Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool

Schaefer, Rafaela; Zóboli, Elma Lourdes Campos Pavone

doi:10.1111/nin.12156

Cited by 29 publications

(26 citation statements)

References 83 publications

(49 reference statements)

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“…In fact, participants manifested a great moral obligation towards patients (Schaefer et al. ), who deserve the best of care even when resources are scarce.…”

Section: Discussionmentioning

confidence: 99%

Non‐nursing tasks as experienced by nurses: a descriptive qualitative study

Grosso¹,

Tonet²,

Bernard³

et al. 2019

International Nursing Review

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Background Different concepts have been used to date (e.g. non‐nursing tasks, organizational work) to define tasks performed by clinical nurses other than nursing care. However, the true essence of nursing work is still poorly understood mostly because nurses are lacking an appropriate lexicon to describe their practice. Aims To describe non‐nursing tasks as experienced by nurses, exploring antecedents and consequences as perceived in daily practice. Methods A descriptive qualitative study from 2015 to 2016. A purposeful sample of nurses was approached. Semi‐structured interviews were used, and content analysis was performed on audio‐recorded and verbatim‐transcribed interviews. Findings A total of 22 nurses participated, the majority of whom were female (16; 72.7%) and their average age was 42.6 years. The concept of ‘Non‐nursing tasks’ is limited in describing what nurses experience in daily practice; the concept of ‘Being out of the nursing role’ emerged as being fully descriptive of the nurses’ experience and this can occur in two dimensions: outside and inside the role of other healthcare professions. The first dimension includes administrative work separating nurses from patients. The second dimension was reported to happen in proximity to patients but in three different directions towards professions requiring: (a) less education (e.g. healthcare assistants), (b) the same amount of education at university level (e.g. physiotherapists), and (c) higher education at university level as compared to nurses, thus performing activities expected by physicians. Antecedents of ‘Being out of the nursing role’ have been identified at the organizational, individual and educational levels; their consequences have been reported at the patient, professional and organizational levels. Conclusion Nurses play various non‐nursing roles, below, above and in the horizontal levels, both inside and outside other healthcare professionals’ role, mainly as a result of their felt moral obligation to offer the best to their patients, the organization's demand to nurses and the imprinting of nursing education. Implications for nursing/health policy Strategies at the nursing professional and policy levels are needed aimed at (a) supporting nurses in optimizing their professional identity, (b) sharing their sense of moral obligation towards patients with other healthcare professionals, and (c) implementing models of care based on interprofessional cooperation.

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“…In fact, participants manifested a great moral obligation towards patients (Schaefer et al. ), who deserve the best of care even when resources are scarce.…”

Section: Discussionmentioning

confidence: 99%

Non‐nursing tasks as experienced by nurses: a descriptive qualitative study

Grosso¹,

Tonet²,

Bernard³

et al. 2019

International Nursing Review

View full text Add to dashboard Cite

show abstract

“…Concerns about less than desirable quality of care resulting from poor availability of staff and support is a predominant theme in the literature describing causes of moral distress . The literature thematically supports the idea that the moral saliency of quality of care is aligned with the values of beneficence and nonmaleficence as they directly relate to the well‐being of the individual patient …”

Section: Conceptualization Of Moral Distressmentioning

confidence: 93%

“…18,20,28,29 Additional work by Concerns about less than desirable quality of care resulting from poor availability of staff and support is a predominant theme in the literature describing causes of moral distress. 24,[31][32][33] The literature thematically supports the idea that the moral saliency of quality of care is aligned with the values of beneficence and nonmaleficence as they directly relate to the well-being of the individual patient. [7][8][9]27 2.1 | Antecedents to moral distress Antecedents to moral distress include an individual with a defined set of values within an atmosphere of heightened moral responsibility.…”

Section: Conceptualization Of Moral Distressmentioning

confidence: 99%

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework

Welborn

2019

Nurs Forum

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Topic Neonatal nurses who care for infants with symptoms of neonatal abstinence syndrome (NAS) may experience moral distress through conflicting professional ethics. The nurse may find it difficult to simultaneously exemplify beneficence and nonmaleficence. Objective The purpose of this paper is to explore the moral distress of nurses in the context of infants experiencing symptoms of NAS and apply a new conceptual model to this phenomenon. Understanding how nurses navigate moral dilemmas may provide insight into strategies to better support them to address moral conflict. Methods Moral distress was explored in the context of nurses who care for infants with symptoms of NAS. A literature review was completed, followed by the application of the model onto the derived themes. Results The theoretical application resulted in a framework that exemplifies the experience of caring for infants with symptoms of NAS and their families described by many nurses within the literature. If moral distress is not resolved, negative outcomes may be experienced by the nurse, with additional negative outcomes experienced by the family. Conclusion This theoretical model provided insight into the experience of moral distress surrounding nursing care for infants with symptoms of NAS. Additional research is needed to investigate moral residue and moral resilience in this particular caregiving dynamic.

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“…Negative emotions, such as job dissatisfaction, might reduce professional commitment and increase the risk of turnover, whereas positive work environments might decrease turnover rates (Suliman & Aljezawi, ). Organizational job stressors are related to the organizational context, such as high workload, complexity of care and patient suffering (Andela, Truchot, & Van der Doef, ) and to inter‐personal factors, such as work‐life interference and nurses' relationships with other healthcare professionals (Liu et al, ; Schaefer, Zoboli, & Vieira, ). With regard to the current alarming shortage of nurses worldwide, it is important to investigate the relationship between professional commitment in (novice) nurses, negative emotions and organizational job stressors and, even more importantly, to identify the most crucial job stressors in terms of association with negative emotions and hence with job commitment.…”

Section: Introductionmentioning

confidence: 99%

Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses

Hoeve

Brouwer

Kunnen

2019

Journal of Advanced Nursing

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Aims Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions. Design The study used an observational cohort design. Methods Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013–September 2014. Results Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work‐life imbalance; only conflicting job demands, and lack of control related to professional commitment directly. Conclusion(s) To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events. Impact Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention.

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Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool

Cited by 29 publications

References 83 publications

Non‐nursing tasks as experienced by nurses: a descriptive qualitative study

Non‐nursing tasks as experienced by nurses: a descriptive qualitative study

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework

Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses

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