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Kovanci MS, Atli Özbaş A. Moral distress and moral sensitivity in clinical nurses. Res Nurs Health 2024; 47:312-323. [PMID: 38142307 DOI: 10.1002/nur.22366] [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: 05/16/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
Health care providers are expected to have a certain moral sensitivity (MS) to make an ethical assessment. Moral distress (MD) is a common phenomenon in nursing. It can negatively affect nurses physically, psychologically, socially, and spiritually. This study aimed to investigate the relationship between MD and MS among nurses using a cross-sectional descriptive design. The study was conducted in two stages. The first stage was a methodological study that analyzed validity and reliability of the Measure of MD-Healthcare Professionals. The second stage was a descriptive- predictive analysis that investigated the relationship between MD and MS. The MD intensity and frequency scores of the participants were high and moderately high, respectively. There was no direct effect on the total score and frequency of MS and MD. However, a direct and significant negative effect of MS was seen on the intensity of MD. Based on the results of this study, MS should be considered as a measure in studies aimed at understanding MD among clinical nurses. Empowerment programs should be established to increase the awareness of health workers about ethical and moral situations and to support them to cope with the problems they experience in these areas.
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Affiliation(s)
- Mustafa Sabri Kovanci
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
| | - Azize Atli Özbaş
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
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Hu J, Chen X, Khoshnood K, Luo E, Muramatsu T, Yang M. A survey of ethical sensitivity among nursing students and its influencing factors. Nurs Ethics 2024:9697330231225399. [PMID: 38207220 DOI: 10.1177/09697330231225399] [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] [Indexed: 01/13/2024]
Abstract
BACKGROUND Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today's healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students' ethical sensitivity status and the factors influencing it have not been described. OBJECTIVE This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students. RESEARCH DESIGN This was a cross-sectional study. We firstly cross-culturally adapted the Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates. PARTICIPANTS AND RESEARCH CONTEXT The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China. ETHICAL CONSIDERATIONS The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092. RESULTS A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p < .01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity. DISCUSSION Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13-52). The humanistic caring ability of Chinese nursing students is still at a low level. CONCLUSION Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability.
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Affiliation(s)
- Juan Hu
- Xiangya Nursing School of Central South University; Hunan College of Foreign Studies
| | - Xi Chen
- The Hong Kong Polytechnic University
| | | | | | | | - Min Yang
- Xiangya Nursing School of Central South University
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Cruz Araújo AA, de Godoy S, Arena Ventura CA, Rodolfo Silva Í, Santos de Almeida EW, Costa Mendes IA. Reflections on nursing students fear and anxiety arising from clinical practicums. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e13. [PMID: 36867786 PMCID: PMC10017137 DOI: 10.17533/udea.iee.v40n3e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/05/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anxiety and fear are emotional responses that may emerge when individuals anticipate threats. Undergraduate nursing students may experience feelings of hopelessness and anguish in the clinical learning experience, directly impacting their academic performance. This study aims to reflect upon the fear and anxiety faced by nursing students during clinical training. SYNOPSIS OF CONTENTS Two thematic axes were focused: Students' perception regarding preceptorship attitudes and positions; Relational teaching-learning processes and their influence on the students' professional identity. Preceptors are expected to encourage the establishment and maintenance of good relationships in the collaborative network in which students are included, especially with the multi-professional health team, to have more comprehensive academic support. CONCLUSIONS The role and importance of each individual in academic training, such as students and professors, is emphasized, seeking to promote positive experiences in the teaching-learning process to enable undergraduate students to more effectively develop moral sensitivity and take responsibility for patient-centered care.
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Affiliation(s)
| | - Simone de Godoy
- University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Quek CWN, Ong RRS, Wong RSM, Chan SWK, Chok AKL, Shen GS, Teo AYT, Panda A, Burla N, Wong YA, Chee RCH, Loh CYL, Lee KW, Tan GHN, Leong REJ, Koh NSY, Ong YT, Chin AMC, Chiam M, Lim C, Zhou XJ, Ong SYK, Ong EK, Krishna LKR. Systematic scoping review on moral distress among physicians. BMJ Open 2022; 12:e064029. [PMID: 36691160 PMCID: PMC9442489 DOI: 10.1136/bmjopen-2022-064029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians. METHODS A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows. RESULTS A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions. CONCLUSIONS Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.
