Moral Sensitivity and Moral Distress in Critical Care Unit Nurses

Somayeh Mohammadi, Fariba Borhani, Mostafa Roshanzadeh

Abstract


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Background and Aim: Nurses, as an extensive group of the caring teams, are constantly faced with moral issues, which can play a key role in the quality of the care provided. Of these challenges, one is moral distress which can have different effects on patients, nurses and care systems. In the meantime, another factor that can play a pivotal role in preserving the moral values and the prevention of moral distress in nurses is moral sensitivity. Moral sensitivity enables the nurses to interpret and respond to the needs of their clients in accordance with moral principles, which would play an important role in preventing the conditions causing moral distress. Therefore, the present study was carried out aiming to determine the relationship between moral distress and moral sensitivity among nurses.

 

Materials and Methods: This descriptive analytical study was conducted on 257 nurses employed in teaching hospitals affiliated to Birjand University of Medical Sciences (South Khorasan) in 2015. The sampling method was available sampling among the nurses working in intensive care units (ICU CCU, NICU, and dialysis) in the whole province meeting the inclusion criteria of the study. The data collection tool was a three-part questionnaire consisting of the demographic information questionnaire, Corly moral distress questionnaire, and the Korean version of the Hun moral sensitivity questionnaire. The demographic information questionnaire examined such characteristics as age, sex, location of work, years of service, and the type of employment. Corly moral distress questionnaire, designed in 1995 and revised in 2001, consists of 21 questions. Each of the questions involves a position indicative of moral distress. The options of the questionnaire are designed based on the two dimensions of intensity and frequency and arranged according to the Likert scale from zero (not at all) to 5 (very much) for the intensity of the distress, and from zero (never) to 5 (repeatedly) for the frequency of the distress. Reliability of the questionnaire, using Cronbach's alpha method, is 0.93 and its validity, using CVI method, is 88 percent. The Korean version of the Hun moral sensitivity questionnaire consists of 25 questions on the three areas of “respect for the patient”, “professional responsibility”, and “moral behavior”. The questionnaire includes five items on a Likert scale from “strongly disagree” (0) to “strongly agree” (4). The reliability of the questionnaire is determined by Cronbach's alpha as 0.79. Having obtained all the necessary permits, the research colleague distributed this questionnaire in the study environment. Of the total 270 questionnaires distributed, 263 questionnaires were collected. A number of questionnaires were excluded due to some errors in the responses. A total of 257 questionnaires were subjected to statistical analysis. Collecting the questionnaires took a month. The collected data were analyzed running descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (Chi-square, t-test, ANOVA, and Pearson correlation coefficient) in SPSS statistical software version 16.

 

Ethical Considerations: Having received the University Ethics Committee’s formal approval (number 94:145), the questionnaires were distributed among the participants, and the research units were given complete information about the aims of the research and how to respond to the questionnaires. Written consent was collected from all participants in the study. Additionally, all of the nurses were assured of anonymity of the questionnaires and confidentiality of the information.

 

Findings: There was no significant relationship between the intensity of moral distress and the nurses’ moral sensitivity (P = 0.2). The mean scores (out of 5) were 3.5 ± 0.66 for the total moral distress, 3.5 ± 0.75 for the intensity of moral distress, and 3.54 ± 0.66 for the frequency of moral distress, respectively. The mean for moral sensitivity (out of 4) was 3.1 ± 0.45. There was, however, a statistically significant relationship between moral distress and age, years of service and the type of the ward (P<0.05). Likewise, the relationship between moral sensitivity and the number of years of service and age of the nurses was also significant (P<0.05).

 

Conclusion: The results of the study indicated that people who do not have sufficient executive power for moral performance will experience moral distress, despite their high and low levels of moral sensitivity. Thus, given the levels of moral distress and moral sensitivity of the nurses in the study, it is necessary for the hospital administrators to take some specific measures to carry out periodic reviews of this phenomenon, and hold some codified trainings in this regard. As for moral sensitivity, some right steps need to be taken in moral performance through increasing the nurses’ awareness and adopting their attitudes towards moral issues, particularly for new moral challenges. According to the obtained results, there was a significant relationship between moral distress, and age and years of service. It can be said that since the mean score for this phenomenon at the ICU was much higher than those of other investigated sections, it is recommended that managers supervise nurses in these sections more, and that nurses in these sections be changed in rotation and be transferred to the sections where such phenomena are less observed. In addition, as the level of distress among nurses in this study in proportion to higher age and service experience was reported lower than others, it can be concluded that the presence of experienced people in of nursing teams can be a controlling factor, especially for the less experienced nurses when facing challenges. Moreover, it is also probable that these people’s experience may reduce other nurses’ distress, especially the novice ones. Furthermore, this phenomena should be monitored in all parts of the hospitals, and many of its consequences be averted through taking such measures as consultation and appraising its main causes from the nurses’ perspectives. 

 

Please cite this article as: Mohammadi S, BorhaniF, Roshanzadeh F. Moral Sensitivity and Moral Distress in Critical Care Unit Nurses. Med Ethics J 2017; 10(38): 19-28.


Keywords


Moral Distress; Moral Sensitivity; Critical Care Unit; Nursing

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References


Cummings CL. The Effect of Moral Distress on Nursing Retention in the Acute Care Setting. UNF Theses and Dissertations; 2009. 371. Available at: http://digitalcommons.unf.edu/etd/371

Ferrell BR. Understanding the moral distress of nurses witnessing medically futile care. Oncol Nurs Forum 2006; 33(5): 922-930.

