Clinical and Health Sciences, University of South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA 5000, Australia.
Clinical and Health Sciences, University of South Australia, Australia; School of Health and Social Care, Edinburgh Napier University, Scotland, UK.
Women Birth. 2023 Sep;36(5):e544-e555. doi: 10.1016/j.wombi.2023.04.005. Epub 2023 May 8.
Moral distress is a psychological concept that describes the harm associated with actions or inactions that oppose an individuals' moral beliefs. Moral distress is linked to moral compromise in the workplace that may negatively impact mental wellbeing. Current tools available to assess moral distress are not specific for the Australian health care system or midwifery practice.
The aim of this study was to develop a list of situational and outcome statements associated with moral compromise and levels of moral distress in midwifery to inform the development of a tool to measure levels of moral distress in midwives.
This e-Delphi study was the third stage of a sequential exploratory mixed-methods study. Using an online strategy, three iterative rounds of e-Delphi were collected and analysed for consensus on situations leading to moral distress and the associated psychological outcomes.
Twenty participants contributed across the three rounds. Consensus was met in 40 morally compromising situation statements. The highest level of consensus related to excessive workloads and the associated negative impact of this on women and families. Consensus on outcomes following exposure to morally distressing situations led to the development of a continuum scale from moral frustration to moral injury.
DISCUSSION/CONCLUSION: This is the first study to use a consensus method to establish different levels of moral compromise, frustration, distress, and injury in midwifery practice. The findings of this study contribute to a growing body of literature that supports the concept of moral distress occurring across a continuum.
道德困境是一种心理概念，描述了与个人道德信仰相悖的行为或不作为所带来的伤害。道德困境与工作场所中的道德妥协有关，可能会对心理健康产生负面影响。目前用于评估道德困境的工具不适用于澳大利亚的医疗保健系统或助产实践。
本研究旨在确定与助产实践中的道德妥协和道德困境程度相关的情境和结果陈述，为开发衡量助产士道德困境程度的工具提供信息。
这是一项序列探索性混合方法研究的第三阶段。使用在线策略，进行了三轮迭代的电子德尔菲研究，并对导致道德困境的情况以及相关心理结果的共识进行了分析。
共有 20 名参与者参与了三轮研究。在 40 个道德上有争议的情况陈述中达成了共识。最高程度的共识与工作量过大有关，以及这对妇女和家庭的负面影响。对接触道德困境情况后的结果达成共识，导致从道德挫折到道德伤害的连续量表的发展。
讨论/结论：这是第一项使用共识方法确定助产实践中不同程度的道德妥协、挫折、困境和伤害的研究。本研究的结果为越来越多的文献提供了支持，这些文献支持道德困境在连续体上发生的概念。
