Rost Michael, Montagnoli Caterina, Eichinger Johanna
University of Basel.
University of Applied Sciences and Arts of Western Switzerland.
Nurs Ethics. 2024 Sep 27;32(5):9697330241281498. doi: 10.1177/09697330241281498.
Numerous studies have evidenced moral distress among midwives; however, to date no research synthesis on causes of moral distress among midwives has been conducted. A scoping review was carried out to identify, comprehensively map, and categorize possible causes of moral distress among midwives, and to identify knowledge gaps. Six data bases were searched using Boolean logic. To be included, studies had to (a) present empirical findings on (b) causes of moral distress (c) among midwives (d) in English, German, French, or Italian. We included a final set of 43 studies. The vast majority of studies came from high-income countries (83.7%) and used a qualitative approach (69.8%); 48.8% of the studies were published in the past 5 years. Identified single reasons of moral distress were grouped into eight broader clusters, forming a coherent framework of reasons of moral distress: societal disregard, contemporary birth culture, resources, institutional characteristics, interprofessional relationships, interpersonal mistreatment of service users, defensive practice, and challenging care situations. These clusters mostly capture moral distress resulting from a conflict between external constraints and personal moral standards, with a smaller proportion also from an intraindividual conflict between multiple personal moral standards. Despite projected increases in demand for midwives, the midwifery workforce globally faces a crisis and is experiencing substantial strain. Moral distress further exacerbates the shortage of midwives, which negatively affects birth experiences and birth outcomes, ultimately rendering it a public health issue. Our findings offer points of leverage to better monitor and alleviate moral distress among midwives, contributing to reducing attrition rates and improving birth experiences and birth outcomes. Further research is essential to explore the issue of ecological moral distress, develop evidence-based interventions aimed at alleviating moral distress among midwives, and evaluate the effects of both individual and system-level interventions on midwives, intrapartum care, and service users' outcomes.
众多研究已证实助产士存在道德困扰；然而，迄今为止尚未对助产士道德困扰的原因进行过研究综述。开展了一项范围综述，以识别、全面梳理和归类助产士道德困扰的可能原因，并找出知识空白。使用布尔逻辑搜索了六个数据库。纳入的研究必须：（a）呈现关于（b）道德困扰原因的实证研究结果，（c）针对助产士，（d）以英文、德文、法文或意大利文发表。我们最终纳入了43项研究。绝大多数研究来自高收入国家（83.7%），并采用定性研究方法（69.8%）；48.8%的研究是在过去5年发表的。识别出的道德困扰的单一原因被归为八个更宽泛的类别，形成了一个连贯的道德困扰原因框架：社会漠视、当代生育文化、资源、机构特征、跨专业关系、对服务使用者的人际虐待、防御性医疗行为以及具有挑战性的护理情况。这些类别大多涵盖了外部限制与个人道德标准之间冲突导致的道德困扰，也有较小比例来自多个个人道德标准之间的个体内冲突。尽管预计对助产士的需求会增加，但全球助产士劳动力面临危机且承受着巨大压力。道德困扰进一步加剧了助产士短缺的问题，这对分娩体验和分娩结局产生负面影响，最终使其成为一个公共卫生问题。我们的研究结果提供了可加以利用的要点，以更好地监测和缓解助产士的道德困扰，有助于降低流失率并改善分娩体验和分娩结局。进一步的研究对于探索生态道德困扰问题、制定旨在缓解助产士道德困扰的循证干预措施以及评估个体和系统层面干预措施对助产士、产时护理和服务使用者结局的影响至关重要。
