Tomura Michiko
Psychiatric Nursing, Japanese Red Cross Hiroshima College of Nursing, Hatsukaichi, Japan.
Nurs Ethics. 2023 Nov-Dec;30(7-8):1095-1113. doi: 10.1177/09697330231153915. Epub 2023 May 24.
Research has shown that moral distress negatively impacts nurses, patients, and organizations; however, several scholars have argued that it can be an opportunity for positive outcomes. Thus, factors that may mitigate moral distress and catalyze positive change need to be explored.
The purpose of this study was to explore the relationships among structural and psychological empowerment, psychiatric staff nurses' experience of moral distress, and strategies for coping with moral distress.
A descriptive cross-sectional correlational study.
A total of 180 registered nurses working in psychiatric hospitals in Japan participated. This study examined relationships among key variables using four questionnaires to assess structural and psychological empowerment, moral distress for psychiatric nurses, and coping strategies. Statistical analyses of correlations and multiple regressions were conducted.
The study was approved by the institutional review board at the author's affiliated university.
Psychiatric nurses perceived moderate levels of structural and psychological empowerment, and their experiences of moral distress were related to low staffing. Structural empowerment was negatively related to the frequency of moral distress but not the intensity. Contrary to expectations, psychological empowerment was not found to mitigate nurses' moral distress. Multivariate regression analyses revealed that the significant predictors of moral distress were the leaving issues unresolved coping style, the problem-solving coping style, and a lack of formal power, which explained 35% and 22% of the variance in the frequency and intensity of moral distress, respectively.
In psychiatric hospitals in Japan, nurses experience moral distress that compromises the quality of care they provide. Therefore, formal support for nurses in voicing and investigating their moral concerns is required to bestow formal power by establishing a ward culture that includes shared governance.
研究表明，道德困扰会对护士、患者和组织产生负面影响；然而，一些学者认为它可能是产生积极结果的契机。因此，需要探索可能减轻道德困扰并促成积极变革的因素。
本研究的目的是探讨结构赋权和心理赋权、精神科护士的道德困扰经历以及应对道德困扰的策略之间的关系。
描述性横断面相关性研究。
共有180名在日本精神病医院工作的注册护士参与了研究。本研究使用四份问卷来评估结构赋权和心理赋权、精神科护士的道德困扰以及应对策略，以此检验关键变量之间的关系。进行了相关性和多元回归的统计分析。
该研究获得了作者所属大学的机构审查委员会的批准。
精神科护士感受到中等程度的结构赋权和心理赋权，他们的道德困扰经历与人员配备不足有关。结构赋权与道德困扰的频率呈负相关，但与强度无关。与预期相反，未发现心理赋权能减轻护士的道德困扰。多元回归分析显示，道德困扰的显著预测因素是遗留问题未解决的应对方式、解决问题的应对方式以及缺乏正式权力，它们分别解释了道德困扰频率和强度变异的35%和22%。
在日本的精神病医院，护士经历的道德困扰会影响他们提供的护理质量。因此，需要为护士提供正式支持，让他们能够表达并调查自己的道德关切，通过建立包括共同治理的病房文化来赋予正式权力。
