Miller Preston H, Epstein Elizabeth G, Smith Todd B, Welch Teresa D, Smith Miranda, Bail Jennifer R
The University of Alabama in Huntsville College of Nursing.
The University of Alabama.
Nurs Ethics. 2023 Nov-Dec;30(7-8):939-959. doi: 10.1177/09697330231191279. Epub 2023 Aug 28.
Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.
道德困扰（MD）在护理文献中有充分记载，当各种限制因素阻碍正确的行动方案得以实施时就会发生。近年来，护士群体中MD的测量频率有所增加，尤其是自新冠疫情以来。与其他护士群体相比，护士领导者对MD的了解较少。开展了一项定性系统评价，旨在综合护士领导者中MD的经历。该评价检索了三个数据库（医学期刊数据库、护理及健康领域数据库和美国心理学会心理学文摘数据库），共检索到303篇文章。在文章评审和筛选过程中，作者遵循了系统评价和Meta分析的首选报告项目（PRISMA）评审标准。评审后，确定了六篇符合评审标准的文章，并使用定性研究的批判性评估技能计划（CASP）清单对质量进行了评估。本次系统评价无需伦理审查。本评价纳入的六项研究分别来自美国、巴西、土耳其和伊朗。领导角色涵盖从科室领导到行政领导。根据CASP标准给出的质量评分在6至9分之间（中等至高质量）。综合分析得出了三个主题：（1）道德困扰极具消耗性；（2）受系统约束；（3）适应以克服困难。护士领导者中MD的独特促成因素包括领导角色本身以及应对出现的道德情境时面临的挑战。在未来MD干预措施的制定中应考虑护士领导者的观点。
