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Ghobadi A, Sayadi L, Nayeri ND, Shabestari AN, Varaei S. The nurses' perception of the factors influencing professional misconduct: A qualitative study. Nurs Ethics 2024; 31:281-295. [PMID: 37599451 DOI: 10.1177/09697330231184469] [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: 08/22/2023]
Abstract
BACKGROUND Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors. AIM This study aimed to explain the factors influencing professional misconduct in nurses. RESEARCH DESIGN This qualitative study was conducted using the conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach. ETHICAL CONSIDERATIONS The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality. FINDINGS Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics). CONCLUSION This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.
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Affiliation(s)
- Akram Ghobadi
- Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Sayadi
- Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
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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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Afoko V, Hewison A, Newham R, Neilson S. Moral distress in nurses in developing economies: an integrative literature review. J Res Nurs 2023; 28:609-627. [PMID: 38162718 PMCID: PMC10756174 DOI: 10.1177/17449871231216606] [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: 01/03/2024] Open
Abstract
Background Moral distress has been extensively studied in developed economies; however, not much in terms of studies has been carried out in developing economies. Objective To review the literature reporting the experience of moral distress in nurses in health care settings in developing economies. Design An integrative literataure review was used. Method Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online Cochrane and Psych INFO were searched to retrieve titles and abstracts of papers on the experience of moral distress in nurses in developing economies. Results Sixteen articles reporting the experience of moral distress in nurses in developing economies published between 1984 and March 2019 were used for the review. Analysis of the findings revealed seven themes, nurses' experience of moral distress, inadequate material and human resources, end-of-life challenges, cultural and religious beliefs as a source of moral distress, perceived inactions of medical and nursing staff, impact of moral distress on nurses in developing economies and coping strategies. Conclusion There is paucity of empirical studies on moral distress in nurses in developing economies. More qualitative studies are needed in various cultural settings to enhance its understanding in nurses working in developing economies.
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Affiliation(s)
- Vivian Afoko
- Lecturer, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Alistair Hewison
- Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Roger Newham
- Associate Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Susan Neilson
- Senior Lecturer, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Lotfi-Bejestani S, Atashzadeh-Shoorideh F, Ghafouri R, Nasiri M, Ohnishi K, Ghadirian F. Is there any relationship between nurses' perceived organizational justice, moral sensitivity, moral courage, moral distress and burnout? BMC Nurs 2023; 22:368. [PMID: 37803416 PMCID: PMC10559416 DOI: 10.1186/s12912-023-01536-x] [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: 12/13/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
AIM The present study is an attempt to investigate the relationship between Corley's model variables in mental health nurses. BACKGROUND Based on Corley's model, burnout and moral distress in nurses are, in retrospect, the consequences of the interplay of organizational and individual factors such as perceived organizational justice, moral sensitivity, and moral courage. The relationship between two variables or three variables of Corley's moral distress model has been investigated, but the test of Corley's moral distress model with more variables has not been done. Therefore, this research was proposed with the aim of investigating the relationship between the variables of moral courage and moral sensitivity (as characteristics of nurses), perceived organizational justice (as an antecedent), moral distress, and job burnout (as consequences of moral distress). METHODS The study was conducted as a descriptive correlational study involving 500 nurses working in the mental health wards of hospitals. Data collection was conducted using perceived organizational justice scale, moral sensitivity scale, moral courage scale, moral distress scale, and burnout inventory. RESULTS The results showed a significant relationship between perceived organizational justice, moral sensitivity, moral courage, and moral distress (< 0.05). Moreover, perceived organizational justice and moral distress had an inverse relationship. Moral sensitivity and moral courage had a direct relationship with moral distress (< 0.05). Furthermore, the results showed inadequate model fitness. CONCLUSIONS This study adds to the existing knowledge about the experiences of mental health nurses and their interactions with both organizational and individual factors. It highlights that the connections between perceived organizational justice, moral sensitivity, moral courage, moral distress, and burnout are intricate and multifaceted. As we deepen our understanding of these relationships, it opens the door for the development of interventions and strategies to enhance nurses' well-being and the quality of care they deliver in mental health settings. Moreover, future research and ongoing refinement and expansion of Corley's model will be crucial in addressing the complex challenges within the healthcare sector.
