Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands.
Franciscus Gasthuis & Vlietland, Franciscus Academy, Rotterdam, the Netherlands.
Int J Nurs Stud. 2024 Oct;158:104864. doi: 10.1016/j.ijnurstu.2024.104864. Epub 2024 Jul 23.
As frontline caregivers, nurses often find themselves at the crossroads of complex ethical decisions that can significantly impact patient outcomes and their own well-being. Identifying the areas of experienced moral dilemmas in the workplace and gaining insight into the prevalence of moral distress can lead to a healthier workplace environment.
This study aims to examine the frequency, intensity and level of moral distress among nurses who work in a hospital, and to identify the variables associated with the level of moral distress.
Cross-sectional study.
One university hospital and six general hospitals.
654 of the 1095 nurses working on inpatient units filled out the questionnaire (response rate 60 %).
The intensity and frequency of moral distress was assessed using the Moral Distress Scale-Revised (MDS-R). We also asked two additional questions about considering leaving their job, and if they could describe a distressing case and how moral distress was discussed. Multivariable regression analysis was conducted to identify the variables associated with the level of moral distress.
The overall mean MDS-R score of the 654 included nurses was low at 36.4 (SD 26). Nurses reported to have frequent dilemmas regarding organizational aspects and aspects of end-of-life care. The multivariable analyses showed that higher levels of moral distress were experienced by registered nurses, nurses working on a medical ward, and nurses who had ever left or considered leaving their job, or considering leaving their job at the moment.
Although nurses in our study experiences low levels of moral distress, they do experience moral dilemmas related to organizational topics and end of life care. We all need to pay attention to these dilemmas and how to discuss them in order to achieve a resilient nursing profession at a time of major nursing shortages.
Caring for increasingly complex patients in a dynamic healthcare system is likely to continue to produce morally challenging scenarios.
作为一线医护人员，护士经常处于复杂的伦理决策的十字路口，这些决策可能会对患者的结果和自身的健康产生重大影响。确定工作场所中经历的道德困境领域，并深入了解道德困境的普遍性，可以营造更健康的工作环境。
本研究旨在调查在医院工作的护士经历道德困境的频率、强度和程度，并确定与道德困境程度相关的变量。
横断面研究。
一所大学医院和六所综合医院。
在住院病房工作的 1095 名护士中，有 654 名（应答率 60%）填写了问卷。
使用修订后的道德困境量表（MDS-R）评估道德困境的强度和频率。我们还问了另外两个问题，即是否考虑离职，以及是否可以描述一个令人痛苦的案例以及如何讨论道德困境。进行多变量回归分析以确定与道德困境程度相关的变量。
纳入的 654 名护士的总体 MDS-R 评分平均值较低，为 36.4（SD 26）。护士报告说，他们经常面临组织方面和临终关怀方面的困境。多变量分析显示，注册护士、在医疗病房工作的护士、曾经离职或考虑离职的护士以及目前正在考虑离职的护士，经历更高程度的道德困境。
尽管我们研究中的护士经历的道德困境程度较低，但他们确实经历了与组织主题和生命末期护理相关的道德困境。我们都需要关注这些困境以及如何讨论它们，以便在护理人员严重短缺的情况下，建立一个有弹性的护理职业。
在动态医疗保健系统中照顾日益复杂的患者，可能会继续产生具有道德挑战性的情况。
