Understanding the Relationships Between Health Care Providers' Moral Distress and Patients' Quality of Death

被引:6
作者
Spence, Jeffrey [1 ,2 ]
Indovina, Kimberly A. [1 ,2 ]
Loresto, Figaro [1 ,3 ,4 ]
Eron, Kathryn [1 ]
Bailey, F. Amos [2 ]
机构
[1] Denver Hlth, Dept Internal Med, 777 Bannock Street, MC 400, Denver, CO 80204 USA
[2] Univ Colorado, Dept Internal Med, Sch Med, Aurora, CO USA
[3] Childrens Hosp Colorado, Dept Res Innovat & Profess Practice, Aurora, CO USA
[4] Univ Colorado, Coll Nursing, Aurora, CO USA
关键词
end of life; in-hospital death; moral distress; quality of death; CANCER; VALIDATION;
D O I
10.1089/jpm.2022.0425
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Introduction: Moral distress is a commonly recognized phenomenon among health care providers; however, the experience of moral distress by staff caring for patients who die during an acute care hospital stay has not been previously examined. It also remains unclear how the quality of a death may impact moral distress among these providers.Objectives: We sought to understand levels of moral distress experienced by intern physicians and nurses who provided care during a patient's final 48 hours of life, and how the perceived quality of death impacted moral distress.Materials and Methods: We utilized a mixed-method prospective cohort design, surveying nurses and interns following inpatient hospital deaths at an academic safety-net hospital in the United States. Participants completed surveys and answered open-ended questions to evaluate moral distress and the quality of the patient's death.Results: A total of 126 surveys were sent to nurses and interns caring for 35 patients who died, with 46 surveys completed. Overall moderate-to-high levels of moral distress were identified among participants, and we found that higher levels of moral distress correlated with lower perceived quality of death. We identified five themes in our qualitative analysis highlighting the challenges nurses and interns face in end-of-life care, including the following: poor communication, unexpected deaths, patient suffering, resource limitations, and failure to prioritize a patient's wishes or best interests.Conclusions: Nurses and interns experience moderate-to-high levels of moral distress when caring for dying patients. Lower quality of end-of-life care is associated with higher levels of moral distress.
引用
收藏
页码:900 / 906
页数:7
相关论文
共 22 条
[1]   Provision of Spiritual Care to Patients With Advanced Cancer: Associations With Medical Care and Quality of Life Near Death [J].
Balboni, Tracy Anne ;
Paulk, Mary Elizabeth ;
Balboni, Michael J. ;
Phelps, Andrea C. ;
Loggers, Elizabeth Trice ;
Wright, Alexi A. ;
Block, Susan D. ;
Lewis, Eldrin F. ;
Peteet, John R. ;
Prigerson, Holly Gwen .
JOURNAL OF CLINICAL ONCOLOGY, 2010, 28 (03) :445-452
[2]   A New Generation of Comfort Care Order Sets: Aligning Protocols with Current Principles [J].
Bender, Melissa A. ;
Hurd, Caroline ;
Solvang, Nicole ;
Colagrossi, Kathy ;
Matsuwaka, Diane ;
Curtis, J. Randall .
JOURNAL OF PALLIATIVE MEDICINE, 2017, 20 (09) :922-929
[3]   MORAL DISTRESS AND PSYCHOLOGICAL EMPOWERMENT IN CRITICAL CARE NURSES CARING FOR ADULTS AT END OF LIFE [J].
Browning, Annette M. .
AMERICAN JOURNAL OF CRITICAL CARE, 2013, 22 (02) :143-152
[4]   Development and evaluation of a moral distress scale [J].
Corley, MC ;
Elswick, RK ;
Gorman, M ;
Clor, T .
JOURNAL OF ADVANCED NURSING, 2001, 33 (02) :250-256
[5]   Circumstances Related to Moral Distress in Palliative Care: An Integrative Review [J].
Corradi-Perini, Carla ;
Beltrao, Julianna Rodrigues ;
Ribeiro, Uiara Raiana Vargas de Castro Oliveira .
AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, 2021, 38 (11) :1391-1397
[6]   A measure of the quality of dying and death: Initial validation using after-death interviews with family members [J].
Curtis, JR ;
Patrick, DL ;
Engelberg, RA ;
Norris, K ;
Asp, C ;
Byock, I .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2002, 24 (01) :17-31
[7]  
Inst Med, 2015, DYING IN AMERICA: IMPROVING QUALITY AND HONORING INDIVIDUAL PREFERENCES NEAR THE END OF LIFE, P1
[8]  
Karlsson M, 2015, INT J HUM CARING, V19, P40, DOI 10.20467/1091-5710-19.1.40
[9]   Does the 'Liverpool Care Pathway' facilitate an improvement in quality of care for dying cancer patients? [J].
Mayland, C. R. ;
Williams, E. M. I. ;
Addington-Hall, J. ;
Cox, T. F. ;
Ellershaw, J. E. .
BRITISH JOURNAL OF CANCER, 2013, 108 (10) :1942-1948
[10]   Moral distress in critical care nursing: The state of the science [J].
McAndrew, Natalie Susan ;
Leske, Jane ;
Schroeter, Kathryn .
NURSING ETHICS, 2018, 25 (05) :552-570