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Affiliation(s)
- Sara Lotfi-Bejestani
- Master of Science in psychiatric nursing student, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing & Management, School of Nursing and midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Raziyeh Ghafouri
- Medical-Surgical Nursing Department, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kayoko Ohnishi
- Graduate School of Nursing, Nagoya City University, Nagoya, Japan
| | - Fataneh Ghadirian
- Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shomalinasab E, Bagheri Z, Jahangirimehr A, Bahramnezhad F. The Nurses' Second Victim Syndrome and Moral Distress. Nurs Ethics 2023; 30:822-831. [PMID: 36988002 DOI: 10.1177/09697330221142079] [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: 03/30/2023]
Abstract
BACKGROUND The increasing prevalence of moral distress in the stressful environment of the intensive care unit (ICU) provides grounds for nursing error and endangers patients' health, safety, and even life. One of the most important reasons for this distress is the treatment team's second victim syndrome (SVS), especially nurses, following errors in the treatment system. OBJECTIVES The present study aimed to determine the relationship between moral distress and SVS in ICUs. RESEARCH DESIGN This cross-sectional study involved a sample size of 96 ICU nurses working in hospitals affiliated with Tehran University of Medical Sciences, Iran, in the 2021-2022 period, who were selected via a simple random sampling method. Data were collected using the Demographic Questionnaire, the second victim experience and support tool (SVEST) and Moral Distress Scale-Revised (MDS-R). Descriptive statistics (percentage, frequency, mean, and SD) and analytical tests (Spearman correlation coefficient test, independent t-test, and ANOVA) were employed for data analysis. PARTICIPANTS AND RESEARCH CONTEXT This study used a sample size of 96 intensive care unit nurses working in hospitals affiliated to Tehran University of Medical Sciences selected by simple random sampling. ETHICAL CONSIDERATIONS The study obtained research ethics approval, and all participants were informed of the voluntary and anonymous nature of their participation. FINDINGS The results showed that 59.4% of nurses suffered a low level of moral distress, and 40.6% suffered from a moderate level of moral distress. The SVS score of 86.5% of the nurses was moderate. There was no significant and direct correlation between moral distress and SVS in nurses; however, there was a significant and inverse correlation between the moral distress intensity and SVS (p = 0.011). CONCLUSION Despite no significant correlation between moral distress and SVS, these variables were at moderate levels. Accordingly, it is suggested to provide a proper ground for expressing morally stressful situations, counseling and training strategies to deal with moral distress, creating support resources for those suffering from SVS, and implementing empowerment programs.
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Affiliation(s)
- Esmat Shomalinasab
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Fatemeh Bahramnezhad
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Watts T, Sydor A, Whybrow D, Temeng E, Hewitt R, Pattinson R, Bundy C, Kyle RG, Jones B. Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed-methods systematic review and thematic synthesis. Nurs Open 2023; 10:6014-6032. [PMID: 37458290 PMCID: PMC10416007 DOI: 10.1002/nop2.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
AIM To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and professional and career intentions. DESIGN Joanna Briggs Institute mixed-methods systematic review and thematic synthesis. Registered in Prospero (Redacted). METHODS Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction. RESULTS Searches yielded 2343 hits. Seventy-seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well-being. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to this systematic review.
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Affiliation(s)
- Tessa Watts
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Anna Sydor
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Dean Whybrow
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Eunice Temeng
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Rachael Hewitt
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | | | - Richard G. Kyle
- Public Health WalesCardiffUK
- Academy of NursingUniversity of ExeterExeterUK
| | - Bethan Jones
- School of Healthcare SciencesCardiff UniversityCardiffUK
- School of Health and Social WellbeingUniversity of West of EnglandBristolUK
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7
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Khaghanizadeh M, Koohi A, Ebadi A, Vahedian-Azimi A. The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial. BMC Med Ethics 2023; 24:58. [PMID: 37542315 PMCID: PMC10403849 DOI: 10.1186/s12910-023-00938-5] [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: 05/28/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity. METHODS In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. RESULTS Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009). CONCLUSIONS The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. REGISTRATION This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.
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Affiliation(s)
- Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Aliakbar Koohi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Sheykh bahayi Street, Vanak Square Tehran, Tehran, P.O. Box 19575-174, Iran
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8
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Kalani Z, Barkhordari-Sharifabad M, Chehelmard N. Correlation between moral distress and clinical competence in COVID-19 ICU nurses. BMC Nurs 2023; 22:107. [PMID: 37029367 PMCID: PMC10080174 DOI: 10.1186/s12912-023-01277-x] [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: 08/29/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Nurses' clinical competence is one of the fundamental necessities for providing safe and effective care. Moral distress, as one type of occupational stressors, can affect various aspects of clinical competence, especially under conditions of complicated medical settings such as the coronavirus disease 2019 (COVID-19) epidemic. This study was conducted with the aim of determining the relationship between moral distress and clinical competence in nurses working in COVID-19 intensive care units (ICUs). METHODS The study was a cross-sectional study. A total of 194 nurses working in COVID-19 ICU affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, central Iran, participated in the study. Data were collected using Demographic Information Questionnaire, Moral Distress Scale, and Clinical Competence Checklist. Data were analyzed with SPSS20 using descriptive and analytical statistics. RESULTS The mean score of moral distress, clinical competence, and skills application were 1.79 ± 0/68, 65.16 ± 15.38, and 145.10 ± 38.20, respectively. Based on Pearson correlation coefficient, there was an inverse and significant relationship between the moral distress score and its dimensions with clinical competence and skills application (P < 0.001). Moral distress was a significant negative predictor that accounted for 17.9% of the variance in clinical competence (R2 = 0.179, P < 0.001) and 16% of the variance in utilization of clinical competence (R2 = 0.160, P < 0.001). CONCLUSION Considering the relationship between moral distress, clinical competence and skills application, to maintain the quality of nursing services, nursing managers can strengthen clinical competence and skills application by using strategies to deal with and reduce moral distress in nurses, especially in critical situations.
