Moral distress and ethical climate in pediatric oncology care impact healthcare professionals' intentions to leave

Abstract

Objective To assess perceptions of ethical climate, experiences of moral distress, and intentions to leave among healthcare professionals in Nordic pediatric oncology care. Methods A cross‐sectional survey with registered nurses, physicians, and nursing assistants at 20 Nordic pediatric cancer centers. Data were collected by using translated versions of the Swedish Hospital Ethical Climate Survey‐Shortened and the Swedish Moral Distress Scale‐Revised. Descriptive analyses and non‐parametric tests were used to describe, summarize, and compare data. Results According to 543 healthcare professionals (response rate 58%), the ethical climate in Nordic pediatric oncology care was positive. Inadequate staffing levels, poor continuity and lack of time were the most common causes of moral distress. Registered nurses experienced significantly higher levels of moral distress compared to physicians and nursing assistants. About 6% of the respondents considered leaving due to moral distress. Typically, they assessed the ethical climate as less positive and reported higher levels of moral distress than those who had no intention to leave. Conclusions Organizational actions that ensure safe staffing levels and improve the continuity of care are needed to prevent moral distress and high staff turnover.

Children’s voices on their values and moral dilemmas when being cared and treated for cancer– a qualitative interview study

“…An interesting aspect is that Carlsson and Nygren [ 34 ] and Gilljam and Arvidsson [ 35 ] point out that trusting, respectful relations give the children the ability to participate in care situations. However, this, according to research findings, might be a struggle as nurses in childhood cancer care find it difficult to cultivate relationships with families [ 36 ]. This is usually related to lack of time, but also to the challenging balance between the children’s and parents’ opinions, and too often the relationship favours the parents [ 36 , 37 ].…”

“…However, this, according to research findings, might be a struggle as nurses in childhood cancer care find it difficult to cultivate relationships with families [ 36 ]. This is usually related to lack of time, but also to the challenging balance between the children’s and parents’ opinions, and too often the relationship favours the parents [ 36 , 37 ]. Therefore, it might be argued that the conditions and competences for building trusting relationships in childhood cancer care should be increased, in order to be able to offer and ensure good care for the family and the child.…”

“Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic”

“…It might be less common when circumstances are normal to experience difficulties in providing good care due to a lack of resources. However, many of the situations described in this study are common sources of moral stress also in daily health care practice, such as non-beneficial treatment and issues related to end-of-life care [ 24 , 25 ]. But it seems like disasters and pandemics are circumstances that can result in more complicated morally stressful situations, which is essential knowledge in preparations for HCWs working in disaster-like situations.…”