Ethical decision-making climate, moral distress, and intention to leave among ICU professionals in a tertiary academic hospital center

Abstract

Background Commentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units (ICUs). Our aim was twofold: (1) to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and (2) determine the association between the ethical climate, moral distress, and intention to leave. Methods We performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire (EDMCQ) and the Measure of Moral Distress for Healthcare Professionals (MMD-HP) tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave. Results Nurses perceived the ethical climate for decision-making as less favorable than physicians (p < 0.05). They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/Pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units (3.54 ± 0.66 vs. 3.43 ± 0.81 vs. 3.30 ± 0.69; respectively; both p ≤ 0.05) and also demonstrated lower moral distress scores (both p < 0.05) and lower “intention to leave” scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated (r = −0.58, p < 0.001); moral distress and "intention to leave" was positively correlated (r = 0.52, p < 0.001); and ethical climate and “intention to leave” were negatively correlated (r = −0.50, p < 0.001). Conclusions Significant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care.

Associação do Sofrimento Moral e Síndrome de Burnout em enfermeiros de hospital universitário

“…Dessa forma, percebe-se que os enfermeiros que trabalham por um período acima de 40 horas semanais têm maior propensão a deixar o emprego se comparados com enfermeiros que possuem uma carga horária de trabalho inferior ou igual a 40 horas semanais (23) , evidenciando que cada aumento na frequência de SM pode dobrar as chances da intenção de sair do emprego (24) .…”

Association between Moral Distress and Burnout Syndrome in university-hospital nurses

“…The intention to resign is justified by the higher MD prevalence and some factors may interfere, such as: long working hours, low wages, and difficulty in relating to other professionals. Thus, it is perceived that nurses who work more than 40 hours per week are more likely to leave their jobs when compared to those who work 40 hours per week or less (23) , which shows that each increase in MD frequency can double the chances of intending to resign (24) .…”

Asociación del Sufrimiento Moral y Síndrome de Burnout en enfermeros de un hospital universitario

“…La intención de dejar el empleo es justificada por la mayor prevalencia del SM y algunos factores pueden interferir, como: largas jornadas de trabajo, salarios reducidos y dificultad de relacionamiento con otros profesionales. De esa forma, se percibe que los enfermeros que trabajan por un período arriba de 40 horas semanales tienen mayor propensión a dejar el empleo si comparados con enfermeros que poseen una carga horaria de trabajo inferior o igual a 40 horas semanales (23) , esto evidencia que cada aumento en la frecuencia del SM puede doblar las chances de la intención de salir del empleo (24) .…”