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Affiliation(s)
- Zohreh Kalani
- Department of Nursing, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Niloufar Chehelmard
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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9
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Gorji MAH, Sahebi AK, Yaghoubi T, Cherati JY, Ahmed S, Zhianfar L. Investigating the link between organisational justice, positive organisational behaviour and productivity in emergency nurses. Emerg Nurse 2023; 31:33-40. [PMID: 36217750 DOI: 10.7748/en.2022.e2134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Human resource management and employees' performance are fundamental to the success of healthcare organisations. Therefore, it is important to consider the factors that may affect employees' performance. AIM To determine the relationship between perceived organisational justice, positive organisational behaviour (POB) and the productivity of emergency nurses. METHOD This was a descriptive-analytical study that involved distributing questionnaires to emergency nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in Iran. The researchers used proportionate stratified sampling to calculate the sample size. Three questionnaires were used to collect data on organisational justice, POB and productivity. The data were analysed using the Pearson correlation coefficient and multiple regression tests. RESULTS The questionnaires were distributed to 284 emergency nurses and completed by 234 of them. The results demonstrated a significant relationship between the productivity of the emergency nurses and the variables of perceived organisational justice and POB. CONCLUSION Higher levels of perceived organisational justice and POB in the ED setting are likely to lead to increased productivity among emergency nurses, and as a result the quality of patient care is likely to improve. Therefore, healthcare organisations should pay particular attention to the application of organisational justice, with the aim of promoting POB among nurses and increasing their productivity.
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Affiliation(s)
| | | | - Tahereh Yaghoubi
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani Cherati
- Faculty of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Leila Zhianfar
- Community Health Department, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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10
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Alimoradi Z, Jafari E, Lin CY, Rajabi R, Marznaki ZH, Soodmand M, Potenza MN, Pakpour AH. Estimation of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics 2023; 30:334-357. [PMID: 36704986 PMCID: PMC9902807 DOI: 10.1177/09697330221135212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. AIM To estimate moral distress among nurses. METHODS This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. ETHICAL CONSIDERATION The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. RESULTS Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. CONCLUSION The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.
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Affiliation(s)
| | - Elahe Jafari
- 113106Qazvin University of Medical Sciences, Qazvin, Iran
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | | | | | | | - Marc N Potenza
- Yale University, USA; Connecticut Council on Problem Gambling, USA; Connecticut Mental Health Center, USA; Wu Tsai Institute, Yale University, USA
| | - Amir H Pakpour
- Jönköping University, Sweden; Qazvin University of Medical Sciences, Iran
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11
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Afoko V, Hewison A, Neilson S, Newham R. Moral distress experienced by neonatal intensive and
paediatric care nurses in Northern Ghana: a qualitative
study. J Res Nurs 2022; 27:519-529. [PMCID: PMC9634244 DOI: 10.1177/17449871221122022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Moral distress has been studied widely in nursing but not in
developing economies. Aim: To investigate how moral distress is experienced by nurses working
in neonatal intensive care and paediatric wards in Northern
Ghana and to determine support measures offered by nurse
managers. Method: Qualitative descriptive method. Forty nurses and fourteen nurse
managers working with children in four hospitals in Northern
Ghana were interviewed. Thematic data analysis was carried
out. Results: Six themes were identified: nurses experience morally distressing
situations due to a variety of causes; the impact of morally
distressing situations on nurses; coping mechanisms of nurses
who experienced morally distressing situations; recommendations
made by the nurses to reduce the incidence of moral distress;
inadequate support measures available to nurse managers and
nurse managers experience moral distress too. Conclusion: The causes of moral distress in developed and developing economies
are similar. The frequency and intensity of moral distress is
high in Northern Ghana. Consistent with other studies conducted
in Africa, nurses and nurse managers relied on their religious
faith as a form of resilience. No support measures are available
to nurse managers to support nurses who experience moral
distress.
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Affiliation(s)
- Vivian Afoko
- PhD Candidate, Nursing, University of
Birmingham, Birmingham, UK
| | - Alistair Hewison
- Reader Nursing, Nursing, University
of Birmingham, Birmingham, UK
| | - Susan Neilson
- Associate Professor Nursing, Nursing,
University of Birmingham, Birmingham, UK
| | - Roger Newham
- Roger Newham, College of Medical
and Dental Sciences, University of Birmingham, Edgbaston, Birmingham
B15 2TT UK.
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12
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Jiang W. Beyond the Psychopathological Approach to Study the Relationship between Body Dissatisfaction and Suicide: A Moderate and Mediated Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6285473. [PMID: 36277888 PMCID: PMC9584680 DOI: 10.1155/2022/6285473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022]
Abstract
This paper provides a comprehensive review of the literature to date on body dissatisfaction and suicide. A moderate and mediated regression analysis suggests that the relationship between these two variables is mediated by depression, anxiety, impulse control, self-esteem, and hopelessness. The relationship is not moderated by gender, ethnicity, or socioeconomic status. The implications for mental health practitioners are discussed in relation to management strategies for body dissatisfaction and suicide risk. Another finding showed that psychological distress had a significant effect on performance achievement and served as a mediating variable for the effect of social justice on performance achievement. This study only focused on the effect of psychological distress on the performance achievement of human resources in the context of Islamic microfinance institutions. Besides, in explaining the model, this study only focused on one point of view of the grand theory, i.e., social exchange theory. This study provided information on alternative strategies in managing and minimizing the risks of psychological distress to improve performance achievement in Islamic microfinance institutions. Apart from that, this study also provided an overview of how to manage social exchange relationships in the context of an organization, so they could be well-maintained. This study examined the effect of psychological distress on the performance achievement of human resources in the context of Islamic microfinance institutions. This study also specifically examined the role of formal justice and social justice as an antecedent of psychological distress. Eventually, this study used the perspective of social exchange theory for the first time in explaining the psychological distress model on the performance achievement of human resources.