Russell AC. Moral distress in neuroscience nursing: an evolutionary concept analysis. J Neurosci Nurs 2012; 44(1): 15-24.

Borhani F, Abbaszadeh A, Nakhaee N, Roshanzadeh M. The relationship between moral distress, professional stress, and intent to stay in the nursing profession. J Med Ethics Hist Med 2014; 7: 3.

Robinson R. Registered nurses and moral distress. Dimens Crit Care Nurs 2010; 29(5): 197-202.

Janvier A, Nadeau S. Moral distress in the neonatal intensive care unit: caregiver's experience. J Perinatol 2007; 27(4): 203-208.

Cavinder C. The relationship between providing neonatal palliative care and nurses' moral distress: an integrative review. Advance Neonat Care 2014; 14(5): 322-328.

Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics 2005; 12(4): 381-390.

Noh D, Kim S, Kim S. Moral Distress, Moral Sensitivity and Ethical Climate of Nurses Working in Psychiatric Wards. J Korean Acad Psychiatr Ment Health Nurs. 2013; 22(4): 307-319.

Abbaszadeh A, Borhani F, Muezzin Nematolahei L. The comparison of the level of moral sensitivity in nursing student and nurses of Kerman University of medical science in 2010. Med Ethics J 2010; 4(12): 39-54. [Persian]

Lutzen K, Johansson A, Nordstrom G. Moral sensitivity: Some differences between nurses and physicians. Nurs Ethics 2000; 7(6): 520-530.

Milliken A. Nurse ethical sensitivity: An integrative review. Nurs Ethics 2016; 26: 969733016646155.

Yeom HA, Ahn SH, Kim SJ. Effects of ethics education on moral sensitivity of nursing students. Nurs Ethics2016; 24: 0969733015622060.

Ohnishi K, Ohgushi Y, Nakano M, Fujii H, Tanaka H, Kitaoka K, et al. Moral distress experienced by psychiatric nurses in Japan. Nurs Ethics 2010; 17(6): 726-740.

Pauly B, Varcoe C, Storch J, Newton L. Registered nurses' perceptions of moral distress and ethical climate. Nurs Ethics 2009; 16(5): 561-573.

Abbaszadeh A, Nakhaei N, Borhani F, Roshanzadeh M. The relationship between moral distress and retention in nurses in Birjand teaching hospitals. Iran J Med Ethics Hist 2013; 6(2):57-66. [Persian]

Lazzarin M, Biondi A, Di Mauro S. Moral distress in nurses in oncology and hematology units. Nurs Ethics 2012; 19(2): 183-195.

Lutzen K, Blom T, Ewalds-Kvist B, Winch S. Moral stress, moral climate and moral sensitivity among psychiatric professionals. Nurs Ethics 2010; 17(2): 213-224.

Izadi A, Imani E, Khademi Z, Asadi Noughabi F, Hajizadeh N, Naghizadeh f .The correlation of moral sensitivity of critical care nurses with their caring behavior. Iran J Med Ethics Hist 2013; 6(2): 43-56. [Persian]

Borhani F, Abbaszadeh A, Sabzevariz S, Dehestani M. The effect of workshop and Follow on nurses’ moral sensitivity. Iran J Med Ethics Hist 2012; 6(21): 11-24. [Persian]

Lutzen K, Dahlqvist V, Eriksson S, Norberg A. Developing the concept of moral sensitivity in health care practice. Nurs Ethics 2006; 13(2): 187-196.

Kim HR, Ahn SH. Moral sensitivity and moral distress among Korean hospital nurses. Korean J Med Ethics 2010; 13(4): 321-336.

Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs 2001; 33(2): 250-256.

Corley MC, Hamric AB. Information on shortened form of Corley’s moral distress scale. Unpublished manuscript, University of Virginia. Available at: http://docs.askives.com/what-is-units-of-distress-scale.html. Accessed in 2014.

Merghati Khoiee E, Vaziri MH, Shahrzad Alizadegan SH, Motevallian SA, et al. Developing the Moral Distress Scale in the Population of Iranian Nurses. Iran J Psychiatry 2008; 3(2): 55-58.

Han SS, Kim J, Kim YS, Ahn S. Validation of a Korean version of the Moral Sensitivity Questionnaire. Nurs Ethics 2010; 17(1): 99-105.

Hamric AB, Davis WS, Childress MD. Moral distress in health care professionals. Pharos Alpha Omega Alpha Honor Med Soc 2006; 69(1): 16-23.

Joolaee S, Jalili HR, Rafee F, Rafii F, Hajibabaee F, Haghani H. Relationship between Moral Distress and Job Satisfaction among Nurses of Tehran University of Medical Sciences Hospitals. Hayat 2012; 18(1): 42-51. [Persian]

Schluter J, Winch S, Holzhauser K, Henderson A. Nurses’ moral sensitivity and hospital ethical climate: a literature review. Nurs Ethics 2008; 15(3): 304-321.

Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics 2009; 20(4): 330-342.

Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care 2005; 14(6): 523-530.

Abdou HA, Baddar FM, Alkorashy A. The relationship between work environment and moral sensitivity among the nursing faculty assistants. World Applied Sci J 2010; 11(11): 1375-1387.

Yoo MS, Shon KC. Effects of nursing ethics education on biomedical ethics awareness, moral sensitivity and moral judgment of nursing students. J Korean Bioethics Assoc 2012; 12(2): 61-76.




DOI: https://doi.org/10.21859/mej-103819

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