9372IRCCS San Raffaele Scientific Institute, Italy.
18985Vita-Salute San Raffaele University, Italy; Tor Vergata University of Rome, Italy.
Nurs Ethics. 2021 Aug;28(5):614-627. doi: 10.1177/0969733020964859. Epub 2020 Dec 3.
Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff.
The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events.
A hermeneutic-phenomenological qualitative study was performed.
Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim.
Ethical approval was obtained from the Institutional Review Hospital Board.
Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured.
In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events.
Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.
在大多数姑息治疗教育计划中，道德困境是一个被忽视的问题，研究主要集中在这一现象作为护理人员的职业问题上。
本研究的主要结果是探讨意大利一所教学医院的护理人员在道德困境事件中经历的原因、感受和应对策略。这项定性研究的次要结果是分析姑息治疗或临终关怀教育是否可以减少道德困境事件。
采用解释学-现象学定性研究。
通过滚雪球抽样招募参与者。访谈由一名访谈者进行和记录，并逐字转录。
从机构审查医院委员会获得了伦理批准。
从访谈分析中出现了六个主要主题：（1）道德困境的原因；（2）道德困境事件中经历的感受和情绪；（3）影响道德困境体验的因素；（4）应对道德困境的策略；（5）从道德困境事件中恢复；和（6）临终陪伴。对于姑息治疗教育的有用性存在不同意见。一些护士表示，参加临终课程无助于他们应对病房中的道德困境事件，他们认为现有的课程应该得到加强和更好的组织。
在这项研究中，道德困境通常与医护人员与患者和/或其家属之间沟通不畅或缺乏沟通以及无法满足患者的最后请求有关。根据我们的发现，对于我们的样本来说，“良好”的临终陪伴概念对于预防道德困境事件极为重要。
在肿瘤血液病学环境中工作的护士经常经历道德困境。在早期确定道德困境的原因对于寻找解决方案至关重要。
