RELATIONSHIPS AMONG PALLIATIVE CARE, ETHICAL, CLIMATE,EMPOWERMENT AND MORAL DISTRESS IN INTENSIVE CAR UNIT NURSES

被引:69
作者
Altaker, Krista Wolcott [1 ]
Howie-Esquivel, Jill [2 ]
Cataldo, Janine K. [3 ]
机构
[1] Sonoma State Univ, Nursing, Rohnert Pk, CA 94928 USA
[2] Univ Virginia, Nursing, Charlottesville, VA USA
[3] Univ Calif San Francisco, Dept Physiol Nursing, San Francisco, CA 94143 USA
关键词
PSYCHOLOGICAL EMPOWERMENT; WORKING;
D O I
10.4037/ajcc2018252
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Intensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance. Objectives To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. Methods Intensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale-Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed. Results Of 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor's degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r= -0.145; P=.02) and ethical climate scores (r=-0.354; P<.001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores. Conclusions Poor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress.The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.
引用
收藏
页码:295 / 302
页数:8
相关论文
共 28 条
[1]  
Allen Rose, 2013, JONAS Healthc Law Ethics Regul, V15, P111, DOI 10.1097/NHL.0b013e3182a1bf33
[2]   Innovative Solutions The Effect of a Workshop on Reducing the Experience of Moral Distress in an Intensive Care Unit Setting [J].
Beumer, Catherine M. .
DIMENSIONS OF CRITICAL CARE NURSING, 2008, 27 (06) :263-267
[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]  
Connors AF, 1996, JAMA-J AM MED ASSOC, V275, P1232
[5]   Nurse moral distress and ethical work environment [J].
Corley, MC ;
Minick, P ;
Elswick, RK ;
Jacobs, M .
NURSING ETHICS, 2005, 12 (04) :381-390
[6]   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
[7]   Moral distress and avoidance behavior in nurses working in critical care and noncritical care units [J].
De Villers, Mary Jo ;
DeVon, Holli A. .
NURSING ETHICS, 2013, 20 (05) :589-603
[8]   Moral distress of staff nurses in a medical intensive care unit [J].
Elpern, EH ;
Covert, B ;
Kleinpell, R .
AMERICAN JOURNAL OF CRITICAL CARE, 2005, 14 (06) :523-530
[9]  
Epstein EG, 2009, J CLIN ETHIC, V20, P330
[10]  
Gordon Elizabeth, 2012, Dynamics, V23, P37