Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

Abstract

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences.

Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

“…Indeed, healthcare professionals report higher levels of moral distress when their managers are closed and “insensitive” to the phenomenon. Moreover, literature shows that communication with patient, its relatives, and colleagues is key to managing or downsizing misunderstandings at all levels, decreasing levels of moral distress [ 40 ].…”

L’infermiere e la percezione del Moral Distress nella cura del fine vita nel paziente dializzato

“…Il MD è un fenomeno complesso frequentemente sperimentato nei reparti nei quali i conflitti etici sono legati al progresso tecnologico e agli ambienti di lavoro ad alta intensità oppure quando gli operatori sono coinvolti in decisioni che riguardano il fine vita (9,11,13). I reparti con alta incidenza di tale problematica sembrano essere quelli di terapia intensiva (14), neonatologia (15), oncologia ( 16) e infine anche quelli di nefrologia e dialisi (17,18).…”

“…A quel tempo, Jameton descriveva il disagio morale come una situazione nella quale un infermiere conosce il diritto di cosa deve fare, ma i vincoli istituzionali rendono quasi impossibile seguire la giusta linea d'azione. Tra i fattori che contribuiscono al disagio morale possiamo includere dilemmi etici, obiettivi di cura non corrispondenti tra i pazienti e le loro famiglie o addirittura la percezione dell'inutilità delle cure (8)(9)(10)(11).…”

„Ich stehe jeden Dienst mit mir selbst im Konflikt“–„Moral distress“ bei Altenpflegenden während der COVID-19-Pandemie

“…Des Weiteren wird eine transparente und kontinuierliche Kommunikation zwischen Pflegenden und Führungskräften als eine zentrale Strategie verstanden, um das Auftreten von Moral distress zu minimieren oder überhaupt erst bewältigen zu können (Villa et al. 2021 ). Ethische Fallbesprechungen und Supervision können dazu beitragen, dass sowohl die Versorgungsqualität als auch die Belastungssituation für die Pflegenden so verbessert werden, dass das Erleben von Moral distress verringert werden kann.…”