Abstract
Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect.
Highlights
The healthcare system is characterized by an important heterogeneity of services and users that make it complex
Moral distress was first theorized in the health care and nursing field in 1984, when Jameton [3] defined it as a human condition that arise when “one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action”
The entire sample of this study was made up of 397 healthcare professionals: 53.65% of the sample was working in a hospital setting, while 46.35% of the sample was working in community settings
Summary
The healthcare system is characterized by an important heterogeneity of services and users that make it complex. Moral distress was first theorized in the health care and nursing field in 1984, when Jameton [3] defined it as a human condition that arise when “one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action”. Studies on this topic were confined to the intensive care setting [4,5], related to end-of-life treatment [6,7]. Empirical research on this topic has seen exponential growth in recent years, intensifying the study of moral distress in any other clinical care setting (long-term care facilities, pediatric or neonatal settings and emergency or mental health departments) [8,9,10]
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