Abstract:The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses' confidence and cultural sensitivity, so as to reduce the moral distress of nurses.
“…A sense of powerlessness to intervene regarding care, treatment and decision‐making perceived as generating needless patient suffering and transgressing core professional values contributed to moral distress among RNs (Berhie et al, 2020; Crespo Drago et al, 2020; De Brasi et al, 2021; Deady & McCarthy, 2010; Harrowing & Mill, 2010; Ko et al, 2019; Langley et al, 2015; Nikbakht Nasrabadi et al, 2018; Prompahakul et al, 2021; Sauerland et al, 2014) and nursing students (Escolar Chua & Magpantay, 2019). This was invariably connected with interventions, treatment and care decisions perceived as futile (Asayesh et al, 2018; Browning, 2013; Choe et al, 2015; Ganz et al, 2013; Dodek et al, 2019; Dyo et al, 2016; Emmamally & Chiyangwa, 2020; Hiler et al, 2018; Hou et al, 2021; Karanikola et al, 2014; Ko et al, 2019; Latimer et al, 2021; Rezaee et al, 2019; Robinson & Stinson, 2016; Silverman et al, 2021; Wiegand & Funk, 2012; Wilson et al, 2013), overly aggressive (Rezaee et al, 2019; Wiegand & Funk, 2012) and inappropriate or unnecessary (Asgari et al, 2019; Browning, 2013; Choe et al, 2015; Christodoulou‐Fella et al, 2017; De Brasi et al, 2021; de Sousa Vilela et al, 2021; Fernandez‐Parsons et al, 2013; Forozeiya et al, 2019; Ganz et al, 2013; Ko et al, 2019; Laurs et al, 2020; Nikbakht Nasrabadi et al, 2018; Silverman et al, 2021) particularly, but not exclusively (de Sousa Vilela et al, 2021; Deady & McCarthy, 2010; Rezaee et al, 2019; Wojtowicz et al, 2014), in the context of end‐of‐life care.We're with the patients a lot more than the providers … we see the futility a lot of the times, because we're like there's no wa...…”
Section: Resultsmentioning
confidence: 99%
“…Findings are mixed regarding how perceived professional autonomy to enact moral agency when faced with moral problems in practice connected with experiencing moral distress (Caram et al, 2019; Choe et al, 2015; Christodoulou‐Fella et al, 2017; Crespo Drago et al, 2020; Dodek et al, 2019; Karanikola et al, 2014; Sarkoohijabalbarezi et al, 2017; Yeganeh et al, 2019). However, RNs' (Deady & McCarthy, 2010; Harorani et al, 2019; Hsun‐Kuei et al, 2018; Ko et al, 2019; Pergert et al, 2019; Sauerland et al, 2014; Silverman et al, 2021; Varcoe et al, 2012) and nursing students' (Escolar Chua & Magpantay, 2019; Krautscheid et al, 2017; Renno et al, 2018) perceived lack of knowledge, self‐competence and confidence in their ability to articulate concerns and fulfil their perceived moral responsibilities in ethically challenging situations generated moral distress (Deady & McCarthy, 2010; Escolar Chua & Magpantay, 2019; Harorani et al, 2019; Hsun‐Kuei et al, 2018; Ko et al, 2019; Krautscheid et al, 2017; Pergert et al, 2019; Renno et al, 2018; Sauerland et al, 2014; Silverman et al, 2021; Varcoe et al, 2012).…”
Section: Resultsmentioning
confidence: 99%
“…Others, however, seemingly remained silent. This was primarily on account of interprofessional team hierarchies, notably the perceived enduring power of the medical profession (Atashzadeh Shorideh et al, 2012; Caram et al, 2019; de Sousa Vilela et al, 2021; Deady & McCarthy, 2010; Escolar Chua & Magpantay, 2019; Ko et al, 2019; Langley et al, 2015; Pavlish et al, 2016; Renno et al, 2018; Silverman et al, 2021; Wolf et al, 2016), encapsulated in the following data extract:Physicians believed [sic] they are above us. They order for patients and they expect us to obey them and not tell them about wrong orders.…”
Section: Resultsmentioning
confidence: 99%
“…power of the medical profession(Atashzadeh Shorideh et al, 2012;Caram et al, 2019;de Sousa Vilela et al, 2021;Deady & McCarthy, 2010;Escolar Chua & Magpantay, 2019;Ko et al, 2019;Langley et al, 2015;Pavlish et al, 2016;Renno et al, 2018;Silverman et al, 2021;Wolf et al, 2016), encapsulated in the following data extract: tient is done by the nurses, it is the nurses who pass on the information. And even with our concern, they do not value our knowledge at all.…”
AimTo examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions.DesignJoanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted).MethodsFive databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.ResultsSearches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being.Patient or Public ContributionNo patient or public contribution to this systematic review.