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Affiliation(s)
- Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Rui Song Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Kun Woo Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Gabrielle Hui Ning Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Emmanuel Jian Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Song Yi Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore
| | - Xuelian Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
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Ong RSR, Wong RSM, Chee RCH, Quek CWN, Burla N, Loh CYL, Wong YA, Chok AKL, Teo AYT, Panda A, Chan SWK, Shen GS, Teoh N, Chin AMC, Krishna LKR. A systematic scoping review moral distress amongst medical students. BMC MEDICAL EDUCATION 2022; 22:466. [PMID: 35710490 PMCID: PMC9203147 DOI: 10.1186/s12909-022-03515-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Characterised by feelings of helplessness in the face of clinical, organization and societal demands, medical students are especially prone to moral distress (MD). Despite risks of disillusionment and burnout, efforts to support them have been limited by a dearth of data and understanding of MD in medical students. Yet, new data on how healthcare professionals confront difficult care situations suggest that MD could be better understood through the lens of the Ring Theory of Personhood (RToP). A systematic scoping review (SSR) guided by the RToP is proposed to evaluate the present understanding of MD amongst medical students. METHODS The Systematic Evidence-Based Approach (SEBA) is adopted to map prevailing accounts of MD in medical students. To enhance the transparency and reproducibility, the SEBA methodology employs a structured search approach, concurrent and independent thematic analysis and directed content analysis (Split Approach), the Jigsaw Perspective that combines complementary themes and categories, and the Funnelling Process that compares the results of the Jigsaw Perspective with tabulated summaries to ensure the accountability of these findings. The domains created guide the discussion. RESULTS Two thousand six hundred seventy-one abstracts were identified from eight databases, 316 articles were reviewed, and 20 articles were included. The four domains identified include definitions, sources, recognition and, interventions for MD. CONCLUSIONS MD in medical students may be explained as conflicts between the values, duties, and principles contained within the different aspects of their identity. These conflicts which are characterised as disharmony (within) and dyssynchrony (between) the rings of RToP underline the need for personalised and longitudinal evaluations and support of medical students throughout their training. This longitudinal oversight and support should be supported by the host organization that must also ensure access to trained faculty, a nurturing and safe environment for medical students to facilitate speak-up culture, anonymous reporting, feedback opportunities and supplementing positive role modelling and mentoring within the training program.
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Affiliation(s)
- Rui Song Ryan Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Ning Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore libraries, Singapore Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, Singapore 8 College Rd,, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Alyousefi N, Alibrahim A, Taleb H, Alotaibi L, Alrahmah L, Aldubaib N, Aljebreen S, Alrowais N, Aljarallah J. The Predictors of Moral Sensitivity Among Physicians. Int J Gen Med 2021; 14:6815-6823. [PMID: 34703287 PMCID: PMC8523900 DOI: 10.2147/ijgm.s336121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The continually advancing nature of health care has improved the quality of care provided to patients. However, it has also resulted in complex ethical issues healthcare providers face in Saudi Arabia. Literature concerning healthcare workers' moral sensitivity in Saudi Arabia is limited. This study aims to estimate moral sensitivity among physicians and determine the factors that influence it. Participants and Methods A descriptive cross-sectional study was carried out among physicians working at a tertiary hospital. The Moral Sensitivity Questionnaire (MSQ) developed by Kim Lützén was used. The lowest score that can be obtained from the MSQ is 30, and the highest score is 210. Low scores demonstrate high ethical sensitivity, and high scores indicate low ethical sensitivity. Results A total of 253 physicians participated in the study. The mean score of moral sensitivity was 90.6±19.6. There is a significant difference in the overall moral sensitivity in relation to age (P = 0.049). There are significant differences in the Moral conflict dimension according to age (P = 0.002), parental status (P = 0.011), being a member of an ethical committee (P = 0.025), years of experience (P = 0.002), clinical ranking (P < 0.001), and previous training in bioethics (P = 0.029). There were significant differences in the Relational orientation dimension with the clinical ranking (P = 0.038) and specialty (P = 0.038). Membership of an ethical committee is a significant variable in the Benefit dimension (P = 0.028). Correlation coefficients between the overall moral sensitivity score and its dimensions were Autonomy (r = 0.68), Practice (r = 0.69), and Holistic approach (r = 0.69). Physicians who previously had training in bioethics (β 2.37, P = 0.022) and physicians who worked with clinical ethics committee (β 2.66, P = 0.008) were more likely to score better in Moral conflict dimension. Conclusion Implementing ethical training for medical students and physicians will help raise their moral sensitivity levels, thereby enhancing how they deal with ethical dilemmas.
