Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, 27100 Pavia, Italy.
Int J Environ Res Public Health. 2022 Mar 24;19(7):3863. doi: 10.3390/ijerph19073863.
In the modern healthcare landscape, moral distress has become an increasingly common phenomenon among healthcare professionals. This condition is particularly prevalent among palliative care professionals who are confronted with bioethical issues in their daily practice. Although some studies described the effects of poor ethical climate and negative affectivity on moral distress, how these variables could be incorporated into a single model is still unclear. Thus, this study aims to investigate whether ethical relationships with the hospital could be related to the intensity and frequency of moral distress, both directly and as mediated by professionals' negative affectivity. Sixty-one Portuguese palliative care professionals completed web-based self-report questionnaires. After exploring descriptive statistics, mediation analyses were performed using the partial least squares method. The results indicated that the presence of positive relationships with the hospital reduced the professionals' negative affectivity levels. This, in turn, led palliative care professionals to experience a lower frequency and intensity of moral distress. Being a physician was positively associated with negative affectivity but not with the frequency of moral distress. Considering the protective role of ethical relationships with hospitals, health organizations could consider implementing interventions to improve hospitals' ethical climate and provide staff with ethics training programs.
在现代医疗保健领域，道德困境已成为医疗保健专业人员中越来越普遍的现象。这种情况在姑息治疗专业人员中尤为普遍，他们在日常实践中面临着生物伦理问题。尽管一些研究描述了不良伦理氛围和消极情感对道德困境的影响，但这些变量如何纳入一个单一的模型仍不清楚。因此，本研究旨在探讨与医院的伦理关系是否与道德困境的强度和频率有关，包括直接影响和通过专业人员的消极情感的中介作用。61 名葡萄牙姑息治疗专业人员完成了基于网络的自我报告问卷。在探索描述性统计数据后，使用偏最小二乘法进行了中介分析。结果表明，与医院建立积极的关系可以降低专业人员的消极情感水平。这反过来又导致姑息治疗专业人员经历较低频率和强度的道德困境。作为一名医生与消极情感呈正相关，但与道德困境的频率无关。考虑到与医院的伦理关系的保护作用，卫生组织可以考虑实施干预措施，以改善医院的伦理氛围，并为员工提供伦理培训计划。