“…A sense of powerlessness to intervene regarding care, treatment and decision‐making perceived as generating needless patient suffering and transgressing core professional values contributed to moral distress among RNs (Berhie et al, 2020; Crespo Drago et al, 2020; De Brasi et al, 2021; Deady & McCarthy, 2010; Harrowing & Mill, 2010; Ko et al, 2019; Langley et al, 2015; Nikbakht Nasrabadi et al, 2018; Prompahakul et al, 2021; Sauerland et al, 2014) and nursing students (Escolar Chua & Magpantay, 2019). This was invariably connected with interventions, treatment and care decisions perceived as futile (Asayesh et al, 2018; Browning, 2013; Choe et al, 2015; Ganz et al, 2013; Dodek et al, 2019; Dyo et al, 2016; Emmamally & Chiyangwa, 2020; Hiler et al, 2018; Hou et al, 2021; Karanikola et al, 2014; Ko et al, 2019; Latimer et al, 2021; Rezaee et al, 2019; Robinson & Stinson, 2016; Silverman et al, 2021; Wiegand & Funk, 2012; Wilson et al, 2013), overly aggressive (Rezaee et al, 2019; Wiegand & Funk, 2012) and inappropriate or unnecessary (Asgari et al, 2019; Browning, 2013; Choe et al, 2015; Christodoulou‐Fella et al, 2017; De Brasi et al, 2021; de Sousa Vilela et al, 2021; Fernandez‐Parsons et al, 2013; Forozeiya et al, 2019; Ganz et al, 2013; Ko et al, 2019; Laurs et al, 2020; Nikbakht Nasrabadi et al, 2018; Silverman et al, 2021) particularly, but not exclusively (de Sousa Vilela et al, 2021; Deady & McCarthy, 2010; Rezaee et al, 2019; Wojtowicz et al, 2014), in the context of end‐of‐life care.We're with the patients a lot more than the providers … we see the futility a lot of the times, because we're like there's no wa...…”
Section: Resultsmentioning
confidence: 99%
“…Findings are mixed regarding how perceived professional autonomy to enact moral agency when faced with moral problems in practice connected with experiencing moral distress (Caram et al, 2019; Choe et al, 2015; Christodoulou‐Fella et al, 2017; Crespo Drago et al, 2020; Dodek et al, 2019; Karanikola et al, 2014; Sarkoohijabalbarezi et al, 2017; Yeganeh et al, 2019). However, RNs' (Deady & McCarthy, 2010; Harorani et al, 2019; Hsun‐Kuei et al, 2018; Ko et al, 2019; Pergert et al, 2019; Sauerland et al, 2014; Silverman et al, 2021; Varcoe et al, 2012) and nursing students' (Escolar Chua & Magpantay, 2019; Krautscheid et al, 2017; Renno et al, 2018) perceived lack of knowledge, self‐competence and confidence in their ability to articulate concerns and fulfil their perceived moral responsibilities in ethically challenging situations generated moral distress (Deady & McCarthy, 2010; Escolar Chua & Magpantay, 2019; Harorani et al, 2019; Hsun‐Kuei et al, 2018; Ko et al, 2019; Krautscheid et al, 2017; Pergert et al, 2019; Renno et al, 2018; Sauerland et al, 2014; Silverman et al, 2021; Varcoe et al, 2012).…”
Section: Resultsmentioning
confidence: 99%
“…Others, however, seemingly remained silent. This was primarily on account of interprofessional team hierarchies, notably the perceived enduring power of the medical profession (Atashzadeh Shorideh et al, 2012; Caram et al, 2019; de Sousa Vilela et al, 2021; Deady & McCarthy, 2010; Escolar Chua & Magpantay, 2019; Ko et al, 2019; Langley et al, 2015; Pavlish et al, 2016; Renno et al, 2018; Silverman et al, 2021; Wolf et al, 2016), encapsulated in the following data extract:Physicians believed [sic] they are above us. They order for patients and they expect us to obey them and not tell them about wrong orders.…”
Section: Resultsmentioning
confidence: 99%
“…power of the medical profession(Atashzadeh Shorideh et al, 2012;Caram et al, 2019;de Sousa Vilela et al, 2021;Deady & McCarthy, 2010;Escolar Chua & Magpantay, 2019;Ko et al, 2019;Langley et al, 2015;Pavlish et al, 2016;Renno et al, 2018;Silverman et al, 2021;Wolf et al, 2016), encapsulated in the following data extract: tient is done by the nurses, it is the nurses who pass on the information. And even with our concern, they do not value our knowledge at all.…”
AimTo examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions.DesignJoanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted).MethodsFive databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.ResultsSearches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being.Patient or Public ContributionNo patient or public contribution to this systematic review.
“…By combining current empirical research results to review the phenomenon of moral distress, nurses engage in personal moral judgment in the face of moral distress. [12][13][14] If nurses can adhere to their moral beliefs, they can take voluntary moral actions to safeguard the patient's best interests even if they feel difficulties, stress, and threats; this is known as moral courage in literatures. [15][16][17] Expressing moral courage and forming moral action are of great significance in reducing the feeling of moral distress.…”
Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress.
Goal: Moral distress literature is firmly rooted in the nursing and clinician experience, with a paucity of literature that considers the extent to which moral distress affects clinical and administrative healthcare leaders. Moreover, the little evidence that has been collected on this phenomenon has not been systematically mapped to identify key areas for both theoretical and practical elaboration. We conducted a scoping review to frame our understanding of this largely unexplored dynamic of moral distress and better situate our existing knowledge of moral distress and leadership.Methods: Using moral distress theory as our conceptual framework, we evaluated recent literature on moral distress and leadership to understand how prior studies have conceptualized the effects of moral distress. Our search yielded 1,640 total abstracts. Further screening with the PRISMA process resulted in 72 included articles.Principal Findings: Our scoping review found that leaders-not just their employeespersonally experience moral distress. In addition, we identified an important role for leaders and organizations in addressing the theoretical conceptualization and practical effects of moral distress.
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