occupational, and COVID-19-related questionnaires and previously validated Spanish version of Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS We obtained permission from the Ethics Committee and participants' informed consent. FINDINGS Data indicates a moderate level of exposure to ethical conflicts. The most frequent ethical conflicts were related to situations about "treatment and clinical procedures." The most intensity of ethical conflicts was related to situations about "treatment and clinical procedures" and "dynamics of the service and working environment." No statistical significance was identified between the socio-demographic variables and level of exposure to ethical conflicts. However, for critical care nurses working in ICU, nurses with perceived worked stress had a higher level of exposure to ethical conflicts. Likewise, critical care nurses whose family/friends were infected with COVID-19 had a higher level of exposure. CONCLUSIONS Critical care nurses experience a moderate level of exposure to ethical conflicts which is consistent with the results of previous studies. A deeper understanding of ethical conflicts in conflictive situations allows recognition of the situations that occur in everyday clinical practice, identification of the ethical conflicts, and facilitation of the nurses working in the challenging clinical situation.
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Affiliation(s)
- Anjita Khanal
- International Postgraduate Centre of University of Oviedo, 16763University of Oviedo, Oviedo, Spain
| | - Sara Franco-Correia
- Faculty of Medicine and Health Sciences, 16763University of Oviedo, Oviedo, Spain
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14
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Villa M, Balice-Bourgois C, Tolotti A, Falcó-Pegueroles A, Barello S, Luca EC, Clivio L, Biegger A, Valcarenghi D, Bonetti L. Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212012. [PMID: 34831768 PMCID: PMC8618535 DOI: 10.3390/ijerph182212012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022]
Abstract
Background: During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses’ ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. Methods: Design—Multicentre online survey. Setting—Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman’s rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses’ characteristics and outcome variables, and the Mann–Whitney/t-test to compare groups. Results: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low–moderate level of ethical conflict (median = 111.5 [76–152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96–13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56–9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. Conclusions: Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.
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Affiliation(s)
- Michele Villa
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete 48, 6900 Lugano, Switzerland;
| | - Colette Balice-Bourgois
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland;
| | - Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland;
- Correspondence:
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, Consolidated Research Group SGR 269 Quantitative Psychology, University of Barcelona (Spain), Campus Bellvitge, Pavelló de Govern, 3a planta, Despatx 331, Feixa Llarga, s/n L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Serena Barello
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Department of Phychology, Università Cattolica del Sacro Cuore, Milano and Cremona, L.Go Gemelli 1, 20123 Milan, Italy;
| | - Elena Corina Luca
- Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 46, 6903 Lugano, Switzerland;
| | - Luca Clivio
- ICT Data Science & Research Unit, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland;
| | - Annette Biegger
- Nursing Department Direction, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzonal, Switzerland;
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland;
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland;
- Department of Business Economics, University of Applied Sciences and Arts of Southern Switzerland, Health and Social Care, Via Violino, 11, 6928 Manno, Switzerland
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15
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Liu Y, Cui N, Zhang Y, Wang X, Zhang H, Chen D, Sun S, Jin J. Psychometric properties of the ethical conflict in nursing questionnaire critical care version among Chinese nurses: a cross-sectional study. BMC Nurs 2021; 20:133. [PMID: 34320972 PMCID: PMC8316889 DOI: 10.1186/s12912-021-00651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results The ECNQ-CCV-C achieved Cronbach’s alphas 0.902 and McDonald’s omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. Conclusions The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00651-x.
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Affiliation(s)
- Yuanfei Liu
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Nianqi Cui
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Yuping Zhang
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shunxia Sun
- Department of Nursing, The General Hospital of Chongqing, Chongqing, China
| | - Jingfen Jin
- The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), No.88 Jiefang road, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China. .,Changxing Branch Hospital of SAHZU, No.66 Taihu middle road, Changxing Country, Huzhou, 313100, Zhejiang, China.
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16
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Falcó-Pegueroles A, Zuriguel-Pérez E, Via-Clavero G, Bosch-Alcaraz A, Bonetti L. Ethical conflict during COVID-19 pandemic: the case of Spanish and Italian intensive care units. Int Nurs Rev 2020; 68:181-188. [PMID: 33615479 DOI: 10.1111/inr.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. BACKGROUND During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. SOURCES OF EVIDENCE Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. DISCUSSION The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. CONCLUSIONS Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. IMPLICATIONS FOR NURSING PRACTICE AND POLICY Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.
