Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, 13100Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo.
Kanto Gakuin University, 1-50-1 Mutsuurahigashi, Kanazawa-ku, yokohama-city, Kanagawa.
Nurs Ethics. 2022 Sep;29(6):1341-1352. doi: 10.1177/09697330221085773. Epub 2022 May 18.
Although, moral distress presents a serious problem among critical care nurses in many countries, limited research has been conducted on it. A validated scale has been developed to evaluate moral distress and has enabled cross-cultural comparison for seeking its root causes.
This study aimed to (1) clarify the current status of moral distress among nurses who worked in critical care areas in Japan, (2) compare the moral distress levels among nurses in Japan with previously reported results from the United States (US), and (3) explore the factors associated with moral distress.
A nationwide cross-sectional study was conducted.
We conducted a self-administered questionnaire survey using the Measure of Moral Distress-Healthcare Professionals (MMD-HP) among critical care nurses who were randomly selected from hospitals across Japan. The mean differences between the two countries were compared using a Student's t-test with summary statistics. The factors associated with higher levels of moral distress were examined using a multiple regression analysis.
The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214 and M2019-045).
We obtained 955 valid responses from 94 facilities. In Japan, the items with the highest moral distress scores were those related to aggressive/inappropriate treatment. The total MMD-HP score was significantly higher in Japanese nurses compared to US nurses (122.8 ± 70.8 vs 112.3 ± 73.2). Some factors, such as leadership experience, were associated with higher moral distress.
The top root causes of moral distress were similar to potentially inappropriate treatments in both countries.
This study revealed the factors associated with higher moral distress and its characteristics in each country. These results can be used for reducing moral distress in the future.
尽管道德困境在许多国家的重症监护护士中是一个严重的问题，但对此的研究有限。已经开发出一种经过验证的量表来评估道德困境，并能够进行跨文化比较以寻找其根本原因。
本研究旨在：(1)阐明在日本重症监护病房工作的护士的道德困境现状，(2)比较日本护士的道德困境水平与之前在美国报告的结果，(3)探讨与道德困境相关的因素。
一项全国性的横断面研究。
我们使用从日本各地医院随机选择的重症监护护士的医疗保健专业人员道德困境量表（Measure of Moral Distress-Healthcare Professionals，MMD-HP）进行了一项自我管理的问卷调查。使用学生 t 检验和汇总统计数据比较了两个国家之间的差异。使用多元回归分析检查与更高水平道德困境相关的因素。
该研究得到了东京医科齿科大学伦理委员会的批准（批准号：M2018-214 和 M2019-045）。
我们从 94 家医院获得了 955 份有效回复。在日本，道德困境得分最高的项目与激进/不适当的治疗有关。日本护士的总 MMD-HP 评分明显高于美国护士（122.8 ± 70.8 vs 112.3 ± 73.2）。一些因素，如领导经验，与更高的道德困境有关。
道德困境的主要原因与两国的潜在不适当治疗相似。
本研究揭示了与更高道德困境相关的因素及其在每个国家的特征。这些结果可用于将来减轻道德困境。
