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Moral distress and ethical climate in a Swedish nursing context:perceptions and instrument usability
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
Universitetssjukhuset Örebro samt Karlskoga lasarett, Örebro läns landsting.
Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
Jönköping University, School of Health Science.
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2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 23-24, 3483-3493 p.Article in journal (Refereed) Published
Abstract [en]

Aim. The aim was fivefold: to describe Swedish nurses' perceptions of moral distress and determine whether there were differences in perceptions depending on demographic characteristics and to describe the usability of the Moral Distress Scale in a Swedish context. Further, the aim was to describe Swedish nurses' perceptions of ethical climate and the relationship between moral distress and ethical climate.

Background. Moral distress has been studied for more than two decades and the Moral Distress Scale is the most widely used instrument for measuring it. Moral distress has mainly been studied in relation to nurses' characteristics, but increasing attention has been paid to contextual aspects, such as ethical climate, that could be associated with moral distress.

Design. Descriptive, with a quantitative approach.

Methods. The study used two questionnaires: the Moral Distress Scale and the Hospital Ethical Climate Survey. The study was carried out at two hospitals in Sweden and included 249 nurses.

Results. Both level and frequency of moral distress were low, however level of moral distress was high in situations when the patient was not given safe and proper care. Generally, the frequency of moral distress was lower than the level. Of the situations on the Moral Distress Scale, 13 of the 32 were considered irrelevant by 10-50% of the participants. The more positive the ethical climate was perceived to be, the less frequentely morally distressing situations were reported.

Conclusions. Since a positive ethical climate was associated with less frequent occurencies of moral distress, it should be investigated what contributes to a positive ethical climate. To be used in a Swedish context, the Moral Distress Scale needs further revision.

Relevance to clinical practice. Open dialouges at wards are encouraged regarding what practices contribute to a positive ethical climate.

Place, publisher, year, edition, pages
2011. Vol. 20, no 23-24, 3483-3493 p.
Keyword [en]
ethical climate, moral distress, nurses, questionnaires, Sweden
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-16264DOI: 10.1111/j.1365-2702.2011.03753.xOAI: oai:DiVA.org:hj-16264DiVA: diva2:446873
Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2012-01-02Bibliographically approved
In thesis
1. Encountering ethical problems and moral distress as a nurse: Experiences, contributing factors and handling
Open this publication in new window or tab >>Encountering ethical problems and moral distress as a nurse: Experiences, contributing factors and handling
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore and describe what nurses find ethically problematic and morally distressing in their work, the factors contributing to the arising of ethically problematic situations and the actions reported taken in order to handle them, thus creating an ethical climate.

Descriptive as well as correlational and exploratory designs were employed in the four papers on which this thesis is based. A total of 283 nurses from 21 acute care wards at four Swedish hospitals participated. Interviews were analyzed using qualitative content analysis and the critical incident technique, and questionnaires were analyzed using descriptive and non-parametric statistics.

The nurses described ethical problems and moral distress related to decision making about life-sustaining treatment, but also when they experienced difficulties in preserving a patient’s integrity and when they could not give care that was necessary and safe. Inadequate communication between healthcare staff, the physicians’ ways of handling potentially ethically problematic situations and patients’ poor state of health, which hindered their participation in decisions concerning them, were some of the factors that could contribute to the rise of an ethically problematic situation. Among the actions described as being used to handle ethical problems and moral distress, some were explicitly stated to promote a positive ethical climate, i.e. a perceived positive handling of ethical issues. These were supporting each other in the working group, using policies and routines as help, giving care based on the needs of patients and their next of kin and daring to speak out, thus contributing to setting a standard for behavior. Having the need for explanations and information satisfied and working as a team also promoted a positive ethical climate.

In conclusion, the professional role of being a nurse seems to be of importance not only when it comes to what situations are experienced as ethically problematic and morally distressing, but also concerning what factors may contribute to the rise of them. Perceiving a positive ethical climate may mediate these experiences.

Place, publisher, year, edition, pages
School of Health Sciences, Jönköping University, 2011. 67 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 20
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-16429 (URN)978-91-85835-19-5 (ISBN)
Public defence
2011-11-11, Forum Humanum, Hälsohögskolan, Jönkping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-21 Created: 2011-10-20 Last updated: 2014-05-20Bibliographically approved

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