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Background: Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff. Research question: The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events. Research design: A hermeneutic-phenomenological qualitative study was performed. Participants and research context: Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim. Ethical considerations: Ethical approval was obtained from the Institutional Review Hospital Board. Findings: Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured. Discussion: In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients’ last requests. According to our findings, the concept of ‘good’ end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events. Conclusion: Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.

Stoma patients and their caregivers need to be autonomous in stoma care, but there are few instruments for measuring the level of self‐care. This study aims to develop and test the psychometric properties of the Ostomy Self‐Care Index (OSCI) and the Caregiver Contribution to Self‐Care in Ostomy Patient Index (CC‐OSCI), from a clinical, operative and psychosocial perspective. A multicentre validation study was conducted on a convenience sample of 468 ostomy patients and 227 caregivers. The signed informed consent forms were obtained before data collection. Tool validation was performed by testing content validity, construct validity, criterion and internal consistency. Two indexes were developed, building on the self‐care theory of chronic illness. For the OSCI, 32 items were developed and grouped into four 5‐point Likert scales: maintenance, monitoring, management and confidence. For the CC‐OSCI, 22 items were developed and grouped into three 5‐point Likert scales: maintenance, monitoring and management. The content validity indexes for the OSCI and CC‐OSCI were 95% and 93%, respectively. Exploratory factor analysis showed appropriate factor loadings (OSCI: min 0.395 to max 0.852; CC‐OSCI: min 0.442 to max 0.841). Criterion validity was established through significant correlation between levels of quality of life, complications, readmissions and self‐care in patients and caregivers. Strong internal consistency was found for the overall index, and within the scales (OSCI: α = 0.975; CC‐OSCI: α = 0.972). The OSCI and CC‐OSCI are valid and reliable indexes. Further studies specifically aimed at predicting the level of self‐care are especially recommended.