-
Nursing Ethics 2023Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured... (Review)
Review
Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.
Topics: Humans; Pandemics; Nursing Care; Leadership; Qualitative Research; Morals
PubMed: 37845832
DOI: 10.1177/09697330231191279 -
Pain Management Nursing : Official... Feb 2024In addition to a physical and emotional experience, pain is also a morally infused experience with deep, often subconscious, meaning for many sufferers. Whether...
In addition to a physical and emotional experience, pain is also a morally infused experience with deep, often subconscious, meaning for many sufferers. Whether justified or not, for many people, pain may represent loss, judgement, unworthiness, abandonment, punishment, and even existential suffering and thoughts of death. The moral meaning of pain is what influences the associated experiences of stigma, loneliness, and guilt that contribute to suffering. It is why nurses and other healthcare practitioners have long adhered to a moral obligation to treat those with pain, implying a duty to attempt to make right the wrong of undeserved suffering. Yet the moral meaning of pain is rarely discussed and is often overlooked when establishing a relationship with and a treatment plan for a person with pain. It is the unattended moral meaning of pain that may contribute to unnecessary suffering, futile treatment, and even moral dilemmas in establishing care. In this paper, I explore the definition of morality itself, the moral meaning of pain, and its implications for care. I discuss how moral pluralism in contemporary society contributes to various moral perceptions that influence a person's pain experience and how their pain is treated. Finally, I make the case that using a narrative approach to intentionally look for moral meaning in an individual's pain story may reveal opportunities for more effective pain management options.
Topics: Humans; Morals; Pain; Pain Management; Moral Obligations; Emotions
PubMed: 37926633
DOI: 10.1016/j.pmn.2023.10.003 -
Clinical Psychology Review Mar 2024Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the... (Review)
Review
BACKGROUND
Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use.
METHOD
We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale.
RESULTS
We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.
CONCLUSIONS
Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.
Topics: Humans; Stress Disorders, Post-Traumatic; Morals; Psychometrics; Surveys and Questionnaires; Reproducibility of Results
PubMed: 38218124
DOI: 10.1016/j.cpr.2023.102377 -
MedEdPORTAL : the Journal of Teaching... 2023Moral injury comprises feelings of guilt, despair, shame, and/or helplessness from having one's morals transgressed. Those underrepresented in health care are more...
INTRODUCTION
Moral injury comprises feelings of guilt, despair, shame, and/or helplessness from having one's morals transgressed. Those underrepresented in health care are more likely to experience moral injury arising from micro- and macroaggressions. This workshop was designed for interprofessional health care providers ranging from students to program leadership to raise awareness about moral injury and provide tools to combat it.
METHODS
This 75-minute interactive workshop explored moral injury through a health care lens. It included components of lecture, case-based learning, small-group discussion, and individual reflection. Participants completed anonymous postworkshop evaluations, providing data on satisfaction and intention to change practice. We used descriptive statistics to analyze the quantitative data and applied content analysis to the qualitative data.
RESULTS
The workshop was presented at two local academic conferences. Data were collected from 34 out of 60 participants, for a response rate of 57%. Ninety-seven percent of participants felt the workshop helped them define and identify moral injury and was a valuable use of their time, as well as indicating they would apply the information learned in their daily life. One hundred percent would recommend the workshop to a friend or colleague. Almost half felt they could implement strategies to address moral injury after participating in the workshop.
DISCUSSION
This workshop proved to be a valuable tool to define and discuss moral injury. The materials can be adapted to a broad audience.
Topics: Humans; Stress Disorders, Post-Traumatic; Morals; Leadership
PubMed: 37927405
DOI: 10.15766/mep_2374-8265.11357 -
Cognition Aug 2024The social-contract tradition of Hobbes, Rousseau, Kant, and Rawls has been widely influential in moral philosophy but has until recently received relatively little...
