Multi-professional perspectives to reduce moral distress: A qualitative investigation

Moral distress in Pediatric otolaryngology: A survey of ASPO members

OBJECTIVES

1. Determine the prevalence of moral distress for pediatric otolaryngologists in North America. 2. Evaluate the impact of demographic variables on moral distress levels.

METHODS

Moral distress is defined as "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action". The Moral Distress Survey-Revised (MDS-R) is a 21-question survey measuring moral distress in pediatric patients. A modified MDS-R (validated with pilot data in pediatric otolaryngology) was anonymously distributed to American Society of Pediatric Otolaryngology (ASPO) members. Descriptive statistics, bivariate and multivariate analysis were performed.

RESULTS

Response rate was 86/656 (13 %). Mean modified MDS-R score was 49 (range 3-128), which is lower than that found in the literature for pediatric surgeons (mean 72), pediatric intensivists (means 57-86), and similar to pediatric oncologists (reported means 42-52). Female respondents had higher MDS-R scores than males (60 vs. 50). Providers in practice <20 years had higher moral distress scores than those practicing >20 years (54 vs. 43). Factors leading to higher degrees of distress involved communication breakdowns/lack of provider continuity and seeing other providers provide false hope to patients.

CONCLUSION

Pediatric Otolaryngologists have low degrees of moral distress compared to other pediatric subspecialists. Those with fewer years of experience have higher levels of moral distress. Further research is necessary to determine the impact of moral distress on the wellness of pediatric otolaryngologists.

Critical care nurse leaders' moral distress: A qualitative descriptive study

BACKGROUND

Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience.

RESEARCH AIM

The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress.

RESEARCH DESIGN

A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection.

PARTICIPANT AND RESEARCH CONTEXT

Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023.

ETHICAL CONSIDERATIONS

This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection.

FINDINGS

UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress.

CONCLUSIONS

The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed.

Confronting moral injury across health systems: Enhancing medical social workers' resilience and well-being

Research has demonstrated that encounters of potentially moral injurious events (PMIEs) may result in longstanding psychological trauma that impact healthcare workers' mental health and well-being. In this paper, we explore strategies to alleviate PMIEs for medical social workers. In-depth semi-structured interviews (30-60 min) were conducted with medical social workers (n = 75) across the state of Texas. Supported by directed content analysis, textual data were coded and categorised to finalize emerging themes. Findings demonstrate that multilevel strategies ought to be implemented into daily healthcare practice. PMIEs that impact frontline healthcare delivery can be alleviated by having formal and informal support systems (e.g., mentorship, supervision, counselling) as well as honest and transparent interprofessional collaborative care to facilitate psychological team safety. PMIEs across the healthcare organisation, perhaps due to internal policies and practices, may be reduced by implementing educational initiatives and building ethical workplace cultures that serve to explicitly reduce stigma associated with mental health and enhance worker well-being. PMIEs that derive from macro-level social policies (e.g., insurance, health disparities) may be alleviated by instituting patient advocacy initiatives and dismantling systems of oppression to lessen psychological stress and trauma. Hospital leadership ought to understand how the United States healthcare industry triggers PMIEs across the healthcare workforce. Multi-tiered practices and policies that addresses frontline delivery care, leadership and administrative responsibilities, and the healthcare industry can enhance psychologically safe workplaces and elicit macro-level institutional reform in how health systems function. These findings have important implications for healthcare policy makers, practitioners, educators, and researchers to inform future research and practice development.

Coping strategies of intensive care unit nurses reducing moral distress: A content analysis study

BACKGROUND

Moral distress has negative effects on physical and mental health. However, there is little information about nurses' coping strategies reducing moral distress.

AIM

The purpose of this study was to investigate the coping strategies of intensive care unit nurses reducing moral distress in Iran.

STUDY DESIGN

This is a qualitative study with a content analysis approach.

PARTICIPANTS AND RESEARCH CONTEXT

The research sample consisted of nurses working in intensive care units of teaching hospitals affiliated to Tehran University of Medical Sciences. Samples were selected among eligible nurses by purposive sampling. Data were obtained through 17 in-depth, individual, and semi-structured interviews with 17 nurses. Graneheim and Lundman's (2004) 6-step content analysis method was used to analyze the data. Data management was also performed by MAXQDA software version 20. The COREQ checklist was used to report the study.

ETHICAL CONSIDERATIONS

This project was approved by the Ethics Committee of Tehran University of Medical Sciences. All ethical guidelines in research were followed.

FINDING

The data analysis resulted in the formation of two main categories of desirable coping strategies (with two subcategories of compensation and rejuvenation) and less desirable coping strategies (with three subclasses of indifference over time, escape and concealment).

DISCUSSION

The intensive care unit nurses in dealing with ethical problems first try to solve the problem through discussion, but when they fail to resolve it peacefully, they resort to several coping strategies. Factors, such as increasing experience, lack of support from hospital managers and officials, poor communication between colleagues, the need to maintain hierarchy, fear of reprimand, and a sense of powerlessness, changed the nurses' preferred strategies. It is important for managers to provide a blame/punishment-free atmosphere for expression of ethical experiences; a supportive atmosphere in which staff can engage in ethical discussions without fear of punishment. They should also provide opportunities for rest, rejuvenation, and adequate training for their employees.