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Affiliation(s)
- Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences. Quantitative Psychology Research Group (SGR 269), University of Barcelona, Barcelona, Spain
| | | | - Gemma Via-Clavero
- Critical Care Unit, Hospital Universitari de Bellvitge, Nursing Research Group (GRIN-IDIBELL), Barcelona, Spain.,Pediatric Critical Care Unit, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Alejandro Bosch-Alcaraz
- Pediatric Critical Care Unit, Sant Joan de Deu Hospital, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University de Barcelona, Barcelona, Spain
| | - Loris Bonetti
- Clinical Expert in Nursing Research, Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.,University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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17
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Abstract
BACKGROUND A growing body of evidence about nurses' ethical conflicts has been added to nursing science in recent decades, but no research has been done in Estonia. Ethical conflicts are a cultural and context sensitive phenomenon, so the historical, legal, social, economic and political backgrounds and position of nursing have had an impact on ethical conflict experiences. AIM Describe nurses' experiences of ethical conflicts. METHOD A qualitative, descriptive study was conducted among nurses (n = 21) in May-October 2018 in Estonia. The data were collected in the form of semi-structured individual interviews and analysed using the inductive content analysis method. ETHICAL CONSIDERATIONS Due to the sensitive nature of the research topic, only individual interviews were carried out. FINDINGS Nurses' ethical conflicts were related to situations that violated the rights, safety or well-being of the patient or relatives, caused them suffering, were against their will or threatened nurses' dignity and professionalism through a variety of practices, attitudes and relationships. The insufficiency of patient care and professional collaboration emerged as important sources of nurses' ethical conflicts and were connected to historical and societal factors. CONCLUSIONS In order to achieve good quality of care, nurses need to have appropriate education and organisational support to carry out ethical daily care. More research is needed to understand the multidimensional cultural and contextual knowledge of ethics and nurses' ethical conflicts.
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Affiliation(s)
| | - Ere Uibu
- 87178University of Tartu, Estonia
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18
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Abstract
BACKGROUND Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit. There is a gap in our understanding of nurses' perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. RESEARCH QUESTION/OBJECTIVES/METHODS The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. PARTICIPANTS AND RESEARCH CONTEXT Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. ETHICAL CONSIDERATIONS This study was approved by the Institutional Review Board at the organization where the study took place. FINDINGS Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. DISCUSSION Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. CONCLUSION These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA; Froedtert & the Medical College of Wisconsin, USA
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19
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Zuriguel-Pérez E, Falcó-Pegueroles A, Agustino-Rodríguez S, Gómez-Martín MDC, Roldán-Merino J, Lluch-Canut MT. Clinical nurses's critical thinking level according to sociodemographic and professional variables (Phase II): A correlational study. Nurse Educ Pract 2019; 41:102649. [PMID: 31698254 DOI: 10.1016/j.nepr.2019.102649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 07/10/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022]
Abstract
Critical thinking ability is one of the basic competencies of clinical nurse and is widely accepted as being associated with the provision of quality care, however, the few evidence-based data related to the relationship between level of critical thinking ability and nurses' sociodemographic and professional characteristics. The aim of this study was to identify the level of critical thinking among nurses in clinical practice according to sociodemographic and professional variables. Descriptive cross-sectional and correlational study was carried out in a sample of 339 nurses from medical, surgical and critical care units at a tertiary care hospital. This study is related to a previous publication that presents psychometric analysis. Data were compiled using the Nursing Critical Thinking in Clinical Practice Questionnaire and ad hoc form for the recording of sociodemographic and professional characteristics. The statistical analysis of the data was performed using frequency, Mann-Whitney U Test, Kruskal-Wallis Test, and Pearson's correlation coefficients. Nurses reported moderate levels of critical thinking. Older nurses, with 11-15 years of experience in the actual unit, with continuous shift work, a permanent contract and master's degree indicated a higher level of critical thinking. Critical thinking skills are related to certain socio-demographic and professional variables, particularly age, years of experience, shift work, type of contract and educational level.
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Affiliation(s)
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Spain(1)(2).
| | | | | | - Juan Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada School of Nursing, Barcelona, Spain(2)
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20
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Conflict Experienced by Nurses Providing End-of-life Care in Emergency Departments in Japan. J Trauma Nurs 2019; 26:154-163. [PMID: 31483774 DOI: 10.1097/jtn.0000000000000441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.
