Schwenzer Karen J, Wang Lijuan
University of Virginia Health System, Charlottesville, VA, USA.
Crit Care Med. 2006 Dec;34(12):2967-73. doi: 10.1097/01.CCM.0000248879.19054.73.
To test the reliability and validity of a modified moral distress tool, originally developed for the nursing profession, on respiratory care practitioners. To describe the relationship between moral distress, career dissatisfaction, and job turnover in respiratory care.
A 28-question survey was developed. Three categories of survey questions were predefined: "individual responsibility," "not in the patient's best interest," and "deception." Additional questions measured career dissatisfaction, job turnover, and demographic information.
University Hospital at the University of Virginia Health System, a 552-bed tertiary care hospital.
Fifty-seven of 115 (49.6%) of respiratory care practitioners responded to the survey.
Exploratory factor analysis was used to investigate the underlying factor structure. After we extracted theoretically meaningful factors, reliability of each factor was estimated. Multiple regression analysis was conducted to test if the underlying factors predicted career dissatisfaction and job turnover.
The factor analysis yielded a five-factor structure. Several questions in the "not in patient's best interest" category scored the highest moral distress including disagreements with surrogate decision makers and providing futile care. Higher scores were also found with questions regarding the perception of unsafe staffing and passively or actively participating in deception. None of the demographic variables predicted career dissatisfaction or job turnover. However, the perception of unsafe staffing was found to be a significant factor in predicting career dissatisfaction and job turnover.
In this one-center pilot study, respiratory care practitioners reported experiencing moral distress in many areas of their practice. Distress related to the perception of unsafe staffing may be related to career dissatisfaction and job turnover. Further exploration of the factors that contribute to respiratory care practitioners' moral distress is needed, as well as implementing ways to ameliorate it.
测试一种最初为护理专业开发的改良道德困扰工具在呼吸治疗从业者中的可靠性和有效性。描述呼吸治疗中道德困扰、职业不满和工作离职之间的关系。
开发了一份包含28个问题的调查问卷。预先定义了三类调查问题：“个人责任”、“不符合患者最佳利益”和“欺骗”。其他问题测量职业不满、工作离职和人口统计学信息。
弗吉尼亚大学健康系统的大学医院，一家拥有552张床位的三级护理医院。
115名呼吸治疗从业者中的57名（49.6%）回复了调查问卷。
采用探索性因素分析来研究潜在的因素结构。在提取出具有理论意义的因素后，估计每个因素的可靠性。进行多元回归分析以测试潜在因素是否能预测职业不满和工作离职。
因素分析得出了一个五因素结构。“不符合患者最佳利益”类别中的几个问题道德困扰得分最高，包括与替代决策者的分歧以及提供无效治疗。在关于不安全人员配置的认知以及被动或主动参与欺骗的问题上也发现了较高得分。没有任何人口统计学变量能预测职业不满或工作离职。然而，不安全人员配置的认知被发现是预测职业不满和工作离职的一个重要因素。
在这项单中心试点研究中，呼吸治疗从业者报告在其许多实践领域都经历了道德困扰。与不安全人员配置认知相关的困扰可能与职业不满和工作离职有关。需要进一步探索导致呼吸治疗从业者道德困扰的因素，以及实施改善这种情况的方法。
