Golestan University of Medical Sciences, Iran.
Nurs Ethics. 2019 Nov-Dec;26(7-8):2195-2203. doi: 10.1177/0969733018806342. Epub 2018 Nov 3.
Nursing is a profession that has always been accompanied with common ethical concerns. There are some evidences which indicate that narrative writing on traumatic experiences may improve an individual's emotional health.
This study aimed to determine the effectiveness of narrative writing on moral distress of nurses working in intensive care unit.
This study was a clinical trial with pre- and post-test design. The frequency and intensity of moral distress was measured by a valid and reliable questionnaire (Corely) at baseline and after 8 weeks. The intervention group was asked to write about their deepest emotions and stressful experiences in the intensive care unit for 8 weeks.
Using consensus sampling, 120 nurses of intensive care unit and neonatal intensive care unit of the teaching hospitals (in Iran) were invited to and were randomly allocated into the intervention and control groups.
Participation was voluntary, data were anonymized, and the confidentiality of the participating nurses and their institutions maintained. The ethical approval was obtained from an IRB or research ethics committee.
In total, 106 nurses completed the trial consisting of 87.75% females. The mean work experience of nurses in the intervention and control groups was 7.21 ± 4.96 and 8.28 ± 5.45 years, respectively. Independent t-test showed no statistical difference neither in the intensity of moral distress ( = 0.8), nor in its frequency ( = 0.5) between the two groups.
As nurses constantly face ethical tensions, moral distress is a phenomenon that results from the different situations of critical care units. Their concern about receiving negative feedback from the managerial level may have influenced the outcome of the intervention.
Narratives writing by the nurses showed no effect on reducing the intensity and frequency of moral distress. It seems that due to the intensity of moral distress in clinical settings, we need to test variety solutions to reduce the problem.
护理是一个始终伴随着常见伦理问题的职业。有一些证据表明，叙述创伤经历可能会改善个体的心理健康。
本研究旨在确定叙事写作对重症监护病房护士道德困境的影响。
这是一项具有前后测试设计的临床试验。在基线和 8 周后，使用经过验证和可靠的问卷（Corely）测量道德困境的频率和强度。干预组被要求在 8 周内撰写有关其在重症监护病房最深切的情感和压力经历。
采用共识抽样法，邀请伊朗教学医院的重症监护病房和新生儿重症监护病房的 120 名护士参与，并将其随机分配到干预组和对照组。
参与是自愿的，数据是匿名的，参与护士及其机构的机密性得到维护。本研究已获得伦理委员会或研究伦理委员会的批准。
共有 106 名护士完成了这项试验，其中 87.75%为女性。干预组和对照组护士的平均工作经验分别为 7.21±4.96 年和 8.28±5.45 年。独立 t 检验显示两组在道德困境的强度（t=0.8）和频率（t=0.5）上均无统计学差异。
由于护士经常面临伦理紧张，道德困境是重症监护病房不同情况导致的现象。他们对从管理层收到负面反馈的担忧可能影响了干预的结果。
护士的叙述写作对减轻道德困境的强度和频率没有影响。看来，由于临床环境中道德困境的强度，我们需要测试各种解决方案来解决这个问题。
