6614University of Pittsburgh, USA; The University of Texas Health Science Center at Houston, USA.
12338The University of Texas Medical Branch at Galveston, USA.
Nurs Ethics. 2020 Sep;27(6):1450-1460. doi: 10.1177/0969733020916747. Epub 2020 May 14.
To examine interprofessional healthcare professionals' perceptions of triggers and root causes of moral distress.
Qualitative description of open-text comments written on the Moral Distress Scale-Revised survey.
A subset of interprofessional providers from a parent study provided open-text comments that originated from four areas of the Moral Distress Scale-Revised, including the margins of the 21-item questionnaire, the designated open-text section, shared perceptions of team communication and dynamics affecting moral distress, and the section addressing an intent to leave a clinical position because of moral distress. Open-text comments were captured, coded, and divided into meaning units and themes using systematic text condensation.
Twenty-eight of the 223 parent study participants completing the Moral Distress Scale-Revised shared comments on situations contributing to moral distress.
All 28 participants working in the four medical center intensive care units reported feelings of moral distress. Feelings of moral distress were associated with professional anguish over patient care decisions, team, and system-level factors. Professional-level contributors reflected clinician concerns of continuing life support measures perceived not in the patient's best interest. Team and unit-level factors were related to poor communication, bullying, and a lack of collegial collaboration. System-level factors included clinicians feeling unsupported by senior administration and institutional culpability as a result of healthcare processes and system constraints impeding reliable patient care delivery.
Approval was obtained from the Institutional Review Board (IRB) of the University of Texas Health IRB and the organization in which the study was conducted.
Moral distress was associated with feelings of anguish, professional intimidation, and organizational factors that impacted the delivery of ethically based patient care. Participants expressed a sense of awareness that they may experience ethical dilemmas as a consequence of the changing reality of providing healthcare within complex healthcare systems. Strategies to combat moral distress should target team and system interventions designed to improve interprofessional collaboration and support professional ethical values and moral commitments of all healthcare providers.
探讨跨专业医疗保健专业人员对道德困境的触发因素和根本原因的看法。
对修订后的道德困境量表调查中的开放式文本评论进行定性描述。
从一项母研究中的一组跨专业提供者中选择了提供开放式文本评论的人员，这些评论源于修订后的道德困境量表的四个领域，包括 21 项问卷的边缘、指定的开放式文本部分、影响道德困境的团队沟通和动态的共同看法，以及因道德困境而打算离开临床岗位的部分。使用系统文本凝结法捕获、编码和将开放式文本评论分为有意义的单位和主题。
完成修订后的道德困境量表的 223 名母研究参与者中的 28 名分享了导致道德困境的情况的评论。
所有在四个医疗中心重症监护病房工作的 28 名参与者都报告了道德困境的感觉。道德困境的感觉与对患者护理决策、团队和系统层面因素的专业痛苦有关。专业层面的贡献反映了临床医生对继续支持被认为不符合患者最佳利益的生命支持措施的关注。团队和单位层面的因素与沟通不畅、欺凌和缺乏同事合作有关。系统层面的因素包括临床医生感到不受高级管理层的支持以及由于医疗流程和系统限制阻碍可靠的患者护理提供而导致的机构责任。
获得了德克萨斯大学健康伦理委员会和研究所在组织的机构审查委员会 (IRB) 的批准。
道德困境与痛苦、专业恐吓以及影响提供基于伦理的患者护理的组织因素有关。参与者表示意识到他们可能会因为在复杂的医疗保健系统中提供医疗保健的现实变化而面临道德困境。应对道德困境的策略应针对旨在改善跨专业合作和支持所有医疗保健提供者的专业伦理价值观和道德承诺的团队和系统干预措施。