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Affiliation(s)
- Wei Jiang
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China
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Magnavita N, Chiorri C, Acquadro Maran D, Garbarino S, Di Prinzio RR, Gasbarri M, Matera C, Cerrina A, Gabriele M, Labella M. Organizational Justice and Health: A Survey in Hospital Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159739. [PMID: 35955099 PMCID: PMC9367749 DOI: 10.3390/ijerph19159739] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 05/14/2023]
Abstract
In complex systems such as hospitals, work organization can influence the level of occupational stress and, consequently, the physical and mental health of workers. Hospital healthcare workers were asked to complete a questionnaire during their regular occupational health examination, in order to assess the perceived level of organizational justice, and to verify whether it was associated with occupational stress, mental health, and absenteeism. The questionnaire included the Colquitt Organizational Justice (OJ) Scale, the Karasek/Theorell demand-control-support (DCS) questionnaire for occupational stress, and the General Health Questionnaire (GHQ12) for mental health. Workers were also required to indicate whether they had been absent because of back pain in the past year. Organizational justice was a significant predictor of occupational stress. Stress was a mediator in the relationship between justice and mental health. Occupational stress was more closely related to perceptions of lack of distributive justice than to perceptions of procedural, informational, and interpersonal justice. Physicians perceived significantly less distributive justice than other workers. In adjusted univariate logistic regression models, the perceptions of organizational justice were associated with a significant reduction in the risk of sick leave for back pain (OR 0.96; CI95% 0.94−0.99; p < 0.001), whereas occupational stress was associated with an increased risk of sick leave (OR 6.73; CI95% 2.02−22.40; p < 0.002). Work organization is a strong predictor of occupational stress and of mental and physical health among hospital employees.
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Affiliation(s)
- Nicola Magnavita
- Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Department of Woman, Child & Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-3473300367
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genova, 16126 Genova, Italy
| | - Daniela Acquadro Maran
- WOW—Work and Organisational Well-Being Research Group, Department of Psychology, Università di Torino, 10124 Torino, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Reparata Rosa Di Prinzio
- Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | | | | | - Anna Cerrina
- Local Sanitary Unit Roma4, 00053 Civitavecchia, Italy
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Organizational Justice and Health: Reviewing Two Decades of Studies. JOURNAL OF THEORETICAL SOCIAL PSYCHOLOGY 2022. [DOI: 10.1155/2022/3218883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Organizational justice refers to employees’ perceptions of the fairness of decision-making rules and policies in the workplace. Lack of justice is suggested to be a significant psychosocial risk factor that affects employees’ attitudes and health. The aim of this narrative review was to compile the evidence available about the effects of organizational justice on health. To this end, a literature search was carried out using the Web of Science, PubMed, and PsycINFO databases. The final sample consisted of 103 articles that studied the effects of justice on mental health (40 results), job stress (26), sickness absence (15), physical health (14), absenteeism/presenteeism (3), safety at work (3), and health of third parties (2). The results show that perceptions of workplace justice predict employees’ mental health, stress-related health problems, and lower levels of sickness absence were relatively compelling. Future studies should focus on less-researched outcomes and on how these associations are modified by other variables for a better understanding of how justice affects health, with a view to being able to carry out preventive measures more efficiently.
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Deressa B, Adugna K, Bezane B, Jabessa M, Wayessa G, Kebede A, Tefera G, Demissie Y. The Relationship Between Organizational Commitment and Organizational Justice Among Health Care Workers in Ethiopian Jimma Zone Public Health Facilities. J Healthc Leadersh 2022; 14:5-16. [PMID: 35140539 PMCID: PMC8820756 DOI: 10.2147/jhl.s345528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background The healthcare service sector is confronting a global labor shortage. Despite this fact, health care professionals are still highly vulnerable to organizational injustice, which negatively influence organizational commitment, putting an additional burden on the health sector. Thus, this study aimed to investigate the correlation between organizational commitment and organizational justice among health care workers. Methods Facility-based cross-sectional study design was conducted among 395 health care professionals in the Jimma zone. Four Hospitals and 10 health centers were involved in the study randomly. The sample was distributed proportionally based on the number of health care workers. To select individuals, a systematic random sampling method was employed. Data were collected through self-report questionnaire using modified Alan and Mayer scale to measure organizational commitment and Niehoff and Moorman scale to measure organizational justice. The validity of the tools was checked using the reliability coefficient alpha and it was >0.7. The collected data were cleaned and entered into EpiData software version 3.1 and exported to SPSS version 20 for analysis. Descriptive and inferential statistics were done. Results This study revealed that 212 (53.7%) of the respondents scored a low level of organizational commitment. About half of the participants, 202 (52.2%), judged organizational justice were fair. All organizational justice dimensions showed a positive and significant correlation with all organizational commitment dimensions. Thus, the finding revealed that overall organizational commitment and organizational justice had a strong and positive correlation (r = 0.695**, P < 0.01). From the regression analysis distributive justice (B = 0.382, 95% CI: 0.31–0.45), and procedural justice (B = 0.17, 95% CI: 0.06–0.283) were among the factors affecting organizational commitment. Conclusion and Recommendation This study showed a strong link between organizational commitment and organizational justice. This suggests that organizational justice has been recognized as a motivator and factor influencing health care workers’ organizational commitment. As a result, enhancing organizational justice can help to maintain the commitment of healthcare workers and the facility’s capabilities.
