<p>Moral Distress and Its Associated Factors Among Nurses in Northwest Amhara Regional State Referral Hospitals, Northwest Ethiopia</p>

Abstract

Background: Moral distress is the cognitive-emotional dissonance that arises when one feels compelled to act against one's moral requirements. The study aimed to assess the proportion of moral distress and associated factors among nurses working in Northwest Amhara Regional State referral hospitals in 2018. Methods: A cross-sectional study was conducted among nurses working at Northwest Amhara regional state referral hospitals from April 1-30/2018. A total of 423 study participants were enrolled in the study. A systematic random sampling technique was used to select the study participants. A pretested self-administered structured questionnaire was used to collect data. Moral Distress Scale-Revised (MDS-R) was used to assess the proportion of moral distress. Epi info version 7 for data entry and SPSS version 22 for data analysis were used. A binary logistic model was computed. Variables having p-value < 0.5 with 95% CI were used to declare the presence of significant associations. Results: A total of 423 study participants were enrolled in the study with a response rate of 97.4%. The mean (SD) age of the respondents was 30.62 ± 5.7 years. The majority of nurses 350 (85%) were degree and above holders in nursing. The proportion of moral distress among nurses was found to be 83.7%. Work experience 11-20 years [adjusted odds ratio (AOR)=2, 95% CI: 1.01, 3.34], perceived poor team communication [AOR=4.5, 95% CI: 1.78, 11.62], perceived powerlessness in decision making [AOR=3.3, 95% CI: 1.38, 7.87], inadequate staffing [AOR=2.96, 95% CI: 1.26, 6.97], and inappropriate provision of care [AOR=4.12, 95% CI: 1.55, 10.9] were significantly associated with moral distress. Conclusion: Nurses frequently experienced moral distress in clinical settings. Perceived poor communication, perceived powerlessness in decision making, inadequate staffing, and inappropriate provision care were the factors associated with moral distress.

The burden of healthcare-associated infection in Ethiopia: a systematic review and meta-analysis

“…Besides, nearly 68% of health professionals were less satisfied with their work in the Amhara region [ 42 ]. Additionally, about 84% of nurses were morally distressed in the northwestern part of the country [ 43 ]. As a result, acquisition of HCAI from unsafe hands of unsatisfied healthcare providers augmented by less adherence to infection prevention and morally less prepared nurses might limit the quality of patient care in healthcare facilities.…”

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

“…The result was higher than studies conducted in China (3.12%) [ 35 ], Morocco (10.3%) [ 36 ], Botswana (13.54%) [ 6 ], and South Africa (7.67%) [ 7 ]. The possible reasons for high prevalence in this study might be very low hand hygiene practice by physicians and resource constraints [ 37 ], low adherence to infection prevention practice [ 38 ], low level of job satisfaction [ 39 ], morally distressed nurses [ 40 ], and low implementation of the nursing process [ 41 ] in our settings, and also less attention given to HCAI.…”

“…Hence, the nosocomial infection becomes inevitably high because these less satisfied health professionals are less likely to deliver quality healthcare. Additionally, about 84% of the nurses in the northwestern part of the country [ 40 ] were morally distressed, thus causing HCAI as morally less prepared nurses were unable to deliver quality nursing care.…”

A comparison of the ethical climate of operating rooms from the perspective of operating room nursing students and staff: An analytical study

“…Ethical distress has negative consequences for both the health team and the patient. 41 Therefore, all members of the surgical team, especially physicians, should pay special attention to this vital dimension of communication to achieve quality care, especially the best surgical outcome in the operating room. 42 Managers must take actions to improve teamwork in the operating room.…”