家庭护理护理中的道德困境的预测因素和后果：一项横断面调查。
Predictors and consequences of moral distress in home-care nursing: A cross-sectional survey.
机构信息
International Graduate Academy, Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
German Federal Institute for Occupational Safety and Health, Dresden, Germany.
出版信息
Nurs Ethics. 2023 Nov-Dec;30(7-8):1199-1216. doi: 10.1177/09697330231164761. Epub 2023 Jun 12.
BACKGROUND
Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress.
OBJECTIVE
This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany.
RESEARCH DESIGN
A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic regressions, and Rasch analyses were performed.
PARTICIPANTS AND RESEARCH CONTEXT
The invitation to participate was sent to every German home-care service ( = 16,608).
ETHICAL CONSIDERATIONS
The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health.
RESULTS
A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence.
CONCLUSIONS
To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector.
背景
护士在日常工作中经常会遇到一些道德上难以处理的情况，从而导致道德困境。
目的
本研究旨在探讨德国家庭护理护士的道德困境现象，并描述其与工作相关的预测因素和个体后果。
研究设计
采用横断面设计。在一项针对德国家庭护理护士的在线调查中，使用道德困境量表和 COPSOQ III 问卷。进行了频率分析、多元线性和逻辑回归以及 Rasch 分析。
参与者和研究背景
向德国的每一家家庭护理服务机构（=16608 家）发出了参与邀请。
伦理考虑
该研究得到了德国联邦职业安全与健康研究所数据保护办公室和伦理委员会的批准。
结果
共有 976 名家庭护理护士参与了这项研究。工作特征，如高情绪需求、频繁的工作与生活冲突、低工作影响力和低社会支持，与家庭护理护士道德困境引起的更大困扰有关。家庭护理服务的组织特征，如与患者的时间间隔，预测了道德困境。由于道德困境而引起的高度困扰水平预测了更高的倦怠、更差的健康状况以及离职和离开职业的意愿，但并未预测病假。
结论
为了防止家庭护理护士遭受道德困境的严重后果，应制定适当的干预措施。家庭护理服务机构应考虑家庭友好型班次，提供社会支持，如团队内部的交流机会，并帮助应对情绪需求。必须为患者护理安排足够的时间，并防止短期接管未知的轮班。有必要开发和评估旨在减少道德困境的额外干预措施，特别是在家庭护理护理领域。
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