Moral distress among nurses: A mixed-methods study

Abstract

Background: Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. Objective: This study aims to describe the experience of moral distress and related factors among Thai nurses. Design: A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated. Participants: Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand. Ethical considerations: This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151. Results: A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress. Discussion: Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored. Conclusions: Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context.

Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review

“…Studies were conducted in ten countries: UK (n=14),37–50 Australia (n=6),51–56 USA (n=5),57–61 Sweden (n=5),62–66 Canada (n=4),67–70 New Zealand (n=2),71 72 Saudi Arabia (n=1),73 the Netherlands (n=1),74 Thailand (n=1)75 and China (n=1) 76. Years of publication ranged from 2001 to 2021.…”

“…Most studies reported having conducted a general analysis of themes (n=22) 37–43 45–49 55 60 61 64 67 68 70 72–74. Content analysis51–54 56 57 62 65 66 76 and thematic analysis involving specific frameworks were conducted as well 44 50 58 59 69 75. Other methods included narrative analysis,63 basic descriptive analysis71 and matrix analysis 59…”

“…The majority of studies were conducted in hospital settings (n=28) 37 38 40 41 44 45 47–49 51–56 58 59 63–71 73 75 76. Other clinical settings included care homes (n=10),42 43 50 57 60–62 67 72 74 hospices (n=5),39 41 46 48 55 community (n=5)40 50 55 59 76 and primary care (n=4) 40 41 48 50…”

“…Three studies included only nurses and other healthcare professionals 43 56 60. 13 studies focused on a particular group of professionals such as nurses,49 54 55 63 64 66 69 73 75 doctors,57 59 physician assistants58 or healthcare assistants 72. Two studies included any type of clinician who wrote an entry in patients’ medical records 52 53.…”

“…Various staff members were involved in decision-making (table 2). Included studies most often reported decisions involving nurses and doctors 38–41 43–47 49 51 52 54–56 62–71 73 75. Evidence showed that decision-making between different types of nurses62 and between doctors with different specialties48 59 occurred as well.…”