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Affiliation(s)
- Nada Alyousefi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Aljouhara Alibrahim
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Haifaa Taleb
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lama Alotaibi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leena Alrahmah
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Noorah Aldubaib
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shahad Aljebreen
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Norah Alrowais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Jamal Aljarallah
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Abdollahi R, Iranpour S, Ajri-Khameslou M. Relationship between resilience and professional moral courage among nurses. J Med Ethics Hist Med 2021; 14:3. [PMID: 34849212 PMCID: PMC8595071 DOI: 10.18502/jmehm.v14i3.5436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/16/2021] [Indexed: 11/24/2022] Open
Abstract
Nurses need to be resilient to be able to endure their working conditions, and their moral courage can affect their resilience. This work aimed at studying the relationship between resilience and professional moral courage among nurses working in hospitals. This descriptive cross-sectional study was conducted on 375 nurses working in teaching hospitals in the city of Ardabil in Iran in 2019. Data was collected using the following questionnaires: a demographic questionnaire, Sekerka et al. Moral Courage Scale and Davidson-Connor Resilience Scale. The reliability of the Davidson-Connor Resilience Scale, and Moral Courage Scale were found to be 89% and 85% using the test-retest method. The data were analyzed by Pearson correlation coefficient, t-test, variance analysis, and linear regression using the SPSS software version 24. In participating nurses, mean scores were 6.35±0.5 for total moral courage (favorable) and 79.35±0.35 (moderate) for resilience, respectively. A positive and significant relationship was observed between resilience and professional moral courage (P<0.05, r=0.1). Given the positive and significant relationship between resilience and professional moral courage, nurses require to have the high moral courage to enhance their resilience. Determining factors affecting moral courage and resilience, as well as finding strategies and creating an appropriate moral climate can increase nurses' morally courageous behaviors and resilience.
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Affiliation(s)
- Reza Abdollahi
- Researcher, Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran; Researcher, Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Sohrab Iranpour
- Assistant professor, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran; Assistant professor, Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Mehdi Ajri-Khameslou
- Assistant professor, Department of Critical Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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KOVANCI MS, HİÇDURMAZ D. Ahlaki Cesaret: Tanımı, Ahlaki Sıkıntı ve Ahlaki Duyarlılık İle İlişkisi ve Geliştirilmesi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.683548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Borhani F, Saleh ZN, Loghmani L, Rasouli M, Nasiri M. Moral distress and compassion fatigue in nurses of neonatal intensive care unit. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/93473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Tenner L, Hlubocky FJ, Blanke CD, LeBlanc TW, Marron JM, McGinnis MM, Spence RA, Taylor LP. Let's Talk About Those Herbs You Are Taking: Ethical Considerations for Communication With Patients With Cancer About Complementary and Alternative Medicine. J Oncol Pract 2019; 15:44-49. [PMID: 30629899 DOI: 10.1200/jop.18.00432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Oncologists face ethical challenges when patients use potentially harmful complementary and alternative medicine in addition to or instead of conventional treatments for their cancer. For example, a patient may forego effective cancer treatment in favor of alternative therapies and suffer significant harm as a result. Similarly, false beliefs about the efficacy of complementary therapies may complicate the process of shared decision making about cancer treatment. In this vignette, we discuss clinicians' obligations and provide recommendations for ethically sound communication practices in this clinical context.
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Affiliation(s)
| | | | | | | | - Jonathan M Marron
- 5 Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
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Zolala S, Almasi-Hashiani A, Akrami F. Severity and frequency of moral distress among midwives working in birth centers. Nurs Ethics 2018; 26:2364-2372. [PMID: 30348054 DOI: 10.1177/0969733018796680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When individuals are aware of the appropriate ethical practice, but lack the ability to do it, they will suffer from moral distress. Moral distress is a frequent phenomenon in clinical practice which can have different effects on the performance of physicians, nurses, and midwives, and therefore patients and health care systems. RESEARCH OBJECTIVE The present study aimed to determine the severity and frequency of moral distress in midwives working in birth centers. RESEARCH DESIGN This study is a descriptive cross-sectional research. Researcher-made questionnaire was used to gather data. PARTICIPANTS AND RESEARCH CONTEXT A total of 180 midwives working in the labor ward of the public birth centers affiliated to Shahid Beheshti University of Medical Sciences were included to the study by census. ETHICAL CONSIDERATIONS Official permission for data collecting was obtained from the directors of the birth centers affiliated to Shahid Beheshti University of Medical Sciences. Then, after explaining the objectives of the study and assuring the confidentially of information, verbal consent of the participants was obtained. FINDINGS The total mean ± standard deviation of the severity and frequency of moral distress were 3.85 ± 0.75 and 3.03 ± 0.48, respectively. The highest severity and the lowest frequency of moral distress were obtained for the assistance for abortion and the lowest severity of moral distress was related to the organizational domain. However, the highest frequency of moral distress was related to futile care field. The mean of moral distress severity in the midwives with associate degree was significantly lower than other levels of education. Also, there was a significant relationship between age and moral distress frequency (p = 0.010). DISCUSSION The midwives' moral distress was relatively high as expected. This finding is consistent with the results of similar studies in intensive care unit nurses. CONCLUSION After identifying the level and most important factors of moral distress among midwives, the next step is empower them to prevent moral distress, in particular efforts to change structures.
