The Association of Moral Distress and Demographic Characteristics in the Nurses of Critical Care Units in Tehran, Iran

Background & Aims: Multiple sclerosis (MS) is a progressive, chronic disorder of the nervous system, which results in a gradual loss of ability following the attack of the immune system to the nervous system. The disease causes mortality and disability and decreases the quality of life. Caring for MS patients is an important issue and might take many years. Disease progression results in a greater need for patient care and more responsibilities of caregivers. The progressive and disabling nature of the disease affects various aspects of the patient and the care provider’s life. In fact, caregivers of these patients experience several psychological, physical, social, and economic problems (e.g., death anxiety and decreased quality of life). In addition, stress and depression are higher in care providers of MS patients, compared to other caregivers. Patients' caregivers are exposed to the process of death, pain, and fear of the patient's death during care, which may affect their quality of life. Since the quality of life of caregivers directly affects the quality of life of patients, supporting these individuals is of paramount importance. Therefore, this study aimed to determine the relationship between death anxiety and quality of life in caregivers of MS patients. Materials & Methods: This descriptive, correlational study was performed on 200 MS patients, who referred to the MS Patient Support Association in Tehran, Iran in 2018. The subjects were selected by convenience sampling, and data were collected using a demographic characteristics questionnaire, quality of life short-form 36 questionnaire (SF-36), and Templer Death Anxiety Scale. The instruments were filled by caregivers in the form of self-report in 20-30 minutes at the center following receiving written consent. In addition, data analysis was performed in SPSS version 16 using descriptive (frequency, frequency percentage, mean and standard deviation) and inferential (analysis of variance, independent t-test, Scheffé's method, and Pearson’s correlation coefficient). Results: In this study, the mean age of the participants was 40.39±11.75 years, and most caregivers were male (58.5%). Moreover, 40% of the caregivers were the spouses of patients, and 54.5% of them cared for patients alone. The mean duration of patient care was 8.7±5.9. Most caregivers had a diploma (36.2%) and 58.3% of them had a private home. Furthermore, 44.2% of caregivers had government jobs and moderate economic status. About half of the people (50.8%) had social security insurance, and 54.5% of caregivers stated that they care for the sick person alone. In the study of caregivers’ quality of life, the highest and lowest mean and standard deviation of caregivers' quality of life scores were obtained in areas of physical function and role limitation for emotional reasons, respectively. Evaluation of caregivers’ anxiety showed that 143 (71.5%) participants had a low death anxiety score (zero-seven), whereas 57 (28.5%) received a high death anxiety score (above eight). In addition, the mean death anxiety and quality of life score of caregivers were 5.92±3.82 and 55.42±14.82, respectively. There was a linear and indirect relationship between death anxiety and overall quality of life score, physical function dimension, physical problems, emotional problems, energy and vitality, emotional health, social functioning, pain and general health, physical health, and mental health (P<0.05). overall, a reverse and significant correlation was found between death anxiety and quality of life and its dimensions, meaning that an increase in death anxiety led the employees. According to the results, increased death anxiety in caregivers decreased their quality of life. Given the significant relationship between death anxiety and quality of life, it is suggested that more support be provided to caregivers to decrease their death anxiety and eliminate their problems. Due to the progressive nature and psychological outcomes of MS, caregivers of patients with this condition require ongoing psychological training to help them be more effective in caring for patients. Therefore, it is necessary to create programs to help caregivers and improve their quality of life in order to pay attention to themselves and their needs. In the field of management and nursing education, nurses must continue to learn about the importance of care and caregivers and the need to pay attention to these people and address the disabilities that these individuals (patients and caregivers) experience.