Foster Wendy, McKellar Lois, Fleet Julie-Anne, Creedy Debra, Sweet Linda
Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia; School of Health and Social Care, Edinburgh Napier University, Scotland, UK.
Women Birth. 2024 May;37(3):101592. doi: 10.1016/j.wombi.2024.101592. Epub 2024 Feb 28.
Moral distress is a phenomena that occurs following a compromise to moral beliefs. Moral distress has been reported across health professions, including midwifery. Although there are validated tools to assess for moral distress, none have been identified that suit the Australian healthcare system or midwifery.
The aim of this study was to pilot the Barometer of Moral Distress in Midwifery.
This study was the fourth stage of a mixed method project. Using a cross-sectional approach, a survey tool including demographic questions, the Barometer of Moral Distress in Midwifery, and the Copenhagen Burnout Inventory assessed tool stability, reliability, and validity.
A total of 103 surveys were completed. A test-retest demonstrated tool reliability and stability (a =.97). Factor analysis confirmed internal consistency; Factor 1 - Professional Identity (a=.91), Factor 2 - Inadequate Resources (a=.85), and Factor 3 - Unethical Cultures (a=.88). Concurrent validity was demonstrated through positive correlations between self-reported types of moral distress with mean scores for each Factor. Strong correlations were identified between work-related burnout and mean scores, while only weak correlations were noted between client-related burnout and mean scores. Only Factor 1 demonstrated a correlation between leaving the profession and mean scores.
DISCUSSION/CONCLUSION: This was the first moral distress tool that assessed both frequency of exposure and psychological outcomes to score moral distress. Findings indicate that moral distress in midwifery is not associated with caring work but with occupational environments. Further research is required to assess self-sacrifice in moral distress.
道德困扰是一种在道德信念受到损害后出现的现象。包括助产领域在内的各健康职业领域均有道德困扰的相关报道。尽管有经过验证的工具可用于评估道德困扰，但尚未发现适用于澳大利亚医疗保健系统或助产领域的工具。
本研究旨在对助产领域道德困扰晴雨表进行试点。
本研究是一个混合方法项目的第四阶段。采用横断面研究方法，使用一种包含人口统计学问题、助产领域道德困扰晴雨表以及哥本哈根倦怠量表的调查工具来评估工具的稳定性、可靠性和有效性。
共完成了103份调查问卷。重测显示工具具有可靠性和稳定性（α = 0.97）。因子分析证实了内部一致性；因子1 - 职业认同（α = 0.91），因子2 - 资源不足（α = 0.85），因子3 - 不道德文化（α = 0.88）。通过自我报告的道德困扰类型与各因子平均得分之间的正相关证明了同时效度。工作相关倦怠与平均得分之间存在强相关性，而客户相关倦怠与平均得分之间仅存在弱相关性。只有因子1显示出离开该职业与平均得分之间存在相关性。
讨论/结论：这是首个既评估暴露频率又评估心理结果以对道德困扰进行评分的道德困扰工具。研究结果表明，助产领域的道德困扰与关怀工作无关，而是与职业环境有关。需要进一步研究来评估道德困扰中的自我牺牲情况。
