Burston Adam, Eley Robert, Parker Deborah, Tuckett Anthony
School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia.
Int J Older People Nurs. 2017 Jun;12(2). doi: 10.1111/opn.12144. Epub 2016 Dec 23.
The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting.
Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting.
An existing instrument, the Moral Distress Scale (Revised) was identified and amended. Amendments were subject to expert review for face and content validity. Data were collected from aged care nurses working in residential and community aged care, in Australia. Reliability was assessed using Cronbach's alpha with exploratory factor analysis undertaken for construct validity.
106 participants completed the survey, 93 (87.7%) identified as female and 13 (12.3%) male. Participants ranged in age from 21 to 73 years, with a mean time working in nursing of 20.6 years. The frequency component of the instrument demonstrated an alpha of 0.89, the intensity component 0.95 and the instrument as a whole 0.94. Three factors were identified and labelled as: Quality of Care, Capacity of Team and Professional Practice. Mean scores indicate a low occurrence of moral distress, but this distress, when experienced, was felt with a moderate level of intensity. Primary causes of moral distress were insufficient staff competency levels, poor quality care because of poor communication and delays in implementing palliation.
The instrument demonstrates validity and reliability within the Australian aged care setting. Further analysis with larger populations is required to support these findings.
Australian aged care workers do experience moral distress. They suffer adverse consequences of this distress and quality of care is negatively impacted. This newly validated instrument can be used to quantify the occurrence of moral distress and to inform targeted interventions to reduce the occurrence and intensity of the experience.
本研究旨在深入了解老年护理工作人员的道德困扰经历。本研究的目标是使用并验证一种现有的工具来测量老年护理环境中的道德困扰。
道德困扰是一种与员工满意度和留任率相关的现象，在护理行业中很常见。存在测量道德困扰的工具；然而，尚无经过验证的工具来测量老年护理环境中的道德困扰。
确定并修订了一种现有的工具——道德困扰量表（修订版）。修订内容经过专家审查以确保表面效度和内容效度。数据收集自澳大利亚从事住宿和社区老年护理工作的老年护理护士。使用克朗巴哈系数评估信度，并进行探索性因素分析以评估结构效度。
106名参与者完成了调查，其中93人（87.7%）为女性，13人（12.3%）为男性。参与者年龄在21岁至73岁之间，平均护理工作年限为20.6年。该工具的频率部分显示克朗巴哈系数为0.89，强度部分为0.95，整体工具为0.94。确定了三个因素并分别标记为：护理质量、团队能力和专业实践。平均得分表明道德困扰发生率较低，但这种困扰一旦出现，强度适中。道德困扰的主要原因是员工能力水平不足、沟通不畅导致护理质量差以及姑息治疗实施延迟。
该工具在澳大利亚老年护理环境中显示出效度和信度。需要对更多人群进行进一步分析以支持这些发现。
澳大利亚老年护理工作者确实经历道德困扰。他们遭受这种困扰的不良后果，护理质量也受到负面影响。这种新验证的工具可用于量化道德困扰的发生率，并为有针对性的干预措施提供依据，以减少这种经历的发生率和强度。