The social-contract tradition of Hobbes, Rousseau, Kant, and Rawls has been widely influential in moral philosophy but has until recently received relatively little attention in moral psychology. For contractualist moral theories, ethics is a matter of forming, adhering to, and enforcing (hypothetical) agreements, and morality is fundamentally about acting according to what would be agreed by rational agents. A recent psychological theory, virtual bargaining, models social interactions in contractualist terms, suggesting that we often act as we would agree to do if we were to negotiate explicitly. However, whether such contractualist tendencies (a propensity to make typically contractualist choices) and forms of reasoning (agreement-based cognitive processes) play a role in moral cognition is still unclear. Drawing upon virtual bargaining, we develop two novel experimental paradigms designed to elicit incentivized decisions and moral judgments. We then test the descriptive relevance of contractualism in moral judgment and decision making in five preregistered online experiments (n = 4103; English-speaking Prolific participants). In the first task, we find evidence that many participants show contractualist tendencies: their choices are "characteristically" contractualist. In the second task, we find evidence consistent with contractualist reasoning influencing some participants' judgments and incentivized decisions. Our findings suggest that a propensity to act as prescribed by tacit agreements may be particularly important in understanding the moral psychology of fleeting social interactions and coordination problems. By complementing the rich literature on deontology and consequentialism in moral psychology, empirical approaches inspired by contractualism may prove fruitful to better understand moral cognition.
Topics: Humans; Morals; Judgment; Adult; Female; Male; Young Adult; Decision Making; Middle Aged; Adolescent; Thinking; Aged
PubMed: 38824696
DOI: 10.1016/j.cognition.2024.105838 -
Nurse Education Today Oct 2023The review aims to synthesize and consolidate the factors and situations in which student nurses experience moral distress during their clinical practice and its... (Review)
Review
OBJECTIVES
The review aims to synthesize and consolidate the factors and situations in which student nurses experience moral distress during their clinical practice and its potential implications for patient care and outcomes.
DESIGN
A qualitative systematic review.
DATA SOURCES
The articles were sourced from PubMed, Embase, CINAHL, Scopus, PsycInfo, Web of Science, ERIC (ProQuest), and ProQuest Dissertations and Theses Global Database between their inception dates to December 2022. Reference lists of included studies were also screened for additional studies.
REVIEW METHODS
Published and unpublished primary studies of any qualitative research methods focused on student nurses' experiences of moral distress regardless of their education level were included in this review. Two reviewers independently screened titles and abstracts, assessed full-text articles for eligibility, extracted data, and appraised the quality of included studies. Sandelowski and Barroso's (2007) two-step meta-synthesis approach and Braun and Clarke's (2006) thematic analysis framework were used to analyze and interpret findings from included studies.
RESULTS
Seven studies met the inclusion criteria and were included in the review. The meta-synthesis revealed an overarching theme, "Moral Distress and its Intertwined Roots". This was supported by the four main themes: 1) Inadequacy and lack of autonomy, 2) Unprofessionalism of healthcare professionals, 3) Differing cultural views and values of patients and their relatives, and 4) Healthcare needs versus resource constraints.
CONCLUSION
This review highlights the experiences of student nurses in situations of moral distress, including feelings of inadequacy and powerlessness when faced with ethical challenges, and the negative impact of resource constraints, unprofessional behavior, and cultural differences. Collaborative efforts between healthcare professionals and student nurses are needed to promote shared decision-making, prioritize ethical training, and provide culturally sensitive care to address these challenges and ultimately improve patient care.
Topics: Humans; Culturally Competent Care; Delivery of Health Care; Morals; Qualitative Research; Students, Nursing
PubMed: 37480673
DOI: 10.1016/j.nedt.2023.105912 -
Nurse Education in Practice Aug 2023To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury.
AIMS
To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury.
BACKGROUND
There is a preponderance of nursing literature about moral distress, moral resilience, moral courage and moral injury. However, examining moral resilience and moral courage as mediators remain underreported during the COVID-19 pandemic and in the context of a developing nation.
DESIGN
Correlational, cross-sectional design compliant with the STROBE guidelines.
METHODS
A convenience sample of nurses (n = 412) from the Philippines were recruited using social media platforms (e.g., Facebook, Messenger, Twitter). Four self-report and validated scales (8-item Moral-Distress Appraisal Scale, 21-item Nurses' Moral Courage Scale, 17-item Rushton Moral Resilience Scale and 10-item Moral Injury Symptom Scale: Healthcare Professionals Version) were used to collect data from January to July 2022. Pearson's r, bivariate analysis and multistage regression analyses were used for data analysis.
RESULTS
This study afforded a model that depicted the interrelationships of moral distress, moral resilience, moral courage and moral injury. Moral distress has a negative impact on moral resilience and moral courage while positively affecting moral injury. Moral resilience positively influences moral courage while having a negative impact on moral injury. Moral courage has an indirect impact on moral injury. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury.