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Affiliation(s)
- Shahrzad Zolala
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Forouzan Akrami
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rodger D, Blackshaw B, Young A. Moral distress in healthcare assistants: A discussion with recommendations. Nurs Ethics 2018; 26:2306-2313. [PMID: 30134744 DOI: 10.1177/0969733018791339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants. OBJECTIVE This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures. RESEARCH DESIGN This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts. PARTICIPANTS AND RESEARCH CONTEXT No research participants were part of this analysis. ETHICAL CONSIDERATIONS This article offers a conceptual analysis and recommendations only. FINDINGS The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress. DISCUSSION Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants. CONCLUSION This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.
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Rahnama F, Mardani-Hamooleh M, Kouhnavard M. Correlation between moral sensitivity and self-esteem in nursing personnel. J Med Ethics Hist Med 2017; 10:16. [PMID: 30258550 PMCID: PMC6150914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 12/23/2017] [Indexed: 11/07/2022] Open
Abstract
Nurses are continuously involved with ethical problems in their area of practice and need to possess a satisfactory level of moral sensitivity in order to be able to offer moral care. Additionally, they act as agents for proper management of ethical dilemmas and are therefore required to have high self-esteem. This study aimed to determine the correlation between moral sensitivity and self-esteem in nurses. In this descriptive-correlational research, sample study included 204 nursing personnel working in hospitals affiliated with Iran University of Medical Sciences. Participants were selected by convenience sampling. The data were collected using a demographic form, Lützén's Moral Sensitivity Questionnaire, and Rosenberg's Self-Esteem Questionnaire. Then, the data were analyzed using descriptive and analytical statistics. Written informed consent was obtained from each subject who participated in the research. The mean score for moral sensitivity of the samples was 69.15 ± 5.70, and 20.01 ± 4.76 for their self-esteem. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the two variables under study (r = 0.472 and P = 0.001). There was no correlation between the participants' demographic data and moral sensitivity (P > 0.05), but a significant relationship was found between the participants' level of education and the variable self-esteem (P < 0.05). Since there was a positive and significant relationship between moral sensitivity and self-esteem among the nursing staff, nursing managers should focus on improving the quality of patient care by promoting nurses' moral sensitivity inspired by high self-esteem.
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Affiliation(s)
- Farideh Rahnama
- MSc, Education Development Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Marjan Mardani-Hamooleh
- Assistant Professor, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran. ,Corresponding Author: Marjan Mardani-Hamooleh. Address: Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Zafar St., Vanak Sq., Tehran, Iran. Postal Box 1419733171. Tel: :( +98) 21 88201978
| | - Marjan Kouhnavard
- Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Huang H, Ding Y, Wang H, Khoshnood K, Yang M. The Ethical Sensitivity of Health Care Professionals Who Care For Patients Living With HIV Infection in Hunan, China: A Qualitative Study. J Assoc Nurses AIDS Care 2017; 29:266-274. [PMID: 28967489 DOI: 10.1016/j.jana.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
The level of ethical sensitivity of health care professionals who care for patients with HIV may shed light on ethical behaviors in HIV care. However, little research has determined how such professionals view ethical issues in clinical practice in China. The purpose of our qualitative descriptive study was to explore the ethical sensitivity of health care professionals in Hunan Province, China, and to discuss the existing deficiencies. We used purposive sampling to recruit 17 health care professionals who provided direct care to patients with HIV and conducted interviews with them. Interview transcripts were analyzed by thematic analysis. Informants showed certain sensitivities to ethical issues, but the majority also held stigmatizing attitudes toward patients with HIV, and exhibited ethics driven by HIV-related laws and regulations rather than ethical principles. There is room to improve the ethical sensitivity of health care professionals who care for patients with HIV in China.
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Abstract
: Moral distress is a pervasive problem in the nursing profession. An inability to act in alignment with one's moral values is detrimental not only to the nurse's well-being but also to patient care and clinical practice as a whole. Moral distress has typically been seen as characterized by powerlessness and victimization; we offer an alternate view. Ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience. This article outlines the concept and prevalence of moral distress, describes its impact and precipitating factors, and discusses promising practices and interventions.
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