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21
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Lluch-Canut T, Sequeira C, Falcó-Pegueroles A, Pinho JA, Rodrigues-Ferreira A, Olmos JG, Roldan-Merino J. Ethical conflicts and their characteristics among critical care nurses. Nurs Ethics 2019; 27:537-553. [PMID: 31303110 DOI: 10.1177/0969733019857785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. AIM The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version and, second, to analyse Portuguese critical care nurses' level of exposure to ethical conflict and its characteristics. METHODS A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. ETHICAL CONSIDERATIONS The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. FINDINGS The Portuguese version of the Ethical Conflict Nursing Questionnaire-Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources.
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22
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Karjalainen H, Halkoaho A, Pietilä AM, Bendel S, Keränen T. Intensive care nurses' perceptions of various ethics concerns affecting clinical research. Scand J Caring Sci 2019; 33:371-379. [PMID: 30604882 DOI: 10.1111/scs.12632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive-care unit (ICU) nurses have an important role in the recruitment of patients for scientific research and in the performance of clinical research. AIM A study was conducted to examine ICU nurses' perceptions of ethics-related aspects of ICU-based research. The study focused on nurse attitudes and knowledge related to clinical research, with special emphasis on perceptions of the informed-consent process in ICU research. METHOD The study applied a descriptive qualitative approach, involving semi-structured group interviews and theme-based inductive content analysis. Subjects were ICU nurses (n = 28) at a university hospital ICU who had experience with research protocols applied in that unit. FINDINGS The nurses had mainly positive perceptions of clinical studies. They found research beneficial for future patients and for society. The nurses considered the information given to them about the studies inadequate. They were concerned about the fact that the consent for research is almost always obtained at the beginning of the ICU care, when patients and relatives are still in the crisis period. This limits the possibility of understanding and assimilating the information provided on the study. CONCLUSIONS The role of ICU nurses in clinical studies should be more prominent and taken into account in the planning of ICU studies.
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Affiliation(s)
| | - Arja Halkoaho
- Tampere University of Applied Sciences, Tampere, Finland
| | - Anna-Maija Pietilä
- Faculty of Health Sciences, Kuopio Social and Health Care Services, University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tapani Keränen
- Department of Neurology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.,Science Service Center, Kuopio University Hospital, Kuopio, Finland
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23
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Pishgooie AH, Barkhordari-Sharifabad M, Atashzadeh-Shoorideh F, Falcó-Pegueroles A. Ethical conflict among nurses working in the intensive care units. Nurs Ethics 2018; 26:2225-2238. [PMID: 30336767 DOI: 10.1177/0969733018796686] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it. OBJECTIVES This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units. RESEARCH DESIGN This was a descriptive cross-sectional research. PARTICIPANTS AND RESEARCH CONTEXT In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version). ETHICAL CONSIDERATIONS This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed. FINDINGS The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to "using resources despite believing in its futility," with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of "working with incompetent staff." The most frequently observed type of conflict was moral dilemma. CONCLUSION The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment.
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Saberi Z, Shahriari M, Yazdannik AR. The relationship between ethical conflict and nurses' personal and organisational characteristics. Nurs Ethics 2018; 26:2427-2437. [PMID: 30134760 DOI: 10.1177/0969733018791350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict. AIM The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses. METHODS This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0). ETHICAL CONSIDERATIONS All participants were informed about the study's aim and were assured that participation in and withdrawal from the study would be voluntary. FINDINGS The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was "working with professionally incompetent nurses or nurse assistants." Married nurses, nurses with official employment, nurses with master's degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager's conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict. CONCLUSION Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses' exposure to ethical conflict.
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Via-Clavero G, Sanjuán-Naváis M, Romero-García M, de la Cueva-Ariza L, Martínez-Estalella G, Plata-Menchaca E, Delgado-Hito P. Eliciting critical care nurses' beliefs regarding physical restraint use. Nurs Ethics 2018; 26:1458-1472. [PMID: 29495933 DOI: 10.1177/0969733017752547] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses' intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses' beliefs regarding the use of physical restraints would provide additional social information about nurses' intention to perform this practice. AIM To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. RESEARCH DESIGN A belief elicitation study was conducted. PARTICIPANTS AND RESEARCH CONTEXT Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. ETHICAL CONSIDERATIONS Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. FINDINGS Nurses framed the use of restraints as a way of prioritising patients' physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients' relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients' medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. DISCUSSION Safety arguments based on the surrounding work environment were discussed. CONCLUSION Nurses' behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives' involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.
