Characteristics of moral distress from nurses’ perspectives: An integrative review

IF 2.9 3区 医学 Q1 NURSING
Mohannad Aljabery , Isabel Coetzee-Prinsloo , Annatjie van der Wath , Nathira Al-Hmaimat
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引用次数: 0

Abstract

Objective

This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’ perspectives in the literature. These insights will help update existing tools and create new ones to capture moral distress better, guiding the development and implementation of strategies to support nurses in addressing this challenge.

Methods

Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases (EBSCO Medline, CINAHL, and PubMed). Additionally, two journals, Bioethics and Nursing Ethics, were manually searched to reduce search bias. The included studies were primary resources published in English between 2018 and 2023, utilizing quantitative, qualitative, or mixed methods to examine moral distress’s characteristics, components, and definitions. All of identified studies were screened, extracted, and analyzed independently by two researchers.

Results

Nineteen studies were included. The results were grouped into five themes shaping the main characteristics of moral distress: 1) experiencing a moral situation, with five ethically conflicted situations identified, including treatment plans, professional and personal moral values, team dynamics, complex contexts, clinical practices, and patient-centered care; 2) making a moral judgment, where nurses experience moral distress when they cannot act consistently with their values, ethical principles, and moral duties; 3) the presence of constraints, categorized at three levels: individual factors related to the nurse, patient, and patient’s family; team factors related to the team or unit involved; and system factors, including institutional and policy elements; 4) moral wrongdoing, which occurs when nurses are unable to perform the right moral action; and 5) moral suffering, with studies showing that moral distress impacts physical, emotional, and psychological well-being.

Conclusion

The findings enhance the understanding of moral distress characteristics among nursing staff, highlighting the concept of the crescendo effect, which underscores the cumulative and escalating nature of unresolved moral distress, emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.
护士视角下道德困扰的特征:一项综合综述
目的本综述旨在通过对文献中护士观点的分析,找出护理中道德困扰的共同特征,并将其与其他类型的困扰区分开来。这些见解将有助于更新现有工具并创建新的工具,以更好地捕捉道德困境,指导制定和实施支持护士应对这一挑战的战略。方法采用whittemore和Knafl的综合评价方法,系统检索EBSCO Medline、CINAHL和PubMed三个数据库的文献。此外,人工检索了两种期刊,生物伦理学和护理伦理学,以减少检索偏差。纳入的研究是2018年至2023年间以英文发表的主要资源,利用定量、定性或混合方法来研究道德困境的特征、组成部分和定义。所有确定的研究都由两名研究人员独立筛选、提取和分析。结果共纳入19项研究。结果分为五个主题:1)经历道德情境,确定了五种道德冲突情境,包括治疗方案、职业和个人道德价值观、团队动态、复杂情境、临床实践和以患者为中心的护理;2)做出道德判断,当护士不能按照自己的价值观、伦理原则和道德义务行事时,会遇到道德困境;3)存在约束,分为三个层面:与护士、患者和患者家属相关的个体因素;与所涉及的团队或单位有关的团队因素;制度因素,包括制度因素和政策因素;4)道德失当,即护士无法履行正确的道德行为;5)道德痛苦,研究表明道德痛苦会影响身体、情感和心理健康。结论研究结果增强了对护理人员道德困扰特征的理解,突出了渐强效应的概念,强调了未解决道德困扰的累积性和升级性,强调了积极应对道德冲突的必要性,以防止道德操守和职业满意度的侵蚀。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.10
自引率
2.60%
发文量
408
审稿时长
25 days
期刊介绍: This journal aims to promote excellence in nursing and health care through the dissemination of the latest, evidence-based, peer-reviewed clinical information and original research, providing an international platform for exchanging knowledge, research findings and nursing practice experience. This journal covers a wide range of nursing topics such as advanced nursing practice, bio-psychosocial issues related to health, cultural perspectives, lifestyle change as a component of health promotion, chronic disease, including end-of-life care, family care giving. IJNSS publishes four issues per year in Jan/Apr/Jul/Oct. IJNSS intended readership includes practicing nurses in all spheres and at all levels who are committed to advancing practice and professional development on the basis of new knowledge and evidence; managers and senior members of the nursing; nurse educators and nursing students etc. IJNSS seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Contributions are welcomed from other health professions on issues that have a direct impact on nursing practice.
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