University of Virginia, USA.
Nurs Ethics. 2022 May;29(3):582-607. doi: 10.1177/09697330211035489. Epub 2022 Feb 11.
Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by hand search and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact.
道德困境在文献中已有大量研究，对包括护士、医生和其他医疗保健专业人员在内的所有医疗保健专业人员都有明显的不良副作用。然而，人们对针对道德困境的干预措施的质量和效果知之甚少。本综合评价的目的是分析已发表的干预研究，以确定它们在医院环境中的有效性和适用性。在 2020 年 10 月最初发现的 1373 篇文章中，有 18 篇被评估为相关，通过手工搜索增加了 1 项研究，在 2021 年 1 月和 5 月重复搜索后又增加了 2 项研究，共审查了 22 篇文章。这项综述揭示的数据主要来自护士，有些研究努力纳入了其他经历过道德困境的医疗保健专业人员。以教育为基础的干预措施显示出最大的成功，尽管许多研究报告说其影响力有限，很少有研究表明干预后道德困境明显降低。这可能表明，在没有足够支持系统的情况下，很难实时充分解决道德困境。最终，这些研究提出了一些潜在的框架，如果得到全组织支持的支持，可能有助于道德困境干预措施产生可衡量的影响。
