评估与应对道德困扰和道德氛围，第1部分。

Assessing and addressing moral distress and ethical climate, part 1.

作者信息

Sauerland Jeanie, Marotta Kathleen, Peinemann Mary Anne, Berndt Andrea, Robichaux Catherine

机构信息

Jeanie Sauerland, BS, BSN, RN, is nurse manager Outpatient Surgery at University Hospital in San Antonio, Texas. She has a Bachelor's degree in Health Education from Texas A&M University and a BSN from the University of Texas Health Science Center in San Antonio, Texas. She is currently a student at M.D. Anderson working toward a certification in clinical ethics. Her research interest is nurse participation in ethical issues. Kathleen Marotta, BSN, RN, received a Bachelor of Science in Nursing at University of Texas Health Science Center, San Antonio, Texas; Bachelor of Science in Education, Our Lady of the Elms, Chicopee, Massachusetts; and community educator - Shaken Baby Syndrome. Her research interest is moral distress and ethical climate. Mary Anne Peinemann, MSN, RN, received her Diploma of Nursing at St. Paul's School of Nursing in Dallas Texas, and her BSN and MSN from Incarnate Word University. She has worked as a CNS nurse educator in pediatrics at University Health SystemWorked at UHS for 25 years. Her research interests include ethics, how children react to different nurses, and how/why nurses change or not change practices when change is recommended by research evidence. Andrea Berndt, PhD, is an assistant professor and statistician at the University of Texas Health Science Center at San Antonio, School of Nursing. Dr Berndt teaches research and statistics courses in the doctoral program, and provides research and statistics consultation for students, faculty, and community stakeholders. Her research interests primarily focus on assessment, evaluation, and instrumentation in nursing education and healthcare institutions. She received her BS in psychology, MS in Experimental Psychology, and PhD in Industrial-Organizational Psychology from Old Dominion University. Catherine Robichaux, PhD, RN, received her BSN from Cornell University, MSN from Incarnate Word College and PhD from the University of Texas at Austin. She is an assistant professor, adjunct, at

出版信息

Dimens Crit Care Nurs. 2014 Jul-Aug;33(4):234-45. doi: 10.1097/DCC.0000000000000050.

DOI:10.1097/DCC.0000000000000050

PMID:24895954

Abstract

BACKGROUND

There is minimal research exploring moral distress and its relationship to ethical climate among nurses working in acute care settings.

OBJECTIVES

Objectives of the study were to explore moral distress, moral residue, and perception of ethical climate among registered nurses working in an academic medical center and develop interventions to address study findings.

METHOD

A mixed-methods design was used. Two versions of Corley and colleagues' Moral Distress Scale, adult and pediatric/neonatal, were used in addition to Olson's Hospital Ethical Climate Survey. Participants were invited to respond to 2 open-ended questions. This article reports the results for those nurses working in adult acute and critical care units.

RESULTS

The sample (N = 225) was predominantly female (80%); half held a bachelor of science in nursing or higher, were aged 30 to 49 years, and staff nurses (77.3%). The mean item score for moral distress intensity ranged from 3.79 (SD, 2.21) to 2.14 (SD, 2.42) with mean item score frequency ranging from 2.86 (SD, 1.88) to 0.23 (SD, 0.93). The mean score for total Hospital Ethical Climate Survey was 94.39 (SD, 18.3) ranging from 23 to 130. Qualitative comments described bullying, lateral violence, and retribution.

DISCUSSION

Inadequate staffing and perceived incompetent coworkers were the most distressing items. Almost 22% left a previous position because of moral distress and perceived the current climate to be less ethical compared with other participants. Findings may potentially impact nurse retention and recruitment and negatively affect the quality and safety of patient care. Interventions developed focus on the individual nurse, including ethics education and coping skills, intraprofessional/interprofessional approaches, and administrative/policy strategies.

摘要

背景

在急症护理环境中工作的护士中，探索道德困扰及其与道德氛围关系的研究极少。

目的

本研究的目的是探讨在学术医疗中心工作的注册护士中的道德困扰、道德残留以及对道德氛围的认知，并制定干预措施以应对研究结果。

方法

采用混合方法设计。除了奥尔森的医院道德氛围调查外，还使用了科利及其同事的成人版和儿科/新生儿版道德困扰量表。邀请参与者回答两个开放式问题。本文报告了在成人急症和重症监护病房工作的护士的结果。

结果

样本（N = 225）主要为女性（80%）；一半拥有护理学理学学士学位或更高学位，年龄在30至49岁之间，且为 staff nurses（77.3%）。道德困扰强度的平均项目得分从3.79（标准差，2.21）到2.14（标准差，2.42）不等，平均项目得分频率从2.86（标准差，1.88）到0.23（标准差，0.93）不等。医院道德氛围调查的总平均分为94.39（标准差，18.3），范围从23到130。定性评论描述了欺凌、横向暴力和报复行为。

讨论

人员配备不足和认为同事能力不足是最令人苦恼的项目。近22%的人因道德困扰而辞去上一份工作，且与其他参与者相比，他们认为当前的氛围道德性较低。研究结果可能会对护士的留用和招聘产生潜在影响，并对患者护理的质量和安全产生负面影响。制定的干预措施侧重于个体护士，包括道德教育和应对技巧、专业内/跨专业方法以及行政/政策策略。