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Affiliation(s)
- Beshea Deressa
- Department of health policy and management, Jimma University, Jimma, Ethiopia
| | - Kebebe Adugna
- School of Nursing and midwifery, Jimma University, Jimma, Ethiopia
| | - Bezawit Bezane
- Department of health policy and management, Jimma University, Jimma, Ethiopia
| | - Matebu Jabessa
- Department of health policy and management, Jimma University, Jimma, Ethiopia
| | - Gemechis Wayessa
- Clinical governance and quality improvement, Jimma Medical Center, Jimma University, Jimma, Ethiopia
| | - Alemi Kebede
- Department of reproductive health and Nutrition, Jimma University, Jimma, Ethiopia
| | - Gelila Tefera
- Department of health policy and management, Jimma University, Jimma, Ethiopia
- Correspondence: Gelila Tefera; Beshea Deressa, Department of health policy and management, Jimma University, PO Box: 378, Jimma, Oromia, Ethiopia, Tel +251 932448617, Email ;
| | - Yisalemush Demissie
- Department of health policy and management, Jimma University, Jimma, Ethiopia
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Wilson CA, Metwally H, Heavner S, Kennedy AB, Britt TW. Chronicling moral distress among healthcare providers during the COVID-19 pandemic: A longitudinal analysis of mental health strain, burnout, and maladaptive coping behaviours. Int J Ment Health Nurs 2022; 31:111-127. [PMID: 34644443 PMCID: PMC8653372 DOI: 10.1111/inm.12942] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020-December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross-level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.
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Affiliation(s)
| | | | | | - Ann Blair Kennedy
- University of South Carolina School of Medicine Greenville Campus, Greenville, South Carolina, USA
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Ekingen E. The Effect of Organizational Justice on Job Performance and the Mediating Role of Job Satisfaction: A Study on Nurses. Hosp Top 2021; 101:103-112. [PMID: 34592912 DOI: 10.1080/00185868.2021.1969874] [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: 10/20/2022]
Abstract
This study aims identifying the effects of nurses' perceptions of organizational justice on their performance and to test the mediating role of job satisfaction. This is a cross-sectional study. This study conducted with 374 nurses working hospitals. The research model was tested using structural equation modeling and the bootstrap technique. Organizational justice has been found to have a significant impact on job performance and job satisfaction. Job satisfaction had a partial mediating role. The results of this study could guide the more effective and efficient use of human resources in nursing management and contribute to the literature of health and nursing management.
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Affiliation(s)
- Erhan Ekingen
- Health College Department of Health Management, Batman University, Central Campus, Batman, Turkey
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Ghafouri R, Lotfi-Bajestani S, Nasiri M, Ohnishi K, Atashzadeh-Shoorideh F. Psychometrics of the moral distress scale in Iranian mental health nurses. BMC Nurs 2021; 20:166. [PMID: 34507581 PMCID: PMC8431900 DOI: 10.1186/s12912-021-00674-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the challenges that nurses often face in ethical decision-making situations is moral distress. Moral distress is caused by the conflict between professional and individual values in decision-making situations. Despite its importance, there is no reliable scale in Persian to measure it. Therefore, this study was conducted to validate the moral distress scale in mental health nurses in Iranian culture and Persian language. METHODS This study was conducted in two parts: Translation and cross-cultural adaptation and psychometric analysis. The translation and cross-cultural adaptation process was conducted based on the Polit approach. Next, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined. This part of the study was a cross-sectional study. In this step, a demographic questionnaire and the Moral Distress Scale were sent to 500 nurses working in selected educational and medical centers in Iran via online questionnaires. Then, the construct validity of the "Moral Distress Scale" was confirmed by confirmatory factor analysis and the reliability of the instrument was examined by studying the internal consistency with Cronbach's alpha and the internal correlation of the AIC. RESULTS The confirmatory factor analysis showed an acceptable ratio of the expressions in 15 items in three factors: Acquiescence to patients' rights violations (6 items), Unethical conduct by caregivers (5 items), and low staffing (4 items) in the scale. The internal consistency of the instrument with Cronbach's alpha was higher than 7.0. CONCLUSION The Persian version of moral distress with 15 items of the three factors had validity and reliability. According to the present findings, this scale can be used to study moral distress among nurses working in psychiatric wards. Moral distress leads to burnout, increases risks to patient safety and reduces quality of care. Nurses need to be able to assess and manage moral distress. Therefore, considering the side effects, it is necessary to have a reliable and valid scale that can be studied. Considering that culture has an impact on nurses' moral distress, it is suggested that this instrument be studied in and tested in other languages and cultures.
