护士道德困境评估：系统评价和荟萃分析。

Estimation of moral distress among nurses: A systematic review and meta-analysis.

机构信息

Qazvin University of Medical Sciences, Qazvin, Iran.

Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan.

出版信息

Nurs Ethics. 2023 May;30(3):334-357. doi: 10.1177/09697330221135212. Epub 2023 Jan 27.

DOI:10.1177/09697330221135212

PMID:36704986

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9902807/

Abstract

BACKGROUND

Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction.

AIM

To estimate moral distress among nurses.

METHODS

This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis.

ETHICAL CONSIDERATION

The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773.

RESULTS

Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I: 98.4%, Tau:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance.

CONCLUSION

The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.

摘要

背景

在照顾患者时，道德困境是专业护士面临的常见挑战，尤其是在需要快速做出决策时。因此，如果不考虑道德困境，可能会危及患者的护理质量、安全和满意度。

目的

评估护士的道德困境。

方法

本系统评价和荟萃分析在 Scopus、PubMed、ProQuest、ISI Web of Knowledge 和 PsycInfo 中进行了系统检索，截至 2022 年 2 月底。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。使用 STATA 软件版本 14 中的随机效应模型对纳入研究的数据进行汇总分析。选择的关键措施是道德困境总分的平均值及其 95%置信区间。进行亚组分析和荟萃回归分析，以确定道德困境的可能来源和潜在影响变量。使用漏斗图和 Begg 检验评估发表偏倚。使用 Jackknife 法进行敏感性分析。

伦理考虑

本项目的方案已在 PROSPERO 数据库中注册，注册号为 CRD42021267773。

结果

共纳入来自 21 个国家的 86 篇文献和 19537 名参与者。在 0-10 分制上，汇总估计的道德困境平均得分为 2.55 [95%置信区间：2.27-2.84，I：98.4%，τ：0.94]。排除了发表偏倚和小样本效应。与大流行前相比，新冠疫情期间道德困境显著降低。与发达国家的护士相比，发展中国家的护士经历了更高水平的道德困境。护士的工作场所（如医院病房）与道德困扰的严重程度无关。