The Effectiveness of Acceptance and Commitment Therapy in Reducing Moral Distress and Enhancing Cognitive Fusion in Nurses
akhlāq-i pizishkī i.e., Medical Ethics,
Vol. 17 No. 48 (1402),
21 August 2023
,
Page 1-14
https://doi.org/10.22037/mej.v17i48.42446
Abstract
Background and Aim: Due to the nature of the nursing profession, confronting conflicting situations regarding values and facing moral dilemmas is inevitable. It can, in turn, interfere with cognitive function. Therefore, the current research was conducted with the purpose of determining the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing moral distress and enhancing cognitive fusion in the nurses working at Imam Khomeini Hospital, Ilam.
Methods: The present study is a quasi-experimental research with a pre-test and post-test design and a comparison group. The statistical sample consisted of 40 nurses working at Imam Khomeini Hospital, Ilam in 2022, who were randomly assigned into intervention and comparison groups. Data collection was performed using the Moral Distress Scale Corley & et al (2001) and the Cognitive Fusion Questionnaire Gillanders & et al (2010). Eight 90-minute acceptance and commitment therapy training sessions were held weekly; however, the comparison group did not receive any intervention. The data were analyzed by SPSS 16 software using descriptive (frequency, percentage mean, standard deviation) and inferential (Chi-square, Independent T-test, Analysis of covariance) statistical tests.
Ethical Considerations: The principles of research ethics were observed: explaining the research objectives to the participants, obtaining informed consent, maintaining privacy, data confidentiality and providing the participants with the right to withdraw from the study at any stage of implementation.
Results: The findings indicated that Acceptance and Commitment Treatment has a significant effect on reducing moral distress and enhancing cognitive fusion in the nurses belonging to the intervention group compared to the comparison group in the post-test phase (P<0.001).
Conclusion: Based on the findings of the present research, eight weeks’ acceptance and commitment group therapy turned out to be effective in reducing moral distress and enhancing cognitive fusion in nurses.
Please cite this article as:
Basereh F, Amirpour B. The Effectiveness of Acceptance and Commitment Therapy in Reducing Moral Distress and Enhancing Cognitive Fusion in Nurses. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2023; 17(48): e4.
- acceptance and commitment therapy
- moral distress
- cognitive defusion
- nurses
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References
Eva GF, Amo‐Setién F, César LC, Concepción SS, Roberto MM, Jesús MM, et al. Effectiveness of intervention programs aimed at improving the nursing work environment: A systematic review. International Nursing Review. 2024;71(1):148-59.
Dos Santos LM. Sources of Stress, Burnout and Career Decisions of Male Health and Nursing Professionals: A Qualitative Inquiry of the Challenges During the COVID-19 Pandemic. The Qualitative Report. 2023;28(3):886-905.
Heydari A, Meshkinyazd A. Ethical challenges in nursing profession. Journal of Clinical Nursing and Midwifery. 2018;7(1):84-95. [Persian]
Duzgun MV, Ozdemir C, Karazeybek E, Isler A. Psychometric properties of the Turkish version of the moral distress-appraisal scale for nurses. Archives of Psychiatric Nursing. 2023;46:21-25.
Azarabad S, Zaman SS, Nouri B, Valiee S. Frequency, causes and reporting barriers of nursing errors in the operating room students. Research in Medical Education. 2018;10(2):18-27. [Persian]
Eskandari M, Alizadeh S. Moral Distress in Intensive Care Unit Nurses: An Integrated Review. Education and Ethics In Nursing. 2020;9(1,2):1-9. [Persian]
Peng M, Saito S, Guan H, Ma X. Moral distress, moral courage, and career identity among nurses: A cross-sectional study. Nursing Ethics. 2023;30(3):358-69.
Witton N, Goldsworthy S, Phillips LA. Moral distress: Does this impact on intent to stay among adult critical care nurses?. Nursing in Critical Care. 2023;28(2):211-7.
