Background: The complexities of the health care system have imposed complex ethical issues on nurses, resulting in moral distress in all categories of nurses with various specialties. Psychiatric nurses are also exposed to moral dilemmas because they care for vulnerable patients with delusions and suicidal ideation problems. Due to the different experiences of moral distress in different cultures, settings, and wards, we studied this phenomenon in Iranian psychiatric nurses. Objectives: We conducted this study to investigate the causes of moral distress in Iranian psychiatric nurses. Methods: This qualitative study was conducted based on a conventional content analysis on 12 psychiatric nurses selected by the purposive sampling method in 2020 in Shiraz, Iran, considering the maximum diversity. Data were collected through semi-structured interviews with participants for an average of 40 - 60 minutes per interview until data saturation. Results: We obtained causes of moral distress from 7 categories and 20 subcategories. The categories included “lack of professional competence”, “organizational culture”, “individual factors”, “environmental and organizational factors”, “management factors”, “weaknesses in professional and effective communication”, and “observation of moral dilemmas by nurses”. Conclusions: This study demonstrated various causes of moral distress that managers should consider by providing a safe environment and appropriate facilities for psychiatric nurses.
Background: The COVID-19 epidemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in psychiatric nurses during the COVID-19 epidemic. Method: This qualitative study with a conventional content analysis approach involved 12 nurses at Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by unstructured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. Results: From the data analysis, 252 initial codes were extracted, which were obtained by continuous comparison and integration of subcategories of 4 main categories including emotional responses, relational factors, Institutional factors, and management factors caused by Moral Distress in psychiatric nurses. Conclusion: new dimensions of the causes of moral distress associated with the COVID-19 pandemic are discovered. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.
Background The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic. Method This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. Results By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses’ Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies). Conclusion New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.
Context: Moral distress is a common phenomenon in nurses that causes feelings of anger, fatigue, reduced quality of patient care, and leaving the nursing profession. To reduce the negative effects of this phenomenon, it is necessary to study the strategies and mechanisms to deal with it. Aims: It has been less studied in psychiatric nurses, so this study was conducted to investigate the mechanisms and strategies of psychiatric nurses in dealing with situations of moral distress. Settings and Design: This qualitative study was conducted based on a conventional content analysis of 12 psychiatric nurses selected by a purposive sampling method in the 2020 winter in Shiraz, Iran, considering the maximum diversity. Data were collected through semi-structured interviews with participants for an average of 40–60 minutes per interview until data saturation. Results: We obtained strategies for dealing with moral distress in psychiatric nurses in four categories. The categories included “Coping strategies,” “Establish therapeutic and professional communication,” “Managerial support for nurses,” and “Commitment to religious beliefs.” Conclusions: Psychiatric nurses use personal, team, and management strategies to reduce moral distress in themselves and their colleagues and reduce its adverse effects on patients. Management support and organizational cooperation are necessary for the better implementation of these strategies.
Background Moral distress is common phenomenon that has negative consequences on nurses, patients, and healthcare systems. This study aims to design and evaluate an educational program to reduce moral distress in nurses. Methods This multiphase mixed-method study was done in three stage on February 2021 in Shiraz/Iran. In pre-implementation stage, a content analysis study was conducted on 12 participants were interviewed using purposive sampling and then the program was designed according to qualitative data, panel of expertise and literature review according the seven steps of Ewles and Sminett’s model and implemented in one group on 40 nurses using a quasi-experimental design. In Post-Implementation stage, effectiveness of program was evaluated through quantitative and qualitative methods. Quantitative data were gathered by Hamric's 21-question moral distress questionnaire analyzed via SPSS v.25 and analysis of variance repeated measures test. Also, a content analysis study was conducted on 6 PRMD participants using purposive sampling. In Program evaluation stage, convergence of quantitative and qualitative data and the effects of the program were examined. Trustworthiness of qualitative data was accomplished by Lincoln and Guba criteria. Results First quantitative study revealed the causes of moral distress consisted of deficiency in professional competency, unsuitable organizational culture, personal factors, environmental and organizational factors, management factors, insufficiencies in proficient and efficient communication and nurses' observation of moral dilemma. Results of quantitative stage showed that there was a significant difference (p < 0.05) between the mean score of moral distress before, after, 1 and 2 months after the intervention. The participants in secondary qualitative stage, reported increasing their moral knowledge and skills, improving ethical climate, and moral empowerment. Conclusion The use of different educational tools and teaching methods and the participation of managers in designing strategies had a very effective role in the effectiveness of this educational program.
Background: The COVID-19 epidemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in psychiatric nurses during the COVID-19 epidemic. Method: This qualitative study with a conventional content analysis approach involved 12 nurses at Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by unstructured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. Results: From the data analysis, 252 initial codes were extracted, which were obtained by continuous comparison and integration of subcategories of 4 main categories including emotional responses, relational factors, Institutional factors, and management factors caused by Moral Distress in psychiatric nurses. Conclusion: new dimensions of the causes of moral distress associated with the COVID-19 pandemic are discovered. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.
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