Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center

Sirilla, Janet; Thompson, Kathrynn; Yamokoski, Todd; Risser, Mark D.; Chipps, Esther

doi:10.1111/wvn.12213

Cited by 30 publications

(41 citation statements)

References 22 publications

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“…Nurses employed in Mental Health Services (MHN) may encounter a series of ethical issues and related problems, which may lead to morally distressing experiences [ 43 , 44 ]. Moral distress is a phenomenon of increasing concern in mental health nursing practice, education, and research due to the increased frequency of ethically and morally charged situations in mental healthcare settings compared to other clinical contexts [ 22 , 45 , 46 ]. The psychopathological changes in people suffering from mental illness may undermine their capacity to consent treatment procedures [ 47 ].…”

Section: Introductionmentioning

confidence: 99%

Exploration of the Association between Nurses’ Moral Distress and Secondary Traumatic Stress Syndrome: Implications for Patient Safety in Mental Health Services

Christodoulou-Fella

Middleton

Papathanassoglou

et al. 2017

BioMed Research International

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Work-related moral distress (MD) and secondary traumatic stress syndrome (STSS) may be associated with compromised health status among health professionals, reduced productivity, and inadequate safety of care. We explored the association of MD with the severity of STSS symptoms, along with the mediating role of mental distress symptoms. Associations with emotional exhaustion and professional satisfaction were also assessed. This cross-sectional survey conducted in 206 mental health nurses (MHNs) was employed across public sector community and hospital settings in Cyprus. The analysis revealed that MD (measured by the modified Moral Distress Scale) was positively associated with both STSS (measured by the Secondary Traumatic Stress Scale) and mental distress symptoms (assessed by the General Health Questionnaire-28). The association of MD with STSS symptoms was partially mediated by mental distress symptoms. This association remained largely unchanged after adjusting for gender, age, education, rank, and intention to quit the job. Our findings provide preliminary evidence on the association between MD and STSS symptomatology in MHNs. Situations that may lead health professionals to be in moral distress seem to be mainly related to the work environment; thus interventions related to organizational empowerment of MHNs need to be developed.

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Section: Introductionmentioning

confidence: 99%

Exploration of the Association between Nurses’ Moral Distress and Secondary Traumatic Stress Syndrome: Implications for Patient Safety in Mental Health Services

Christodoulou-Fella

Middleton

Papathanassoglou

et al. 2017

BioMed Research International

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“…1a). Compared with third and fourth year students, second year students reported lower median (IQR) composite moral distress scores (8 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] versus 30 and 29 ) and a lower prevalence of burnout (28% versus 48 and 40%). While there was less moral distress and burnout among second year students who had overall less clinical experience, the Rotation experienced on which scenario most commonly experienced b Percentages do not add to 100% because the choices were not mutually exclusive association between moral distress score and burnout did not appear to vary by medical school year (p-forinteraction = 0.62, see Supplement Table 4).…”

Section: Burnoutmentioning

confidence: 99%

“…Among nurses, resident physicians, and attending physicians, moral distress is associated with decreased professional quality-of-life and burnout [8][9][10][11][12][13][14][15][16][17][18][19][20], and burnout is associated with poor mental health and lower quality of patient care [21]. The association between moral distress and burnout has not yet been studied in medical students.…”

Section: Introductionmentioning

confidence: 99%

Moral distress and burnout in caring for older adults during medical school training

et al. 2020

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Background: Moral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics. Methods: A cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1-10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale. Results: Two-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4-7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers and faculty on the inpatient clerkships on medicine, neurology, and surgery, where students most often reported experiencing moral distress. Conclusions: Moral distress is highly prevalent among medical students while caring for older patients, and associated with burnout. Incorporating geriatrics education and debriefing sessions into inpatient clerkships could alleviate medical student moral distress and burnout.

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“…Similarly to our study, Silen et al (2011) identified low frequency with moderate intensity; with an attendant explanation that a more positive ethical climate correlated with a lower frequency of moral distress. Whilst there is complementarity here between all three studies, we do recognise variations across different types of clinical units have been identified by others (Sirilla, Thompson, Yamokoski, Risser, & Chipps, 2017).…”

Section: Phase 1: Measuring Moral Distressmentioning

confidence: 54%

“…Differences such as this in the appearance of moral distress across clinical contexts, are evident in the literature (Burston & Tuckett, 2013;Sirilla et al, 2017 This finding interprets in three ways: (1) these situations do not occur frequently within the aged care workforce, (2) the results are an aberration and not truly representative of the broader aged care workforce, or (3) they occur infrequently in this specific population (that is the context or environment this population operates within). For the first two points noted further exploration with larger samples will provide clarity.…”

Section: Phase 1: Measuring Moral Distressmentioning

confidence: 85%

Moral distress and the Australian aged care worker: A mixed methods study

Burston¹

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Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center

Abstract: Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions.

Cited by 30 publications

References 22 publications

Exploration of the Association between Nurses’ Moral Distress and Secondary Traumatic Stress Syndrome: Implications for Patient Safety in Mental Health Services

Exploration of the Association between Nurses’ Moral Distress and Secondary Traumatic Stress Syndrome: Implications for Patient Safety in Mental Health Services

Moral distress and burnout in caring for older adults during medical school training

Moral distress and the Australian aged care worker: A mixed methods study

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