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Affiliation(s)
- Raziyeh Ghafouri
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Lotfi-Bajestani
- Nursing Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kayoko Ohnishi
- Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Hyogo, Japan
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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19
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Organisational Justice and Political Agency among Nurses in Public Healthcare Organisations: A Qualitative Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179110. [PMID: 34501698 PMCID: PMC8430870 DOI: 10.3390/ijerph18179110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
Nurses are rarely treated as equals in the social, professional, clinical, and administrative life of healthcare organisations. The primary objective of this study is to explore nurses’ perceptions of organisational justice in public healthcare institutions in Majorca, Balearic Islands, Spain, and to analyse the ways in which they exercise their political agency to challenge the institutional order when it fails to reflect their professional ethos. An ethnomethodological approach using critical discourse analysis will be employed. The main participants will be nurses occupying different roles in healthcare organisations, who will be considered central respondents, and physicians and managers, who will be considered peripheral respondents. Data generation techniques include semi-structured interviews, a sociodemographic questionnaire, and the researcher’s field diary. This is one of the first studies to address organisational justice in healthcare organisations from a macrostructural perspective and to explore nurses’ political agency. The results of this study have the potential to advance knowledge and to ensure that healthcare organisations are fairer for nurses, and, by extension, for the patients in their care.
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Zahednezhad H, Shokrollahi N, Gheshlagh RG, Afshar PF. Does heavy mental workload affect moral sensitivity among critical care unit nursing professionals? a cross-sectional study. BMC Nurs 2021; 20:140. [PMID: 34376186 PMCID: PMC8353778 DOI: 10.1186/s12912-021-00662-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Moral sensitivity creates the basic attitude in providing effective ethical care to patients. Heavy mental workload is a major concern of critical care nursing professionals, which could adversely affect nursing staff and patients. The present study aimed to investigate the effects of mental workload and some demographic variables on the moral sensitivity of critical care nursing professionals. Methods This cross-sectional, descriptive-correlational study was performed on 181 nursing professionals working in the critical care units of Shahid Rajaei Cardiovascular Medical and Research Center in Tehran, Iran. Data were collected using a demographic questionnaire, the moral sensitivity questionnaire, and the NASA-task load index to assess mental workload. Data analysis was performed in SPSS version 22 using descriptive statistics, independent t-test, Pearson’s correlation-coefficient, and regression analysis. Results The results of regression analysis yielded no statistical significant relationship between heavy mental workload and moral sensitivity of the critical care nursing professionals, while clinical experience had a positive, significant association with moral sensitivity. Conclusions Although care nursing professionals experience a heavy mental workload in critical care units, it does not decrease their moral sensitivity. In addition, experienced nurses have higher moral sensitivity and lower mental workload. Therefore, it seems that nursing managers should pay special attention to the importance of employing experienced nurses along with younger nurses.
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Affiliation(s)
- Hosein Zahednezhad
- Department of Psychiatric Nursing and Management, School of Nursing & Midwifery, Shahid Beheshti University Of Medical sciences, Velenjak St, Shahid Chamran Highway, Tehran, Iran.
| | - Nasrin Shokrollahi
- Masters of Science in Critical Care Nursing, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tohid Square, Tehran, Iran
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University Of Medical sciences, Pasdaran Blvd., Sanandaj, Iran
| | - Pouya Farokhnezhad Afshar
- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Shahid Hemmat Highway, 1449614535, Tehran, Iran
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21
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Kakemam E, Torkzadeh L, Rouzbahani M, Zahedi H, Chegini Z. The relationship between workplace deviant behaviors and organizational justice among nurses: A cross-sectional survey. Nurs Forum 2021; 56:889-896. [PMID: 34310711 DOI: 10.1111/nuf.12636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/18/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to determine the correlations between workplace deviant behaviors (WDBs) and the levels of the perceived organizational justice among Iranian nurses. DESIGN This was a cross-sectional quantitative research. METHODS The present research was conducted on 424 nurses selected by a convenience sampling method in 2019 (May-August) in Tabriz, Iran. A self-administered questionnaire, including demographic information, organizational justice, and WDBs, was used for data collection. The data were analyzed using descriptive analysis, the Pearson correlation coefficient, and multiple linear regression analysis. RESULTS Based on the findings, nurses had a moderate level of perception of organizational justice while having a low level of perception regarding the occurrence of WDBs. A significantly reverse correlation was found between perceived organizational justice and WDBs (r = -.295, p <.001). Eventually, the findings of multiple linear regression analysis indicated that the level of perceived organizational justice could significantly predict WDBs (the coefficient of determination, R2 = 0.111). CONCLUSION The study findings confirmed the hypothesis that an improvement in the levels of organizational justice was related to a decrease in the occurrence of WDBs. Therefore, hospitals and nursing managers are suggested to build and maintain a supportive and healthy work environment to enhance the levels of perceived organizational justice and to minimize the incidence of WDBs. They should also address reward systems, organizational policies and procedures, interpersonal justice, and shared decision-making in this respect.
