Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review

Kovancı, Mustafa Sabri; Akyar, Imatullah

doi:10.1177/09697330221105638

Cited by 8 publications

(4 citation statements)

References 50 publications

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“…Ultimately, this threatened their professional identity. This aligns with previous findings regarding nurses’ experiences with end-of-life care [ 5 , 33 , 34 ]. Kim et al [ 5 ] explored ethical conflicts among nurses in geriatric hospitals and found that they felt disillusioned with hospitals’ attitudes that considered treatment as only for financial benefit.…”

Section: Discussionsupporting

confidence: 92%

“…According to Prompahakul and Epstein’s integrative review of moral distress among non-Western nurses [ 44 ], although both Western and non-Western healthcare settings have professional hierarchical structures, the extent might differ in non-Western contexts. Kovanci and Akyar [ 34 ] analysed the influence of cultural context on moral distress among ICU nurses and concluded that moral distress is similar in countries with similar cultures and those which are geographically close. Given such culturally distinctive traits, further discourse analysis research reflecting cultural contexts in exploring moral distress among ICU nurses who care for patients undergoing WLT is required.…”

Section: Discussionmentioning

confidence: 99%

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Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

Chang,

Kim,

Cho

et al. 2024

BMC Nurs

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Background Intensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms. Methods This qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee’s Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea. Results We identified four categories of discourses: (1) both “left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses’ beliefs in their nursing values. Conclusion ICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses’ discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses’ understanding of their professional roles and identities as caretakers for dying patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

Chang,

Kim,

Cho

et al. 2024

BMC Nurs

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“…Nurses who feel impeded in expressing their conscientious objection to providing futile care or feel unable to provide palliative care adequately may feel disempowered and/or experience frustration, thus being led to experience moral distress (in the original/strict sense of the term) [38][39][40][41]. Moral distress (in the original/strict sense of the term) occurs when a nurse is constrained in some way from taking an action that she considers morally correct [42,43].…”

Section: Missing Legal Protection Against Job Insecuritymentioning

confidence: 99%

Perceptions and Experiences of Nurses When Confronted With Expressing a Conscientious Objection Towards End-of-Life Care in Greece

Voultsos

Zymvragou

Raikos

2023

Preprint

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AIM Conscientious objection in nursing has been a topic of much discussion in recent years. Healthcare providers’ conscientious objection has been included in Greek legislation. However, little is known about the real experiences of nurses who want to apply conscientious objections in their practice. This study aimed to contribute to filling that gap. METHODS This qualitative study was conducted with eighteen experienced nurses. Data were collected through semi-structured in-depth qualitative interviews conducted with purposively selected nurses during the period from October 2019 to January 2020. Interviews were transcribed verbatim and analysed thematically. The ethical principles of anonymity, voluntary participation and confidentiality were considered. RESULTS Eight major themes and seven subthemes emerged from the thematic data analysis. Oppressive behaviors in the workplace and subservient interactions between nurses and physicians, suboptimal communication and inadequate support of nurses, perceived ineffectiveness of nurses’ conscientious objections, missing legal protection against job insecurity, provision of care labeled ‘futile’, nurses’ false knowledge and perceptions on medical situations related to conscientious objections, nurses’ fears of isolation bullying and negative gossip in the workplace and a trivial amount of nurses’ involvement in medical decisions emerged as barriers to nurses raising conscientious objection. Furthermore, from data analysis, it emerged that some nurses had false knowledge and perceptions on medical situations related to conscientious objections, some nurses experienced mild uncertainty distress about their ethical concerns, nurses considered their remote contribution as participation that can give rise to conscientious objection, a collective conscientious objection raised by nurses might have increased chances of being effective, and upbringing, childhood experiences, education and religion are factors shaping the nurses’ core values. CONCLUSION A total of fifteen themes and subthemes emerged from this study. Most of the findings of this study were previously unknown or undervalued and might be helpful to inform nurses and nursing managers or leaders as well as healthcare policy makers. The results of this study might contribute to addressing the need for creating ethically sensitive health care services and ensuring nurses’ moral integrity and high quality of patient care.

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“…해외에서는 Corley [2]가 도덕적 고뇌와 윤리적 딜레마를 구별하는 것이 매우 중요하며, 임상에 서 피할 수 없고 늘 경험하게 되는 도덕적 고뇌를 장점으로 활용할 수 있도록 간호학생 때부터 윤 리 지식 위주의 교육이 아닌 임상 현장에 직면하 는 다양한 도덕적 고뇌 상황에 직면하도록 교육 할 것을 주장하였다. 이외에 종양 병동 간호사의 윤리적 딜레마와 도덕적 고뇌 [13], 간호사의 도 덕적 고뇌 탐색 [14], 소아암 병동 간호사의 도덕 적 고뇌 [15], 중환자실에서의 도덕적 고뇌 [16], 간호사들의 Covid-19 관련 직업적 소진과 도덕 적 고뇌 [17], 중환자실 간호사의 문화적으로 민 감한 도덕적 고뇌 경험 [18]…”

Section: 서론unclassified

National and International Trends in Research on Moral Distress in Nursing: Text-network Analysis and Topic Modeling

Park¹

2023

Korean J Med Ethics

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This article reports on a study that examined thematic trends in published research, in Korea and abroad, on moral distress in nursing. After extracting English abstracts from 38 domestic and 159 foreign publications, degree-centrality analysis and topic modeling were performed using the NetMiner 4 program. The common core keywords found in the domestic and international abstracts are “nurse, moral distress, moral sensitivity, intensive care unit, end-of-life care, experience, burnout, and care.” The core keywords in the domestic abstracts are “education program, person-centered care, job satisfaction, empowerment, hospital, long-term care facility, nursing practice environment, nursing student, turnover intention, clinical nursing practice, and emergency.” The core keywords in the international abstracts are “patient, family, healthcare provider, palliative care, decision-making, ethical issue, child, dementia patient, management, person, life, and staff.” Topic modeling found three topics that are common to both domestic and international abstracts and two topics that differ. This study suggests that although there are common core subject areas in both domestic and international research, some subject areas are studied more actively abroad and require the attention of domestic researchers.

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Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review

Cited by 8 publications

References 50 publications

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

Perceptions and Experiences of Nurses When Confronted With Expressing a Conscientious Objection Towards End-of-Life Care in Greece

National and International Trends in Research on Moral Distress in Nursing: Text-network Analysis and Topic Modeling

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