CONCLUSIONS
Healthcare organizations, policymakers and nurse managers should include policies and programs that include improving approaches to modifying workplace conditions and evaluating nurses' moral resilience and courage. Nurse managers need to advocate ethics education and professionalism. Nurses must practice self-care strategies to strengthen morally resilient and courageous therapeutic practices.
Topics: Humans; Cross-Sectional Studies; Courage; Pandemics; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; COVID-19; Morals; Nurses
PubMed: 37499534
DOI: 10.1016/j.nepr.2023.103730 -
Journal of Religion and Health Dec 2023Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19...
Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.
Topics: Humans; Courage; Philippines; Mediation Analysis; Pandemics; Stress Disorders, Post-Traumatic; COVID-19; Morals; Nurses
PubMed: 37442900
DOI: 10.1007/s10943-023-01873-w -
Social Science & Medicine (1982) Nov 2023Appeals to intuitive morality may present a novel approach to addressing vaccine hesitancy.
RATIONALE
Appeals to intuitive morality may present a novel approach to addressing vaccine hesitancy.
OBJECTIVE
To better understand the relationship between morality and vaccination by employing Moral Foundations Theory to studies surrounding the HPV vaccination at multiple different levels of decision making.
METHOD
We employed three different study modalities which examined moralities link to vaccination by employing Moral Foundations Theory. A state-wide ecological study aimed to understand population level trends. Two randomized control interventional studies were then created to understand the effects of Moral Foundations Theory based interventions on both parents of children and individual decision makers.
RESULTS
We demonstrated a negative association at the state level between the purity moral foundations and HPV vaccination rates (β = -.75, SE 0.23; p < .01) and a positive association between loyalty and HPV vaccination rates (β = 0.62 SE 0.24; p < .05). The parental study built upon this by demonstrating negative association between higher moral purity scores and attitudes towards the HPV vaccine and intention to vaccinate their children (β = -0.27 SE 0.07; p < .001). Our final study demonstrated a Moral Foundations Theory based intervention was associated with an increase in the odds of indicating an intention to receive the HPV vaccination (adjusted Odds Ratio (aOR) 2.59, 95% Confidence Interval (CI) 1.62-4.14). This equates to a 20% increase in the predicted probability of the intention to receive an HPV vaccine (39% CI (36%-42%) vs 60% CI (57%-63%).
CONCLUSIONS
Together, these studies demonstrate that moral foundations, specifically the purity foundation, appear to have a strong and consistent relationship with HPV vaccination. They also demonstrate the how moral values-based interventions may serve as a novel approach to increase HPV vaccine uptake with potential to be employed to target vaccine hesitancy more broadly.
Topics: Child; Humans; United States; Papillomavirus Infections; Papillomavirus Vaccines; Parents; Health Knowledge, Attitudes, Practice; Morals; Vaccination; Patient Acceptance of Health Care
PubMed: 37801941
DOI: 10.1016/j.socscimed.2023.116257 -
Nursing Ethics 2023Social responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public...
BACKGROUND
Social responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public health. However, few studies focused on the relationship of moral courage, job-esteem, and social responsibility among disaster relief nurses.
OBJECTIVE
To explore the influence of moral courage and job-esteem on the social responsibility in disaster relief nurses and clarify the relationship model between them.
METHODS
A cross-sectional study was conducted among 716 disaster relief nurses from 14 hospitals in central China through an online survey, including moral courage scale, job-esteem scale, and social responsibility questionnaire. The data were analyzed by Pearson's correlation, and the mechanism of the effect of moral courage and job-esteem on social responsibility was completed.
ETHICAL CONSIDERATIONS
This study was approved by the Medical Ethics Committee of the Second Xiangya Hospital of Central South University (Approval Number: 2019016).
RESULTS
Disaster relief nurses' moral courage positively impacted social responsibility (r = 0.677, < 0.01), and moral courage could affect social responsibility through the mediating role of job-esteem.
CONCLUSION
Job-esteem mediated between moral courage and social responsibility among disaster relief nurses. Nursing managers regular assessment of nurses' moral courage and interventions such as meetings and workshops can reduce moral distress, foster morally courageous behavior, enhance job-esteem, and improve social responsibility performance among disaster relief nurses.
Topics: Humans; Courage; Cross-Sectional Studies; Morals; Social Responsibility; Surveys and Questionnaires; Nurses
PubMed: 37192663
DOI: 10.1177/09697330231174540