The relationship between moral distress, ethical climate, and attitudes towards care of a dying neonate among NICU nurses

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Abstract

Background

Nurses working in neonatal intensive care units play a crucial role in providing care to critically ill or premature neonates. However, is not without its challenges, particularly when it comes to making difficult ethical decisions about end-of-life care. In some cases, neonates do not survive despite the best efforts of medical professionals. The present study aimed to investigate the relationship between moral distress, ethical climate, and attitudes towards end-of-life care among nurses working in neonatal intensive care units.

Methods

This is a descriptive-analytical cross-sectional study (May 21, 2021).The research population included 126 nurses working in neonatal intensive care units in Kerman province (Kerman, Jiroft, Bam, and Rafsanjan). Data collection tools included four questionnaires: demographic information, the Frommelt Attitudes towards Care of the Dying (FATCOD), the Hospital Ethical Climate Survey, and the Moral Distress Scale. SPSS22 was used to analyze the data.

Results

The results revealed that the mean frequency and intensity of moral distress were 44.42 ± 17.67 and 49.45 ± 17.11, respectively. The mean ethical climate was 92.21 ± 17.52 and the FATCOD was 89.75 ± 9.08, indicating NICU nurses’ positive perceptions of ethical climate and their favorable attitudes towards EOL care, respectively. The results showed a direct and significant relationship between ethical climate and the FATCOD (P = 0.003, r = 0.26).

Discussion

We suggest policymakers and managers design strategies for better ethical climate in hospitals and reduction of moral distress among nurses.

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Most cited references 48

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Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals

Elizabeth G Epstein, Phyllis B Whitehead, Chuleeporn Prompahakul … (2019)

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Development and evaluation of a moral distress scale.

T Clor, R. Elswick, Jack M. Gorman … (2000)

This methodological research developed and evaluated the moral distress scale from 1994 to 1997. Although nurses confront moral questions in their practice daily, few instruments are available to measure moral concepts. The methodological design used a convenience sample consisted of 214 nurses from several Unites States hospitals. The framework guiding the development of the moral distress scale (MDS) included Jameton's conceptualization of moral distress, House and Rizzo's role conflict theory, and Rokeach's value theory. Items for the MDS were developed from research on the moral problems that nurses confront in hospital practice. The MDS consists of 32 items in a 7-point Likert format; a higher score reflects a higher level of normal distress. Mean scores on each item ranged from 3.9 to 5.5, indicating moderately high levels of moral distress. The item with the highest mean score (M=5.47) was working where the number of staff is so low that care is inadequate. Factor analysis yielded three factors: individual responsibility, not in the patient's best interest, and deception. No demographic or professional variables were related to moral distress. Fifteen percent of the nurses had resigned a position in the past because of moral distress. The results support the reliability and validity of the MDS.

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Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate.

Leslie J Blackhall, Ann Hamric (2007)

To explore registered nurses' and attending physicians' perspectives on caring for dying patients in intensive care units (ICUs), with particular attention to the relationships among moral distress, ethical climate, physician/nurse collaboration, and satisfaction with quality of care. Descriptive pilot study using a survey design. Fourteen ICUs in two institutions in different regions of Virginia. Twenty-nine attending physicians who admitted patients to the ICUs and 196 registered nurses engaged in direct patient care. Survey questionnaire. At the first site, registered nurses reported lower collaboration (p<.001), higher moral distress (p<.001), a more negative ethical environment (p<.001), and less satisfaction with quality of care (p=.005) than did attending physicians. The highest moral distress situations for both registered nurses and physicians involved those situations in which caregivers felt pressured to continue unwarranted aggressive treatment. Nurses perceived distressing situations occurring more frequently than did physicians. At the second site, 45% of the registered nurses surveyed reported having left or considered leaving a position because of moral distress. For physicians, collaboration related to satisfaction with quality of care (p<.001) and ethical environment (p=.004); for nurses, collaboration was related to satisfaction (p<.001) and ethical climate (p<.001) at both sites and negatively related to moral distress at site 2 (p=.05). Overall, registered nurses with higher moral distress scores had lower satisfaction with quality of care (p<.001), lower perception of ethical environment (p<.001), and lower perception of collaboration (p<.001). Registered nurses experienced more moral distress and lower collaboration than physicians, they perceived their ethical environment as more negative, and they were less satisfied with the quality of care provided on their units than were physicians. Provider assessments of quality of care were strongly related to perception of collaboration. Improving the ethical climate in ICUs through explicit discussions of moral distress, recognition of differences in nurse/physician values, and improving collaboration may mitigate frustration arising from differences in perspective.

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Author and article information

Contributors

Neda Asadi: nedaasadi87.nax@gmail.com , n.asadi@kmu.ac.ir

Journal

Journal ID (nlm-ta): BMC Nurs

Journal ID (iso-abbrev): BMC Nurs

Title: BMC Nursing

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6955

Publication date (Electronic): 5 September 2023

Publication date PMC-release: 5 September 2023

Publication date Collection: 2023

Volume: 22

Electronic Location Identifier: 303

Affiliations

[1 ]GRID grid.412105.3, ISNI 0000 0001 2092 9755, Department of Pediatric and Neonatal Intensive Care Nursing, , Kerman University of Medical Sciences, ; Kerman, Iran

[2 ]GRID grid.412105.3, ISNI 0000 0001 2092 9755, Nursing Research Center, , Kerman University of Medical Sciences, ; Kerman, Iran

Article

Publisher ID: 1459

DOI: 10.1186/s12912-023-01459-7

PMC ID: 10478422

PubMed ID: 37670308

SO-VID: ce7222ae-c855-4ae8-91f5-ab7b75285d37

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 13 February 2023

Date accepted : 22 August 2023

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ScienceOpen disciplines: Nursing

Keywords: moral distress,ethical climate,attitude,dying,nicu

Data availability:

ScienceOpen disciplines: Nursing

Keywords: moral distress, ethical climate, attitude, dying, nicu

The relationship between moral distress, ethical climate, and attitudes towards care of a dying neonate among NICU nurses

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Abstract

Background

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Discussion

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Journal of Health Sciences

Most cited references 48

Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals

Development and evaluation of a moral distress scale.

Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate.

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