Kleinknecht-Dolf Michael, Frei Irena Anna, Spichiger Elisabeth, Müller Marianne, Martin Jacqueline S, Spirig Rebecca
University Hospital Zurich, Switzerland.
University Hospital Basel, Switzerland.
Nurs Ethics. 2015 Feb;22(1):77-90. doi: 10.1177/0969733014534875. Epub 2014 Jun 10.
In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place.
The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial indications of the instrument's validity.
The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress.
The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality.
The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress.
The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups.
在诸如诊断相关分组等新的报销系统背景下，道德困扰正成为医疗服务提供者日益严重的问题。道德困扰会引发护士的情绪和身体反应，可能导致他们在情感上与患者疏远，或者导致他们更换工作场所。
这项试点研究的目的是开发一种工具，用于测量德语环境下急症护理护士的道德困扰，测试其适用性，并获得该工具有效性的初步迹象。
该研究于2011年设计为一项横断面试点调查。在瑞士德语区一所大学医院的八个科室进行，294名注册护士被要求填写一份关于道德困扰的网络问卷。
研究提案获得了州伦理委员会的批准。所有参与的护士均提供了知情同意，并被告知数据保密。
调查的回复率为55%。结果显示了问卷中表明有可能引发道德困扰情况的陈述的普遍性。回复中使用了所有类型的答案。大多数参与者认为问卷易于理解，而一些人批评了某些陈述的措辞。更多人认为在线访问前的注册过程过于耗时。护士们确认，结果反映了他们对自身状况的主观评估以及他们的道德困扰经历。
新开发的道德困扰问卷似乎具有表面效度，并且足够适用于我们的研究。结果表明，道德困扰在瑞士医院似乎也是一个相关现象，并且在瑞士诊断相关分组引入之前护士们就已经经历过。
