Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Nurse Educ Today. 2023 Oct;129:105912. doi: 10.1016/j.nedt.2023.105912. Epub 2023 Jul 17.
The review aims to synthesize and consolidate the factors and situations in which student nurses experience moral distress during their clinical practice and its potential implications for patient care and outcomes.
A qualitative systematic review.
The articles were sourced from PubMed, Embase, CINAHL, Scopus, PsycInfo, Web of Science, ERIC (ProQuest), and ProQuest Dissertations and Theses Global Database between their inception dates to December 2022. Reference lists of included studies were also screened for additional studies.
Published and unpublished primary studies of any qualitative research methods focused on student nurses' experiences of moral distress regardless of their education level were included in this review. Two reviewers independently screened titles and abstracts, assessed full-text articles for eligibility, extracted data, and appraised the quality of included studies. Sandelowski and Barroso's (2007) two-step meta-synthesis approach and Braun and Clarke's (2006) thematic analysis framework were used to analyze and interpret findings from included studies.
Seven studies met the inclusion criteria and were included in the review. The meta-synthesis revealed an overarching theme, "Moral Distress and its Intertwined Roots". This was supported by the four main themes: 1) Inadequacy and lack of autonomy, 2) Unprofessionalism of healthcare professionals, 3) Differing cultural views and values of patients and their relatives, and 4) Healthcare needs versus resource constraints.
This review highlights the experiences of student nurses in situations of moral distress, including feelings of inadequacy and powerlessness when faced with ethical challenges, and the negative impact of resource constraints, unprofessional behavior, and cultural differences. Collaborative efforts between healthcare professionals and student nurses are needed to promote shared decision-making, prioritize ethical training, and provide culturally sensitive care to address these challenges and ultimately improve patient care.
本次综述旨在综合并整合学生护士在临床实践中经历道德困境的因素和情境，及其对患者护理和结局的潜在影响。
定性系统综述。
文章来源于 PubMed、Embase、CINAHL、Scopus、PsycInfo、Web of Science、ERIC（ProQuest）和 ProQuest Dissertations and Theses Global Database，检索时间截至 2022 年 12 月。还对纳入研究的参考文献进行了筛选，以获取其他研究。
纳入了本综述的研究为任何定性研究方法的已发表和未发表的原始研究，无论其教育水平如何，均聚焦于学生护士的道德困境体验。两名评审员独立筛选标题和摘要，评估全文文章的入选资格，提取数据，并评估纳入研究的质量。采用桑德洛斯基和巴罗索（2007 年）的两步元综合方法和布劳恩和克拉克（2006 年）的主题分析框架来分析和解释纳入研究的结果。
符合纳入标准的研究有 7 项，纳入本综述。元综合揭示了一个总体主题，“道德困境及其交织根源”。这得到了四个主要主题的支持：1）不充分和缺乏自主权，2）医疗保健专业人员的不专业行为，3）患者及其家属的不同文化观念和价值观，4）医疗保健需求与资源限制。
本综述强调了学生护士在道德困境中的体验，包括面对伦理挑战时的不足和无力感，以及资源限制、不专业行为和文化差异的负面影响。需要医疗保健专业人员和学生护士之间的合作努力，以促进共同决策、优先考虑伦理培训，并提供文化敏感的护理，以应对这些挑战，最终改善患者护理。
