RRL (1)

RELATED LITERATURES Nurses frequently make ethical decisions in the course of their work even though they may not always be aware of doing so. They have different roles as a health care provider, and it is inevitable to experience distress in the nature of their profession. Moral distress is a major problem in nursing and it has generated a remarkable level of interest among scholars in the field of nursing. (McCarthy,2008). The quality of nursing practice is being threatened by the increasing frequency and complexity of ethical challenges that nurses face in their daily routines. (Davis, 2012) Nurses may face obstacle, resulting in conflict between their moral judgement regarding the most appropriate

course

of

action

and

the

actual

treatment

given

to

patients.

(Austin,et.al,2005) this causes the nurses to doubt whether they are fulfilling their duty as patient advocate and trusted care givers. Moral distress is identified as a psychological disequilibrium resulting from not knowing the ethical action to take but not taking it due to an inhibiting medical power structure or institutional policy. (Jameton,1984,1993) it is also described as a sensory event: a negative feeling state experienced when a person makes moral decision but does not follow through by performing the moral behavior indicated by that decision. (Corley,2002). A study was conducted among Iranian intensive care nurses and four dimensions of moral distress were identified, namely: “institutional barriers and complaints”, “communication problems”, “futile actions, malpractice and medical/care errors”, and “inappropriate responsibilities, resources and competencies.” The study showed that the dimensions of moral distress may vary in different settings. (Shorideh,2012).

Moral distress can emanate from a variety of causes with variations also between practitioners in the same clinical situation. A nurse’s world view such as expectations of standards of care, (Austin, 2003) moral sensitivity (Lutzen,2010), and individual ethical perspectives (Cutcliffe,2008) all contribute to the moral distress experience. Perceptions of moral distress may develop from cumulative life experiences and prior experiences in similar or identical situations. The notion that professional experience is a contributing factor is intriguing, there has been some suggestion made that the length of experience in nursing increased the exposure frequency to episodes of moral distress. (Rice,2008) furthermore, nurses lacking experience in addressing ethically challenging situation may be at higher risk of experiencing moral distress. (Meaney,2002). There has been qualitative evidence that reveals that nurses experience moral distress when they fail to act as advocates for patients based on their moral choices while dealing with institutional constraints. (Rittenmeyer,2009) A study was conducted to determine the prevalence and contributing factors of moral distress in medical and surgical nurses and the results revealed that intensity of moral distress was uniformly high in situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. (Rice,2008). The Military is an organization well prepared and experienced in the rapid mobilization and deployment of large volumes of personnel, equipment, and supplies. Military operations other than war, however, present some unique challenges to the capabilities of the military nurses because the focus is different. The limitations of the military or these operations are related primarily to the failure or limited ability of the military nurse to meet the needs of the affected populace within the deployment area. (Agazio,2010)

Moral Distress is particularly significant in the field of military nursing services. Nurses in the military have the need to be responsive at a moment’s notice to take action in critical settings and other related military crisis. They have the duty to accept deployment to different places locally and internationally. Military forces of any country must be assured that its nurses maintain a high readiness capability and that they can perform at peak efficiency for long periods of time under certain conditions. Thus, any military force is concerned about the moral well-being of military nurses and anything, including moral distress, which can affect their ability to carry out their job effectively, Moral distress occurs when a person has responsibility for a moral action, experiences an obstacle in carrying out the desired action, and then experiences negative feeling states when the action is not carried out. The experience of moral distress explicitly requires people to have a responsibility for some action and to feel responsible for the outcomes of their action. Two dimensions were identified with regards to military nursing moral distress phenomenon, these are the psychological disequilibrium experienced when military nurses encounter barrier to their desired moral behavior and the negative feeling such as frustration, anger, anxiety, powerlessness, discomfort and hurt, that accompany the experience of psychological disequilibrium. (Fry et al.1984, 2002).

SUMMARY OF RELATED LITERATURES TITLE & AUTHOR/S Moral distress experienced by nurses: A quantitative literature review Youngjae Oh & Chris Gastmans

Gender and the experience of moral distress in critical care nurses Christopher B O’Connell

MAJOR OBJECTIVES The aim of the review was to examine the quantitative empirical literature about moral distress experienced by nurses. The review included the intensity and frequency of moral distress, sociodemogrphi c variables that influence the frequency and/or intensity of moral distress, factors influencing moral distress and mechanisms of nurses The main aim is to determine if there is a significant gender difference that exists in the moral distress scores of critical care.

VARIABLES

FINDINGS

METHOD

The variables included are sociodemographi c variable, sources, psychological responses and coping strategies concerning moral distress.

The review clarified the notion that nurses experience a rather low frequency of moral distress, but a moderately intense level of moral distress. Although morally distressing experiences may not be frequent, they may have significant impact when they do occur.

