Moral Distress: Identification Among Inpatient Oncology Nurses in an Academic Health System

Marturano, Erin; Hermann, Robin; Giordano, Nicholas A.; Trotta, Rebecca L.

doi:10.1188/20.cjon.500-508

Cited by 14 publications

(29 citation statements)

References 27 publications

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“…43 These relationships have been studied by many scholars without proof of significant associations, 44,45 while some have observed that nurses with longer experience report higher levels of moral distress. 46 Our results indicate a link between years in nursing and frequencies of distressing situations. This could be explained by the rarity of the situations: apparently it will take some time before novice nurses have experienced the situations described in the MDS-R.…”

Section: Discussionmentioning

confidence: 53%

Ethical climate and moral distress in paediatric oncology nursing

Ventovaara¹,

Sandeberg

Räsänen

et al. 2021

Nurs Ethics

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Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

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Section: Discussionmentioning

confidence: 53%

Ethical climate and moral distress in paediatric oncology nursing

Ventovaara¹,

Sandeberg

Räsänen

et al. 2021

Nurs Ethics

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“…The findings of this study further emphasize the literature’s results that oncology nurses experience moral distress. 2,5,10,16 The level of moral distress experienced by this study’s oncology nursing cohort from each of the MDS-R scenarios ranged from 1 to 11.23 (out of 16.) A pre/post comparison of this QI initiative reveals an overall decrease in moral distress score, although the sample was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…4,20 Exact cut off ranges of low, moderate, or high moral distress have not been defined by Hamric et al (2012). 4,16 The moral distress score of the MDS-R validation sample was (91.53 (44.24)).…”

Section: Instrumentmentioning

confidence: 99%

“…6 This avoidance of patient care also affects multiple components of the healthcare system. 2,4,13,15,16…”

Section: Introductionmentioning

confidence: 99%

“…6 This avoidance of patient care also affects multiple components of the healthcare system. 2,4,13,15,16 More broadly, moral distress can cause a pervasively over-taxed workforce within an institution, prompting oncology nurses to be more likely to leave their jobs, leading to high nursing turnover and a negative impact on patient care as nurse to patient ratios may change. 2,4,11,17 Thus, actions should be taken by institutions to decrease the level of moral distress, its impact on nursing, and cultivate the development of ethical competencies.…”

Section: Introductionmentioning

confidence: 99%

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PASTRY: A nursing-developed quality improvement initiative to combat moral distress

et al. 2022

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Background High levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention. Aim “Positive Attitudes Striving to Rejuvenate You: PASTRY” was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses. Research Design A Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric’s Moral Distress Scale–Revised (MDS-R.) This program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving “false hope” to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices. Participants Clinical nurses working on an adult leukemia/lymphoma unit. Ethical considerations This was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution’s Ethics Committee oversaw PASTRY’s implementation. Findings While improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit’s moral distress, led to enhanced camaraderie, and improved nurses’ coping skills. Discussion Measurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions. Conclusion This QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created.

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