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Affiliation(s)
- Edris Kakemam
- Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Torkzadeh
- Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahtab Rouzbahani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Zahedi
- Student Research Committee, Nursing & Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Lönnqvist K, Flinkman M, Vehviläinen-Julkunen K, Elovainio M. Organizational justice among registered nurses: A scoping review. Int J Nurs Pract 2021; 28:e12983. [PMID: 34114303 DOI: 10.1111/ijn.12983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 02/02/2023]
Abstract
AIMS This study aimed to describe and summarize research concerning organizational justice among registered nurses. BACKGROUND Over the recent decades, a number of studies have explored organizational justice. Perceived high organizational justice among employees has been found to correlate with multiple beneficial outcomes, such as job satisfaction, commitment and improved physical and mental health. By contrast, low organizational justice is related to poor productivity, atmosphere at work, health and well-being. DESIGN This study is a scoping review. DATA Seven databases were used to search for peer-reviewed publications published between January 2015 and August 2019. REVIEW METHOD This scoping review utilized Arksey and O'Malley's methodological framework. RESULTS High organizational justice has been found to improve registered nurses' work-related outcomes, health and well-being. Low organizational justice has been linked to undesired work-related outcomes and health problems. CONCLUSION Nurse managers play a key role in promoting organizational justice. Further research is needed to study the relationship between organizational justice and the quality of patient care and safety. There is need for longitudinal studies to understand the effects and nature of organizational justice in the nursing workforce.
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Affiliation(s)
- Katri Lönnqvist
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Mervi Flinkman
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | - Katri Vehviläinen-Julkunen
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Marko Elovainio
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
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Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int J Nurs Stud 2020; 111:103767. [PMID: 32956930 DOI: 10.1016/j.ijnurstu.2020.103767] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND An increasing number of professionals are challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distress in different studies. Yet, there has not been, so far, a systematic assessment of the qualitative properties of the various instruments measuring moral distress in healthcare workers based on a universally accepted standardized framework. OBJECTIVE (1) To identify all instruments for the measurement of moral distress available in recent literature; (2) to evaluate the evidence regarding their measurement properties; (3) to facilitate the selection of the most appropriate instrument to be adopted in practice and research. DESIGN Systematic literature review. DATA SOURCES PubMed, CINAHL, and PyscINFO. REVIEW METHODS The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of the identified studies. The quality of measurement properties of each instrument was evaluated using Terwee's quality criteria. RESULTS Among the 1268 studies found, 88 full-text articles evaluated moral distress adopting different tools. Thirty two of them had a methodological design. The measurement instruments assessed in this review are different in terms of targeted population and items. The instruments were then divided into two main categories: (1) Corley's instruments on moral distress (Moral distress scale and Moral Distress Scale - Revised) and (2) instruments not directly derived from Corley's moral distress theory (Moral Distress thermometer, Moral Distress Risk Scale, Ethical Stress Scale or Moral Distress in Dementia Care Survey). The first set is the most frequently studied and used in different clinical settings and healthcare populations. A variety of psychometric properties have been evaluated for each instrument, revealing different qualities in the methodology used. CONCLUSIONS Several instruments assessing moral distress in healthcare workers have been identified and evaluated in this systematic review. Based on the criteria used here, Corley's instruments on moral distress seems to be the most useful and most appropriate to the clinical setting for practice and research purposes. TWEETABLE ABSTRACT The aim of this systematic review was to identify the instruments measuring moral distress now available in the literature, in order to (1) assess the evidence about their measurement properties, (2) support the selection of the most appropriate instrument to be used in practice and research.
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Affiliation(s)
- Noemi Giannetta
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Giulia Villa
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pennestrì
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Sala
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Mordacci
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
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Alonso Castillo MM, Armendaríz Garcia NA, Alonso Castillo MTDJ, Alonso Castillo BA, López García KS. Clima ético, estrés de conciencia y laboral de enfermeras y médicos que laboran en cuidados intensivos neonatal. REVISTA LATINOAMERICANA DE BIOÉTICA 2020. [DOI: 10.18359/rlbi.4177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
El objetivo del presente estudio fue determinar la relación entre la percepción del clima ético, el estrés moral y el relacionado con el trabajo. El diseño fue descriptivo correlacional y el muestreo fue tipo censo con un total de muestra de 106 participantes (80 profesionales de enfermería y 26 médicos). Los resultados mostraron que existe una relación negativa y significativa del clima ético con el estrés laboral (rs =-.326, p<.01). Además, se identificó como hallazgo adicional que el clima ético predice el estrés relacionado con el trabajo, tanto en médicos como en enfermeras (R2=7.9, p=.004). La evidencia científica del presente estudio confirma que la bioética como ciencia debe ser competencia de todos los profesionales de la salud y, en particular, de la enfermería, debido a los desafíos éticos y morales de su práctica profesional, especialmente en áreas críticas debido a las políticas, la normatividad y los recursos con los que cuentan el lugar de trabajo. Tanto el clima ético como el estrés moral y laboral deben ser considerados por las instituciones de salud, teniendo en cuenta que pueden influir negativamente en la salud de los médicos y enfermeras que brindan los cuidados, lo cual limita la calidad de la atención.
