Community Nursing: The Ethical Issues

Tope, Rosie; Smail, J. Kenneth

doi:10.1007/978-1-349-14569-0_5

Cited by 17 publications

(20 citation statements)

References 1 publication

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“…Moral distress, a term coined in 1984, arises when institutional constraints make it nearly impossible for nurses to pursue a course of action they believe is right (Jameton, 1984, p. 6). For example, nurses believe it is important to protect patients from harm (Corley, 2002, p. 637) yet, in neonatal intensive care units (NICUs) where advanced technology capabilities and extremely premature infants born at 23–24 weeks co‐exist, there is an expectation of a “no holds barred” (Hefferman & Heilig, 1999, p. 174) approach to resuscitation and pharmacological treatment.…”

Section: Literature Review and Theoretical Frameworkmentioning

confidence: 99%

Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses

Lawrence

2011

Nursing Forum

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AIM. The purpose of this study was to examine how nurses' moral distress, education level, and critical reflective practice (CRP) related to their work engagement. The study is relevant to nursing, given registered nurse (RN) documented experiences of job‐related distress and work dissatisfaction, and the nursing shortage crisis. A better understanding of factors that may enhance RN work engagement is needed. METHODS. A non‐experimental, descriptive, correlational design was used to examine the relationships among four variables: moral distress, education level, CRP, and work engagement. The sample included 28 intensive care unit RNs from three separate ICUs in a 355‐bed Southwest magnet‐designated hospital. RESULTS. There was a positive direct relationship between CRP and work engagement, a negative direct relationship between moral distress and work engagement, and CRP and moral distress, together, explained 47% of the variance in work engagement. Additionally, in the neonatal intensive care unit, a positive direct relationship between increased educational level and CRP was identified, with a suggested negative relationship between increased education level and moral distress. IMPLICATIONS. Strategies to promote CRP and reduce moral distress are recommended, to promote RN work engagement. Additionally, further study on the role of education in nurses' work engagement is recommended.

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Section: Literature Review and Theoretical Frameworkmentioning

confidence: 99%

Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses

Lawrence

2011

Nursing Forum

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“…Our study also summarizes the potential consequences of mental health boarding for clinicians, with moral distress emerging as an important theme. Moral distress was defined by Jameton as when one “knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.” 27 While studies exploring moral distress in healthcare workers are limited, one cross‐sectional study evaluating the clinical and ethical needs of ED clinicians found that caring for youth with mental health conditions was a common source of distress 28,29 . This highlights the importance of not only developing therapeutic interventions for patients but ensuring staff is supported in providing clinical care.…”

Section: Discussionmentioning

confidence: 99%

Healthcare quality during pediatric mental health boarding: A qualitative analysis

McCarty

Nagarajan

Halloran

et al. 2022

Journal of Hospital Medicine

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Background: Following initial evaluation and management, youth requiring inpatient psychiatric care often experience boarding, defined as being held in the emergency department or another location while awaiting inpatient care. Although mental health boarding is common, little research has examined the quality of healthcare delivery during the boarding period. Objective: This study aimed to explore the perspectives and experiences of multidisciplinary clinicians and parents regarding mental health boarding and to develop a conceptual model to inform quality improvement efforts. Design, Setting, & Participants: We conducted semistructured interviews with clinicians and parents of youth experiencing boarding. Interviews focused on experiences of care and perceived opportunities for improvement were continued until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed to identify emergent themes using a general inductive approach. Axial coding was used to inform conceptual framework development. Results: Interviews were conducted with 19 clinicians and 11 parents. Building on the Donabedian structure-process-outcome model of quality evaluation, emergent domains, and associated themes included: (1) infrastructure for healthcare delivery, including clinician training, healthcare team composition, and the physical environment; (2) processes of healthcare delivery, including clinician roles and responsibilities, goals of care, communication with families, policies/procedures, and logistics of inter-facility transfer; and (3) measurable outcomes, including patient safety, family experience, mental health status, timeliness of care, and clinician moral distress. Conclusion: This qualitative study summarizes clinician and family perspectives about care for youth experiencing boarding. The conceptual model resulting from this analysis can be applied to implement and evaluate quality improvement endeavors to support this vulnerable population.

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“…Initially coined by Jameton (1984), moral distress is an elusive concept which, in the context of nursing, evades conceptual clarity (Johnstone & Hutchinson, 2015; Pauly et al, 2012) and consensual definition (Deschenes et al, 2020; Morley et al, 2019). Indeed, Morley et al (2019) found 20 moral distress definitions and identified five moral distress subtypes: moral constraint, moral conflict, moral tension, moral uncertainty and moral dilemmas (Morley, Bradbury‐Jones, & Ives, 2020).…”

Section: Introductionmentioning

confidence: 99%

Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed‐methods systematic review and thematic synthesis

et al. 2023

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AimTo examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions.DesignJoanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted).MethodsFive databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.ResultsSearches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being.Patient or Public ContributionNo patient or public contribution to this systematic review.

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Community Nursing: The Ethical Issues

Cited by 17 publications

References 1 publication

Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses

Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses

Healthcare quality during pediatric mental health boarding: A qualitative analysis

Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed‐methods systematic review and thematic synthesis

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