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Affiliation(s)
- Gemma Via-Clavero
- Nursing Research Group (GRIN-IDIBELL), Hospital Universitari de Bellvitge, Spain; University of Barcelona, Spain
| | - Marta Sanjuán-Naváis
- Nursing Research Group (GRIN-IDIBELL), Hospital Universitari de Bellvitge, Spain
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Motaharifar F, Atashzadeh-Shoorideh F, Pishgooie AH, Falcó-Pegueroles A. Translation and psychometric properties of the "ethical conflict in nursing questionnaire: critical care version" in Iran. Electron Physician 2017; 9:3776-3785. [PMID: 28465806 PMCID: PMC5410905 DOI: 10.19082/3776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/15/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Ethical conflict is one of ICU nurses’ main problems, which rise for several reasons that must be measured. Unfortunately, there is no native instrument for measuring ethical conflicts for ICU nurses in Iran. One of the more suitable and new tools for the measurement of ethical conflict is called the “Ethical Conflict in Nursing Questionnaire: Critical Care Version (ECCNQ-CCV).” This study was aimed to translate and investigate psychometric properties of the ECCNQ-CCV in Iranian nurses. Methods In this methodological study, after translation and cultural adaptation, face validity, content validity, and construct validity were assessed. Then, internal consistency and stability were measured for reliability. Two software programs (SPSS version 20 and AMOS) were used for data analysis. Result Face and content validities were acceptable. Confirmatory factor analysis was not fitted. Thus, exploratory factor analysis was done, which showed five factors. However, some of the scenarios in a factor were not compatible with each other, and choosing the fit name for factors was not possible. Thus, all the scenarios were put into one factor, which has been proposed by the developer in the original version. The alpha Cronbach was 0.92 for the total scale. Conclusions Findings show that the one factor Persian version of the ECNQ-CCV has acceptable psychometric properties. It can be used to evaluate ethical conflicts in Iranian ICU nurses.
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Affiliation(s)
- Fatemeh Motaharifar
- M.Sc. Management Nursing Student, Department of Nursing Management, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Ph.D. in Nursing, Assistant Professor, Department of Nursing Management, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hosein Pishgooie
- Assistant Professor, Ph.D., M.Sc., B.Sc., RN., Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Anna Falcó-Pegueroles
- Ph.D. in Nursing, MHSc., RN, Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing., Faculty of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
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Abstract
Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.
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Choi JS, Kim JS. Factors influencing emergency nurses’ ethical problems during the outbreak of MERS-CoV. Nurs Ethics 2016; 25:335-345. [DOI: 10.1177/0969733016648205] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Whenever there has been a worldwide contagious disease outbreak, there have been reports of infection and death of healthcare workers. Particularly because emergency nurses have contact with patients on the front line, they experience ethical problems in nursing while struggling with infectious diseases in an unfavorable environment. Objective: The objective of this study was to explore emergency nurses’ ethical problems and to identify factors influencing these problems during the outbreak of Middle East respiratory syndrome–coronavirus in Korea. Design and sample: For this cross-sectional study, a questionnaire survey was conducted with emergency nurses working in six hospitals selected through convenience sampling from the hospitals designated for Middle East respiratory syndrome–coronavirus patients in the capital area. Methods: Data were collected from 169 emergency nurses in Korea during August 2015. Ethical considerations: This research was approved by the Institutional Review Board of G University in Korea. Results: The findings of this study suggest that during the Middle East respiratory syndrome–coronavirus outbreak, emergency nurses experienced ethical problems tied to a mind-set of avoiding patients. Three factors were found to influence emergency nurses’ ethical problems (in order of influence): cognition of social stigmatization, level of agreement with infection control measures, and perceived risk. Conclusion: Through this study, we obtained information on emergency nurses’ ethical problems during the Middle East respiratory syndrome–coronavirus outbreak and identified the factors that influence them. As found in this study, nurses’ ethical problems were influenced most by cognitions of social stigmatization. Accordingly, to support nurses confidently care for people during future health disasters, it is most urgent to promote appropriate public consciousness that encourages healthcare workers.
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