Methods to Address Moral Distress Experienced by Stem Cell Transplantation Nurses and Build Resiliency

Abstract

level (<30 ng/ml). This demonstrates continued improvement in monitoring and supplementation as well as a sustained workflow (Figure 1). Cohort 2 included 162 patients: 85 autologous and 77 allogeneic. A vitamin D level was performed within 100 days of HSCT in 46% of patients and 19% were VDD. At 6 months post HSCT, 41% had a vitamin D level checked and 30% were VDD. Comparison with pretransplant levels showed that 87% of patients within 100 days and 82% of patients within 6 months had an increase in vitamin D level (Figure 2). Discussion & Implications: The results demonstrate sustained compliance over a two-year time frame of consistent monitoring and supplementation of vitamin D during the peritransplant period. There was a decrease in monitoring at later time points around 100 days and 6 months post HSCT that could be attributed to various factors, however, more follow up is needed. The findings show an increase in Vitamin D sufficiency for patients monitored and maintained on HSCT-Vitamin D specific algorithm post HSCT. Further study is needed to investigate factors which contribute to persistent VDD in a subset of HSCT patients and the impact of vitamin D monitoring/supplementations on long-term HSCT complications. NURSING (RESEARCH)

Moral Distress in Healthcare Providers Who Take Care of Critical Pediatric Patients throughout Italy—Cultural Adaptation and Validation of the Italian Pediatric Instrument

“…First, we hypothesized that nurses would have higher MD than physicians. This scenario has been described as a stable trait of the MD scales and is likely related to the less powerful position nurses have in the units [ 8 , 14 , 25 , 29 , 30 , 31 ]. Second, we would expect healthcare providers considering leaving their position to have higher MD levels than the others, as already demonstrated in many previous studies [ 8 , 25 , 29 , 31 ].…”

Moral distress among health care workers in the intensive care unit; a systematic review and meta-analysis

“…A review by Lamiani et al [41] has found that numerous studies, both quantitative and qualitative, have been published, and these publications mainly focused on nurses working in ICUs. It may be due to the deep-rooted proximity of the nurse-patient relationship and the relevant ethical aspects embedded in their involvement in endof-life care, which made moral distress a relevant experience for healthcare professionals [34,[41][42][43][44][45]. Another study by Nuttgens and Chang showed that moral distress may result from substandard supervision, supervisee vulnerability, supervisee non-disclosure, and organizational pressures [46].…”

A Longitudinal Study of the Impact of Schwartz Center Rounds on Moral Distress

“…3 Feelings of powerlessness, guilt, self-criticism, and low self-esteem from moral distress are reported. 1,[4][5][6][7][8][9][10][11] Negative effects associated with moral distress include avoiding patient interaction, placing blame on administration and coworkers, and experiencing long-term effects on their sense of moral conscience. 3 To address moral distress, Schwartz Center Rounds (SCRs) were implemented at a southeastern US level 1 trauma center and children's hospital.…”

“…1,14 Although most ICU-based research has focused on nurses, moral distress in physicians, respiratory therapists, and pharmacists has also been examined, reflecting the breadth of moral distress in healthcare. 11,[15][16][17]…”

“…Witnessing diminished care due to poor communication was among the top 3 most distressing causes for all disciplines 3 . Feelings of powerlessness, guilt, self-criticism, and low self-esteem from moral distress are reported 1,4-11 . Negative effects associated with moral distress include avoiding patient interaction, placing blame on administration and coworkers, and experiencing long-term effects on their sense of moral conscience 3 …”