Etebari-Asl Z, Etebari-Asl F, Nemati K. A Survey on the Level of Moral Distress among Nurses of Special Wards Affiliated to Educational-Therapeutic Centers in Ardabil University of Medical Sciencesin 2016: A Short Report. Journal of Rafsanjan University of Medical Sciences. 2017;16(2):169-78. [Persian]
Hanifi N, Moqaddam M. The amount of moral courage and moral distress of nurses and their related factors in educational and medical centers of Zanjan. Preventive Care in Nursing & Midwifery Journal. 2022; 12(3):41-9.
Mousavi S, Mokhtardokht A, Parsapoor A, Etemadi-Aleagha A, Shojaei A. Moral Distress in the Care of Anesthetized Patients: The Experience of Iranian Anesthesiologists. Evidence Based Care. 2023; 12(4):17-26.
Shamsalinia A, Mahmoudian A, Sorori B, Yoseframaki M, Vaziri MH. Evaluation of moral distress and its related factors in nurses working in hospitals in Western Mazandaran. Caspian Journal of Health and Aging. 2021; 6(1): 20-8. [Persian]
Gebregziabher D, Berhanie E, Berihu H, Belstie A, Teklay G. The relationship between job satisfaction and turnover intention among nurses in Axum comprehensive and specialized hospital Tigray, Ethiopia. BMC Nursing. 2020;19:1-8.
Arends SA, Steenbergen M, Thodé M, Francke AL, Jongerden IP. Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: A qualitative interview study. Patient Education and Counseling. 2022;105(7):2531-6.
Bayat M, Shahriari M, Keshvari M. The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian social security organization. Journal of Medical Ethics and History of Medicine. 2019;12(8):1-16.
Deschenes S, Tate K, Scott SD, Kunyk D. Recommendations for navigating the experiences of moral distress: A scoping review. International Journal of Nursing Studies. 2021;122:104035.
Hayes SC, Hofmann SG. "Third‐wave" cognitive and behavioral therapies and the emergence of a process‐based approach to intervention in psychiatry. World Psychiatry. 2021;20(3):363-75.
Fooladvand K. The Role of Cognitive Fusion and Mindfulness Components in Prediction of Student’s Depression. Journal of Psychological Studies. 2020;16(3):89-104.
Amiri M, Dowran B, Salimi H, Zarghami M, Fesharaki MG. The relationships between student stressors with psychological problems in students in a military Medical Sciences University in Tehran. Journal of Military Medicine. 2019;21(4):380-9. [Persian]
Barrera-Caballero S, Romero-Moreno R, Del Sequeros Pedroso-Chaparro M, Olmos R, Vara-García C, Gallego-Alberto L, et al. Stress, cognitive fusion and comorbid depressive and anxiety symptomatology in dementia caregivers. Psychology and Aging. 2021;36(5):667-76.
Fallahi V, Ahmadi S. The role of cognitive fusion and social intelligence in the prediction of general health of nurses in hospitals of Parsabad City, 2017: A short report. Journal of Rafsanjan University of Medical Sciences. 2019; 17(11): 1067-76. [Persian]
Towey-Swift KD, Lauvrud C, Whittington R. Acceptance and commitment therapy (ACT) for professional staff burnout: A systematic review and narrative synthesis of controlled trials. Journal of Mental Health. 2023;32(2):452-64.
Sianturi R, Keliat BA, Wardani IY. The effectiveness of acceptance and commitment therapy on anxiety in clients with stroke. Enfermeria Clinica. 2018;28: 94-7.
Diener E, Biswas-Diener Noba R, LeViness P, Wiking M, Kim Research Associate E. Well-being interventions to improve societies. J. Sachs, R. Layard, & Helliwell (Eds.), Global happiness and well-being policy report 2019 [Internet]. Global Happiness Council; 2019. [cited 2023 Feb 19]. Available from: http://ghwbpr-2019.s3.amazonaws.com/UAE/GH19_Ch6.pdf
Mills J. Mindfulness, self-compassion and compassion science in mental health nursing: Commentary on Ruiz-Fernandez et al. Mindfulness therapies on health professionals. International Journal of Mental Health Nursing. 2019;29(3):531-2.
