An Inpatient Surgical Oncology Unit’s Experience With Moral Distress: Part I

Bohnenkamp, Susan; Pelton, Nicole; Reed, Pamela G.; Rishel, Cindy J.

doi:10.1188/15.onf.308-310

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…Of the 17 articles selected for this review, seven corresponded to qualitative studies (22,23,(26)(27)(28)(29)(30); six to quantitative studies (16,(31)(32)(33)(34)(35); two were reflections (36,37); and two were editorials (17, 18) (Figure 3). Eighteen percent of the articles were published between 2006 and 2011, and 82% between 2012 and 2016 (Figure 4).…”

Section: Resultsmentioning

confidence: 99%

“…In diverse studies, participants report that, on occasion, discrepancies exist among the team members with respect to the doses of analgesics that should be administered to a patient (29,33,34). They also indicate that they must follow medical indications that are not aimed at controlling the patient's pain; thereby, this need is postponed (32). Inadequate management of pain is consequential of patient suffering, which can be a source of moral distress for nurses (26), given that providing inadequate care to patients interferes with the good development of their role, which is related with a high intensity of moral distress in these professionals (31).…”

Section: Pain Managementmentioning

confidence: 99%

“…A qualitative study found that some of the important ethical conflicts in oncology refer to confronting situations appertaining to end of life, like administering aggressive treatments during this stage (29), responding to the request of suicide assistance by the patient when a bad prognosis is received (34), and delivering inadequate palliative care (30). This prolongs the process of death with unnecessary aggressive care and offers false hope (32).…”

Section: Assistance To Patients and Their Families During The Process Of Deathmentioning

confidence: 99%

“…Inclusion of nurses as equal partners and informed in formal communication and in the deliberation processes is key to prevent moral distress (23,28,29,32). Staff meetings permit clarifying the procedure to follow in relation to the treatment and care plan (35).…”

Section: Poor Communicationmentioning

confidence: 99%

“…Staff meetings permit clarifying the procedure to follow in relation to the treatment and care plan (35). Discussing ideas, concerns, and feelings that emerge from the complex clinical situation permit diminishing moral distress (23,32) and having better management to provide quality care to other patients (36).…”

Section: Poor Communicationmentioning

confidence: 99%

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Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review

Celis

Méndez

2019

Aquichan

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Objective: To describe the factors that influence the emergence of moral distress in oncology nurses. Methodology: integrative review of the literature whose search will be performed in Web of Science databases, CINAHL (EBSCO), Scielo, Proquest, Pubmed and PsycInfo using the keywords moral distress and oncology nursing and their similes in Spanish, without restriction for years of publication until 2017. Results: The results of this review were grouped into three groups of factors each with subgroups: 1) Organizational factors: ethical climate, evasive culture and resources for ethics delivered by the organization. 2) Particular clinical situations: pain management, information delivery, futile treatment, and assistance to the patient and their family in the process of death, 3) Interpersonal relationships: poor communication, power relations, trust in the team’s competence. Conclusion: the three factors described are triggers of moral distress in oncology nurses. When there are ethical problems and the nurses do not participate in the deliberation process, these problems can be hidden and be normalized, which can diminish the moral sensitivity of the professionals, as well as the possibility of acting as moral agents.

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Section: Resultsmentioning

confidence: 99%

Section: Pain Managementmentioning

confidence: 99%

Section: Assistance To Patients and Their Families During The Process Of Deathmentioning

confidence: 99%

Section: Poor Communicationmentioning

confidence: 99%

Section: Poor Communicationmentioning

confidence: 99%

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Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review

Celis

Méndez

2019

Aquichan

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Acute Care Contexts

Jones-Bonofiglio

2020

The International Library of Bioethics

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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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An Inpatient Surgical Oncology Unit’s Experience With Moral Distress: Part I

Cited by 6 publications

References 14 publications

Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review

Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review

Acute Care Contexts

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

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