Houston Susan, Casanova Mark A, Leveille Marygrace, Schmidt Kathryn L, Barnes Sunni A, Trungale Kelli R, Fine Robert L
Baylor Health Care System in Dallas, Texas, USA.
J Clin Ethics. 2013 Summer;24(2):98-112.
The objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.
Participants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant's discipline. Higher scores reflected greater intensity and/or frequency of moral distress.
More than 2,700 healthcare professionals responded to the survey (response rate 18.14 percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.
Moral distress has previously been described as a phenomenon predominantly among nursing professionals.This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it.
本研究的目的是评估和比较不同群体的医疗保健专业人员在道德困扰的强度、频率和总体严重程度方面的差异。
贝勒医疗保健系统的参与者完成了一项在线七点李克特量表（范围为0至6）的道德困扰调查，该调查包含九个核心临床情景以及针对每个参与者学科的特定情景。得分越高表明道德困扰的强度和/或频率越高。
超过2700名医疗保健专业人员对该调查做出了回应（回复率为18.14%）；调查对象代表了单一医疗系统中各种环境下的多个医疗保健学科。所有学科的道德困扰强度都很高，尽管强度最高的原因因学科而异。九个核心情景的道德困扰平均强度在医生中高于护士，但道德困扰的平均频率在护士中更高。综合考虑强度和频率，不同学科之间的道德困扰平均得分差异具有统计学意义。采用事后分析，护士和治疗师之间的差异最大。
道德困扰以前主要被描述为护理专业人员中的一种现象。这项关于道德困扰的首创性多学科研究表明，这种现象在多个专业医疗保健学科中都很显著。医疗保健专业人员应该对给其他学科的同事造成道德困扰的情况保持敏感。政策制定者和管理人员应该探索减轻道德困扰以及经常伴随的职业倦怠的方法。
