Ashida Kaoru, Kawakami Aki, Kawashima Tetsuharu, Tanaka Makoto
Tokyo Medical and Dental University (TMDU), Japan.
Nurs Ethics. 2021 Nov-Dec;28(7-8):1348-1358. doi: 10.1177/0969733021999738. Epub 2021 Jun 2.
Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress.
The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others.
A nationwide, cross-sectional study was conducted.
We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item.
The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045).
The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients.
Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse's priorities might diverge from those of other team members, which can lead to conflict within the team.
This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress.
道德困扰对重症监护病房的护士有多种不利影响。个人价值观以及价值观与行为自我认知之间的差异是可能导致道德困扰的因素。
本研究的目的是（1）确定日本重症监护病房护士的道德价值观和行为自我认知，以及（2）确定价值观与行为差异较大的项目以及与他人价值观差异较大的项目。
进行了一项全国性的横断面研究。
我们编制了一份包含28个条目的自填式问卷，由日本1014名重症监护病房护士完成。行为的价值观与自我认知之间的差异通过每个价值观项目的得分减去每个行为自我认知项目的得分来计算。与他人价值观差异的大小通过每个项目的标准差来判断。
该研究获得了东京医科齿科大学伦理委员会的批准（批准号：M2018 - 214，M2019 - 045）。
价值观与行为来源差异较大的项目与工作环境和决策支持有关。与他人价值观差异较大的项目与医院管理和向患者披露信息有关。
改善护士的工作环境对于减少道德困扰很重要。护士面临着各种选择，包括为患者争取权益和保护医疗资源的公平分配，而且每个护士的优先事项可能与其他团队成员不同，这可能导致团队内部冲突。
本研究揭示了护士道德困扰风险特别高的项目。研究结果提供了基础信息，可指导减轻道德困扰策略的制定。
