Ethical climate and moral distress in paediatric oncology nursing

Abstract

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP)

“…Moral distress among healthcare professionals has been studied in various healthcare contexts including oncology [ 10 ], palliative care [ 3 ], psychiatry [ 11 ], pediatric care [ 12 ], surgical and medical care [ 13 ], emergency [ 14 ] and intensive care [ 15 – 17 ]. In a study Hancock et al [ 16 ] revealed three principal issues underlying the development of moral distress; namely, organizational issues, exposure to highly intense situations and poor team experiences.…”

“…Bullying, lack of inclusion [ 16 , 25 ] and struggling to share the troubled emotions associated with acting against one’s moral values have been described as giving rise to bad feelings and moral distress [ 26 ]. A positive ethical climate, however, [ 12 , 27 ] and professional independence at work [ 28 ] have been shown to reduce the frequency of morally distressing situations [ 27 , 28 ]. With reference to gender differences, female professionals have reported greater moral distress than males [ 29 ].…”

A cross‐sectional survey of moral distress and ethical climate – Situations in paediatric oncology care that involve children’s voices

“…Institutional constrains that hinder healthcare professionals from acting in accordance with their moral values have aroused an interest to study the relationship between moral distress and ethical climate (Morley et al., 2019 ). Positive perceptions of ethical climate have been associated with less frequent experiences of moral distress (Silen et al., 2011 ; Ventovaara et al., 2021 ).…”

“…So far, most research on moral distress and ethical climate has been conducted in adult care settings, and in paediatric settings mainly among intensive care nurses (Karakachian & Colbert, 2019 ; Koskenvuori et al., 2019 ; Lamiani et al., 2017 ). Lack of research on moral distress and ethical climate in paediatric oncology care led to a research project investigating these topics in the Nordic countries of Sweden, Finland, Denmark, Norway and Iceland (af Sandeberg et al., 2020 ; Pergert et al., 2019 ; Pergert, Bartholdson, Blomgren, et al., 2019 ; Ventovaara et al., 2021 ). As a part of this project, this study was conducted in paediatric oncology centres in Denmark.…”

“…These assess nurses’ experiences of limited truth‐telling despite an active request from a child, performing procedures against children's will and nurses’ perceptions of how often children's wishes are taken into account. As the prior studies from Sweden and Finland have indicated that nurses often struggle with busy work‐shifts (Pergert, Bartholdson, & af Sandeberg, 2019 ; Ventovaara et al., 2021 ), an additional interest was to examine if shortage of time and unsafe staffing levels are related to the situations that involve children's voices.…”