Burton Melissa, Caswell Hollis, Porter Courtney, Mott Sandra, DeGrazia Michele
Melissa Burton, RN, CCRN, is staff nurse II at the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA. Hollis Caswell, MS, RN, CCRN, is lecturer at Sandra R. Berman School of Nursing and Health Professions, Stevenson University, Owings Mills, MD. Courtney Porter, MPH, CPHQ, is program administrative manager III of Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA. Sandra Mott, PhD, CPN, RN-BC, is nurse scientist, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA. Michele DeGrazia, PhD, RN, NNP-BC, FAAN, is director of nursing research, Neonatal Intensive Care Unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor at the Department of Pediatrics, Harvard Medical School, Boston, MA.
Dimens Crit Care Nurs. 2020 Mar/Apr;39(2):101-109. doi: 10.1097/DCC.0000000000000403.
BACKGROUND/INTRODUCTION: Despite a growing population of chronically and acute critically ill neonatal and pediatric patients, there were few published articles related to moral distress as experienced by nurses caring for these patients.
OBJECTIVES/AIMS: The aim of this study was to define moral distress based on the perceptions and experiences of neonatal and pediatric critical care nurses.
A qualitative descriptive study using focus group methodology was undertaken. All nurses with 2 or more years of experience from the 4 neonatal and pediatric intensive care units in a large 404-bed urban pediatric hospital located in the northeast were invited to attend 1 of 15 audio-recorded focus groups lasting 60 to 90 minutes. Once data were transcribed, conventional content analysis was used to develop the definition and categories of moral distress.
Nurse participants defined moral distress as "patient care situations where there is a mismatch or incongruity between expected behaviors of the nurse and his/her personal values/beliefs in the neonatal/pediatric critical care setting." The 2 overarching categories that emerged from the data were patient-focused factors and nurse-focused factors.
DISCUSSION/CONCLUSIONS: Understanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for nursing support and education, with the goal of creating a culture of moral resiliency.
背景/引言：尽管患有慢性和急性危重症的新生儿和儿科患者数量不断增加，但关于护理这些患者的护士所经历的道德困扰的已发表文章却很少。
本研究的目的是根据新生儿和儿科重症护理护士的认知和经历来界定道德困扰。
采用焦点小组方法进行了一项定性描述性研究。邀请了位于东北部一家拥有404张床位的大型城市儿科医院的4个新生儿和儿科重症监护病房中所有具有2年或以上工作经验的护士参加15个时长为60至90分钟的焦点小组中的1个，并进行录音。数据转录后，采用常规内容分析法来确定道德困扰的定义和类别。
参与研究的护士将道德困扰定义为“在新生儿/儿科重症监护环境中，护士的预期行为与其个人价值观/信念之间存在不匹配或不一致的患者护理情况”。从数据中得出的两个主要类别是患者相关因素和护士相关因素。
讨论/结论：了解新生儿和儿科重症护理护士如何界定道德困扰以及其形成原因是制定针对性护理支持和教育策略的基础，目标是营造一种道德韧性文化。
