School of Nursing, McMaster University, Hamilton, Ontario, Canada.
School of Nursing, York University, Toronto, Ontario, Canada.
J Adv Nurs. 2024 Dec;80(12):4974-4988. doi: 10.1111/jan.16135. Epub 2024 Mar 9.
To describe intensive care unit nurses' experiences of moral distress during the COVID-19 pandemic, and their recommendations for mitigative interventions.
Interpretive description.
Data were collected with a purposeful sample of 40 Canadian intensive care unit nurses between May and September 2021. Nurses completed a demographic questionnaire, the Measure of Moral Distress-Healthcare Professionals survey and in-depth interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were categorized and synthesized using reflexive thematic analysis and rapid qualitative analysis.
Half of the nurses in this sample reported moderate levels of moral distress. In response to moral distress, nurses experienced immediate and long-term effects across multiple health domains. To cope, nurses discussed varied reactions, including action, avoidance and acquiescence. Nurses provided recommendations for interventions across multiple organizations to mitigate moral distress and negative health outcomes.
Nurses reported that moral distress drove negative health outcomes and attrition in response to moral events in practice. To change these conditions of moral distress, nurses require organizational investments in interventions and cultures that prioritize the inclusion of nursing perspectives and voices.
Nurses engage in a variety of responses to cope with moral distress. They possess valuable insights into the practice issues central to moral distress that have significant implications for all members of the healthcare teams, patients and systems. It is essential that nurses' voices be included in the development of future interventions central to the responses to moral distress.
This study adheres to COREQ guidelines.
What Problem did the Study Address? Given the known structural, systemic and environmental factors that contribute to intensive care unit nurses' experiences of moral distress, and ultimately burnout and attrition, it was important to learn about their experiences of moral distress and their recommendations for organizational mitigative interventions. Documentation of these experiences and recommendations took on a greater urgency during the context of a global health emergency, the COVID-19 pandemic, where such contextual influences on moral distress were less understood. What Were the Main Findings? Over half of the nurses reported a moderate level of moral distress. Nurses who were considering leaving nursing practice reported higher moral distress scores than those who were not considering leaving. In response to moral distress, nurses experienced a variety of outcomes across several health domains. To cope with moral distress, nurses engaged in patterns of action, avoidance and acquiescence. To change the conditions of moral distress, nurses desire organizational interventions, practices and culture changes situated in the amplification of their voices. Where and on Whom Will the Research Have an Impact on? These findings will be of interest to: (1) researchers developing and evaluating interventions that address the complex phenomenon of moral distress, (2) leaders and administrators in hospitals, and relevant healthcare and nursing organizations, and (3) nurses interested in leveraging evidence-informed recommendations to advocate for interventions to address moral distress. What Does this Paper Contribute to the Wider Global Community? This paper advances the body of scientific work on nurses' experiences of moral distress, capturing this phenomenon within the unique context of a global health emergency. Nurses' levels of moral distress using Measure of Moral Distress-Healthcare Professional survey were reported, serving as a comparator for future studies seeking to measure and evaluate intensive care unit nurses' levels of moral distress. Nurses' recommendations for mitigative interventions for moral distress have been reported, which can help inform future interventional studies.
No patient or public contribution.
描述 COVID-19 大流行期间重症监护病房护士的道德困境体验，以及他们对缓解干预措施的建议。
解释性描述。
2021 年 5 月至 9 月期间，我们使用加拿大重症监护病房的 40 名护士进行了有针对性的样本收集。护士完成了一份人口统计学问卷、《医疗保健专业人员道德困境衡量表》和深入访谈。使用描述性统计对定量数据进行分析。使用反思性主题分析和快速定性分析对定性数据进行分类和综合。
该样本中一半的护士报告了中度道德困境。为了应对道德困境，护士在多个健康领域经历了即时和长期的影响。为了应对，护士们讨论了各种反应，包括行动、回避和默许。护士们针对多个组织提出了缓解道德困境和负面健康结果的干预措施建议。
护士报告说，道德困境导致了负面的健康结果和离职，以应对实践中的道德事件。为了改变这些道德困境的状况，护士需要组织投资于干预措施和文化，优先考虑纳入护理视角和声音。
护士采取各种应对措施来应对道德困境。他们对实践中与道德困境相关的核心问题具有宝贵的见解，这些问题对医疗保健团队的所有成员、患者和系统都有重大影响。必须让护士的声音参与到未来针对道德困境的应对措施的干预措施的制定中来。
本研究遵循 COREQ 指南。
该研究解决了什么问题？鉴于已知的结构性、系统性和环境因素会导致重症监护病房护士的道德困境体验，最终导致倦怠和离职，了解他们的道德困境体验以及他们对组织缓解干预措施的建议非常重要。在全球卫生紧急情况下，对道德困境的这种背景影响了解较少，因此记录这些经历和建议变得更加紧迫。主要发现是什么？超过一半的护士报告了中度道德困境。考虑离开护理实践的护士报告的道德困境得分高于不考虑离开的护士。为了应对道德困境，护士在多个健康领域经历了各种结果。为了应对道德困境，护士们采取了行动、回避和默许等模式。为了改变道德困境的状况，护士们希望组织干预、实践和文化变革能够放大他们的声音。这些研究结果将对谁产生影响？这些发现将对以下人员产生影响：（1）开发和评估旨在解决道德困境这一复杂现象的干预措施的研究人员；（2）医院的领导和管理人员，以及相关的医疗保健和护理组织；（3）有兴趣利用循证建议来倡导干预措施以解决道德困境的护士。这篇论文对更广泛的全球社区有什么贡献？本文推进了护士道德困境体验方面的科学研究工作，在全球卫生紧急情况下描述了这一现象。使用《医疗保健专业人员道德困境衡量表》报告了护士的道德困境水平，这可作为未来旨在衡量和评估重症监护病房护士道德困境水平的研究的比较。报告了缓解道德困境的缓解干预措施的护士建议，这有助于为未来的干预性研究提供信息。
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