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Prompahakul C, Epstein EG. Moral distress experienced by non-Western nurses: An integrative review. Nurs Ethics 2019; 27:778-795. [PMID: 31750780 DOI: 10.1177/0969733019880241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Moral distress has been identified as a significant issue in nursing practice for many decades. However, most studies have involved American nurses or Western medicine settings. Cultural differences between Western and non-Western countries might influence the experience of moral distress. Therefore, the literature regarding moral distress experiences among non-Western nurses is in need of review. AIM The aim of this integrative review was to identify, describe, and synthesize previous primary studies on moral distress experienced by non-Western nurses. REVIEW METHOD Whittemore and Knafl's integrative review methodology was used to structure and conduct the review of the literature. RESEARCH CONTEXT AND DATA SOURCES Key relevant health databases included the Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar databases. Two relevant journals, Nursing Ethics and Bioethics, were manually searched. ETHICAL CONSIDERATION We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. FINDINGS A total of 17 primary studies published between 1999 and 2019 were appraised. There was an inconsistency with regard to moral distress levels and its relationship with demographic variables. The most commonly cited clinical causes of moral distress were providing futile care for end-of-life patients. Unit/team constraints (poor collaboration and communication, working with incompetent colleagues, witnessing practice errors, and professional hierarchy) and organizational constraints (limited resources, excessive administrative work, conflict within hospital policy, and perceived lack of support by administrators) were identified as moral distress's stimulators. Negative impacts on nurses' physical, psychological, and spiritual well-being were also reported. CONCLUSION Further research is needed to investigate moral distress among other healthcare professions which may further build understanding. More importantly, interventions to address moral distress need to be developed and tested.
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Hashish EAA. Nurses’ perception of organizational justice and its relationship to their workplace deviance. Nurs Ethics 2019; 27:273-288. [DOI: 10.1177/0969733019834978] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Today, healthcare organizations are challenged to retain nurses’ generation and to maintain justice that is a predictor of nurses’ behaviors in their work environment. Acquiring knowledge about the level of organizational justice and workplace deviance could help in identifying factors amenable for change that can make a difference in enhancing nurses’ dedication and loyalty to their organizations. Aim: The aim of this study was to investigate nurses’ perception of organisational justice and workplace deviance in their hospital, and to determine the relationship between perceived organisational justice and workplace deviance. Methods: A cross-sectional design was used with a convenient sample of all nurses (N = 400) who were working in inpatient care units at two Egyptian hospitals affiliated to the university and private health sectors in Alexandria governorate, Egypt. Organisational justice and workplace deviance questionnaires proved valid and reliable to measure studied variables. Descriptive analysis, Student’s t-test, Pearson correlation (r), and regression analysis (R2) were used for statistical analysis. Ethical considerations: This study was approved by the Ethics Committee at the Faculty of Nursing, Alexandria University. Informed consent, information confidentiality, and voluntary participation were guaranteed. Results: This study showed that overall nurses’ perceptions of organisational justice and workplace deviance are lower than the average. Organisational justice significantly related negatively to workplace deviance (r = −0.152, p = 0.002) and organisational justice as an independent variable contributed a significant predictive power of workplace deviance (R2 = 0.023). Conclusions: This study highlighted important implications for hospital and nurse managers to create and maintain a healthy and supportive work environment that promotes organisational justice and decreases workplace deviance. To achieve this, a culture of respectful communication, justice in policies, and a proper procedure for allocating resources, workload, and rewards systems is a must. Educational interventions to increase nurses’ awareness of workplace deviance and its potential consequences and coping strategies are imperative for the health of the nursing profession.
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Affiliation(s)
- Ebtsam Aly Abou Hashish
- Faculty of Nursing, Alexandria University, Egypt; King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
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Vargas Celis I, Concha Méndez CA. Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To describe the factors that influence the emergence of moral distress in oncology nurses. Methodology: integrative review of the literature whose search will be performed in Web of Science databases, CINAHL (EBSCO), Scielo, Proquest, Pubmed and PsycInfo using the keywords moral distress and oncology nursing and their similes in Spanish, without restriction for years of publication until 2017. Results: The results of this review were grouped into three groups of factors each with subgroups: 1) Organizational factors: ethical climate, evasive culture and resources for ethics delivered by the organization. 2) Particular clinical situations: pain management, information delivery, futile treatment, and assistance to the patient and their family in the process of death, 3) Interpersonal relationships: poor communication, power relations, trust in the team’s competence. Conclusion: the three factors described are triggers of moral distress in oncology nurses. When there are ethical problems and the nurses do not participate in the deliberation process, these problems can be hidden and be normalized, which can diminish the moral sensitivity of the professionals, as well as the possibility of acting as moral agents.
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Topbaş E, Bay H, Turan BB, Çıtlak U, Emir AH, Erdoğan TK, Akkaya L. The effect of perceived organisational justice on job satisfaction and burnout levels of haemodialysis nurses. J Ren Care 2019; 45:120-128. [DOI: 10.1111/jorc.12271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Eylem Topbaş
- Nursing Department, Faculty of HealthAmasya University İpekköy Yerleşkesi Shell Karşısı İpekköyAmasyaTurkey
| | - Hakan Bay
- Bülent Ecevit University Training and Research HospitalZonguldakTurkey
| | | | - Umut Çıtlak
- Cumhuriyet University Medical FacultySivasTurkey
| | - Ahmet Hüdai Emir
- Ondokuz Mayıs University Medical Faculty of Training HospitalSamsunTurkey
| | | | - Lale Akkaya
- Cumhuriyet University Medical FacultyDialysis UnitSivasTurkey
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