The study conducted an extensive research in different established databases to acquire articles on nurses’ moral distress since Jameton first defined the concept.

The dependent variable in the study was the experiences of critica care nurses in critical care setting. The independent variable was the gender of the nurses who

The results revealed a statistically significant gender difference in mean moral distress scores of participants. Females reportedly

Utilizing a quantitative descriptive design, participants were recruited via an internet nursing community. No material incentives for participation were

participated in the study.

Moral distress and Avoidance behavior in nurses working in critical care and noncritical care units Mary Jo De villers and Holli A DeVon

Ethical Issues Of Air Force Nurse Practitioners In Clinical Practice Carol Lynn Gilchrist, BSN, Capt, USAF, NC

The purpose of this descriptive, cross sectional study was to determine similarities and differences in moral distress and avoidance behavior between critical care nurses and non-critical care nurses Little has been written about the ethical issues faced by nurse practitioners. This study explored some of the ethical issues faced by experienced nurse practitioners in clinical practice. The purpose of this research is to describe and interpret the

The variable of interest include location of employment, length of work experience, moral distress, avoidance thoughts and behavior, age, gender, and race/ethnicity.

The variables included are Educational level, employment status, years of experience

statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low. There was a small positive correlation between moral distress and avoidance behaviors for both the groups. Moral distress is present in both critical care and non-critical care nurses. Nonmaleficenc e and beneficence were often difficult to separate as frequently they were interwoven in situations that AFNPs encountered. The principle of justice was more clearly stated in terms of the

offered. Data analysis was conducted using IBM1 SPSS ver. 21.

A cross-sectional design was used to compare the relationship of moral distress and avoidance behavior.

As a method, phenomenology, concerned primarily with description of the experience, and eliminating presuppositions from the recounting of the experience. qualitative method of research was also used to interpret the meaning of lived

ethical issues AFNPs encounter in clinical practice.

Moral distress: levels, coping and preferred interventions in critical care and transitional care nurses Melissa A. Wilson, Diana M. Goettemoeller, Nancy A. Bevan, & Jennifer M. McCord.

Impact of ethical climate on moral distress revisited: multidimensional view Gulem Atabay, Burcu Guneri Cangarli, & Sebnem Penbek

To examine the level of and frequency of moral distress in staff nurses working in two types of units in an acute care hospital and to gather information for future intervention addressing moral distress.

To investigate the relationship between different types of ethical climate as described in Victor and Cullen’s framework and moral distress intensity among nurses in

AFNPs feeling limited in their ability to provide equal treatment for all patients The variables Overall, the included are nurses reported Years as RN, age, lower levels education level, and frequency certification, & of moral years in MS ICU. distress in these units but their openended responses appeared to indicate moral distress. Nurses identified specific resources that they would find helpful to alleviate moral distress.

The variables included are Age, gender, education level, & years of experience.

Positive correlations were identified between certain types of ethical climate and moral distress intensity.

ethical experiences of AFNPs.

A descriptive questionnaire was used. Nurses completed the 38 item moral distress scale , a coping questionnaire and indicated their preferred methods for institutional support in managing distressing situation a convenience sample of staff nurses was approached to complete the moral distress questionnaire. This study is a correlational study between ethical climate and moral distress. An online survey was administered to collect data. Questionnaire includes moral distress and

Turkish health care settings.

Relationship between Intensive care unit nurses’ moral distress with burnout and anticipated turnover Foroozan Atashzadeh shoorideh, Tahereh Ashktorab, Farideh Yaghmaei & Hamid Alavi Majd.

Determinants of

To determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses.

The variables included are Age, Gender, Marriage status, Education level, Work experience, & work shift.

To determine the

The values of

ethical climate scales in addition to demographic questions Descriptivecorrelational study.

The finding showed ICU nurses’ moral distress and anticipated turnover was high but burnout was moderate. The results revealed that there was a positive statistical correlation between ICU nurses’ age, their work experience and the fraction pof nurses’ number to number of ICU beds with their moral distress and burnout. However, there was no correlation between gender, marriage status, educational degree and work shift and moral distress. The intensity of A prospective

moral distress in medical and surgical nurses at an adult acute tertiary care hospital Elizabeth M. Rice MSN, Mohamed Y. Rady MD PhD, Arreta Hamrick PAC, Joseph L. Verheijde PhD MBA, & Debra K. Pendergast MSN

prevalence and contributing factors of moral distress in medical and surgical nurses.

age, current employment and nursing experience for the entire study cohort were chosen to convert continuous variables into categorical variables. The independent variables include nursing experience and type of patient illness

moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies with years of nursing experience and caring for oncology and transplant patients.

cross-sectional survey using moral distress scale tool was administered to medical and surgical nurses at an adult acute care hospital.