Thomas N, Morris EMJ, Shawyer F, Farhall J. Acceptance and commitment therapy for voices. In Acceptance and Commitment Therapy and Mindfulness for Psychosis. 1st ed. Wiley-Blackwell, 2013.
Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. Journal of Advanced Nursing. 2001;33(2):250-6.
Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research. 2012;3(2):1-9.
Motevallian SA, Alizadegan S, Hossein Vaziri M, Khoiee EM, Goushegir SA, Ghoroubi J. Developing the moral distress scale in the population of Iranian nurses. Iranian Journal of Psychiatry. 2008;3(2):55-8.
Gillanders DT, Bolderston H, Bond FW, Dempster M, Flaxman PE, Campbell L, et al. The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy. 2014;45(1):83-101.
Biglari F, Sheibani Tazraji F, Taghinejad N. Efficacy of Acceptance and Commitment Therapy on the Cognitive Fusion and Self-Care Behaviors of the Students with Type-1 Diabetes. Medical Journal of Mashhad University of Medical Sciences. 2022;65(4):1686-700. [Persian]
Goodarzi F, Soltani Z, Hoseini Seddigh MS, Hamdami M, Ghsemi Jobaneh R. Effects of Acceptance and Commitment Therapy on Emotion Regulation and Quality of Life of Mothers of Children with Intellectual Disability. Middle Eastern Journal of Disability Studies. 2017;7:1-6. [Persian]
El-Ashry AM, Elhay ES, Taha SM, Salem ES, El-Sayed MM. Impact of virtual group-based acceptance and commitment therapy on social adjustment and work-family conflict among intern nurses: a randomized control trial. BMC Psychiatry. 2023;23(1):552.
Hulbert-Williams NJ, Hulbert-Williams L, Patterson P, Suleman S, Howells L. Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme. BMJ Supportive & Palliative Care. 2021.
Lu YE, Li Y, Huang Y, Zhang X, Wang J, Wu L, et al. Effects and mechanisms of a web-and mobile-based acceptance and commitment therapy intervention for anxiety and depression symptoms in nurses: Fully decentralized randomized controlled trial. Journal of Medical Internet Research. 2023;25:e51549.
Hajsadeghi Z, Bassak Nejad S, Razmjoo S. The effectiveness of acceptance and commitment group therapy on depression and anxiety among women with breast cancer. Pajouhan Scientific Journal. 2017;15(4):42-9. [Persian]
Vaklavic EA, Stffileno BA, Carlson E. Moral distress: Using mindfulness-based stress reduction interventions to decrease nurse perceptions of distress. Clinical Journal of Oncology Nursing. 2018;22(3):326-32.
McLoughlin S, Roche BT. ACT: A process-based therapy in search of a process. Behavior Therapy. 2023;54(6):939-55.
Fernández Rodríguez C, Coto Lesmes R, Martínez Loredo V, Cuesta Izquierdo M. Psychological inflexibility, anxiety and depression: The moderating role of cognitive fusion, experiential avoidance and activation. Psicothema. 2022;34(2):240-48.
Faustino B, Vasco AB, Farinha-Fernandes A, Delgado J. Psychological inflexibility as a transdiagnostic construct: Relationships between cognitive fusion, psychological well-being and symptomatology. Current Psychology. 2023;42(8):6056-61.
Mohammadi Farshi A, Shahnazari M, Bahrami Hedaji M, Peyvandi P, Mohammadi Shirmahaleh F. Evaluation of the effectiveness of cognitive therapy based on acceptance and commitment with a focus on self-compassion on deterministic thinking and positive thinking in couples. Advances in Cognitive Science. 2022;24(1):98-114.
Nishikawara R, Maynes T. Moving From Moral Distress to Moral Resilience Using Acceptance and Commitment Therapy. Canadian Journal of Career Development. 2023;22(1):30-40.
Saeedi E, Bekmaz K, Bahram NF. The Relationship between Moral Distress and Professional Stress in the Nurses Caring for Covid-19 Patients at Tehran University of Medical Sciences. Faṣlnāmah-I akhlāq-I Pizishkī - i.E., Quarterly Journal of Medical Ethics. 2022;16(47):1-12. [Persian]
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