Simulation-Based Ethics Education: Building Confidence and Competence in Nursing Students.

Objectives – In recent years, moral distress has become a topic of interest among health professionals. Moral distress is most commonly described in the nursing literature, and refers to a situation wherein an individual knows the correct action to take, but is constrained from doing so. While moral distress differs from the classic ethical dilemma, in recent years practitioners and theorists have advocated for a broadening of the definition of moral distress. To date, no study has examined another group of individuals who frequently interact with patients and who may be constrained by the confines of their role - Consumer Health Information Professionals (CHIPS). The objective of this study was to determine if CHIPS experience moral distress and/or ethical dilemmas, and to determine what, if any, coping strategies these individuals have developed. Methods – This study employed a mixed methods approach. Quantitative data were gathered via an online survey which was distributed to relevant consumer health information professional electronic mail lists. The survey contained demographic questions and a series of questions related to potential discomfort within the context of work as a consumer health information professional. Qualitative data were also gathered through phone interviews with CHIPS. Interview questions included the participant’s definition of moral distress, professional experiences with moral distress, and any coping strategies to manage said distress. Results – The authors received 213 survey responses. To test whether any of our demographic variables help to explain survey response, we used STATA to calculate Pearson correlation coefficients. Individuals who were more likely to experience discomfort in their occupation as CHIPS included individuals with less experience and individuals who identified as Black and Latinx. Interview data indicated that participants most commonly experienced ethical dilemmas related to censorship, providing prognosis information, and feeling constrained by institutional policies. Few interview participants described scenarios that reflected moral distress. Conclusions – CHIPS do not appear to experience moral distress, at least according to its most narrow definition. CHIPS do consistently experience distinct ethical dilemmas, and the most durable patterns of this phenomenon appear to be related to experience level and racial identity. In recent years, researchers have raised calls to broaden the definition of moral distress from its narrow focus on constraint to include uncertainty, and CHIPs do experience moral uncertainty in their work. Further study is needed to determine how to best address the impacts of discomfort caused by ethical dilemmas among these groups.

Undergraduate social work students are exposed to ethical and legal dilemmas during their fieldwork training. This article presents a study that examined these ethical dilemmas in an Israeli sample of undergraduate social work students. 117 students who participated in a course in ethics submitted 31 written presentations of ethical-dilemma analysis. Their oral presentations were recorded and transcribed. Using a qualitative analysis, three major themes emerged: 1. The tension between the duty to maintain client's confidentiality and its violation under certain conditions; 2. The students’ conflict of loyalty toward the client vs. the organization; 3. The question of the clients’ right to self-determination when, in the student's view, this is against their best interests. Our findings point to the vital role of an ethics course in the social work undergraduate curriculum that can enhance students’ knowledge of specific laws relevant to the limits of confidentiality in social work and their ability to analyze ethical dilemmas as future professionals. Furthermore, it is essential to raise awareness in educators and supervisors concerning moral distress that may afflict students coping with ethical dilemmas at this early professional developmental phase.

Development, implementation, and effects of an integrated web-based teaching model in a nursing ethics course

Background:Providing health services is described as an important moral measure, since its major aim is to ensure the welfare of the people who need treatment and care. Moral sensitivity is the ability to identify the existing moral problem and understand the moral consequences of the decisions made on the patient’s part. Physicians are always exposed to moral distress due to various circumstances.Objectives:In this survey, we evaluated moral sensitivity and moral distress among physicians and the relationship of these ethical factors on them. Hence, we assessed y relationship between moral sensitivity and moral distress in physicians will facilitate their sound management so as to provide high-quality and safe health services. Moreover it will confirm proposed theories regarding this subject.Materials and Methods:This cross-sectional descriptive-analytic study aimed at investigating the relationship between moral sensitivity and moral distress among 321 specialist physicians working in hospitals affiliated to Tehran Medical Universities in Tehran. The samples were selected through two-stage random cluster sampling method. A three-partite questionnaire comprising of demographic characteristics, moral distress, and moral sensitivity was used for collecting data which then were analyzed using SPSS-20.Results:There was a negative significant relationship between moral sensitivity and moral distress frequency; there was a positive significant relationship between moral sensitivity and moral distress intensity. Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.Conclusions:Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

In an ethics course, one of the important ways for students to separate ethical values and problems from other problem clusters and to learn how to evaluate ethical values and decision-making is to use the method of case analysis The study was performed descriptively in order to determine the effect of the use of case analysis method under the scope of a nursing ethics course in terms of students’ assessment skills regarding ethical problems. The study was conducted descriptively in order to determine the effect of the use of the case analysis method on students’ assessment skills of ethical problems in teaching an ethics course in nursing. 58 students taking the ethics course in the undergraduate program at the Nursing Department at Gazi University in the Health Sciences Faculty during the 2009-2010 academic years constituted the sample for the study. Research data were obtained by using a data collection form. This form included a total of ten questions, two of which were related to each of four cases, and two of which were related to the students’ participation in a scientific program regarding ethics and their academic averages. A data collection form was used three times in the nursing ethics course. Numbers, percentages, and a Cochran Test were also used in the assessment of data. In the first case, it was determined that the students’ awareness of the nature of common violations of ethical principles had increased over time but that the differences were not statistically significant. In the second case, students’ awareness of the ethical values involved and the sources that they referred to in making ethical decisions were examined and it was determined that the difference was statistically significant. In the third and the fourth cases, it was found that the students’ awareness of the presence of characteristic ethical dilemmas had increased gradually in each phase but that the difference was not statistically significant. In line with these results, it is suggested here that the case analysis method may be used effectively for students taking an ethics course and that this study could be repeated using a large sampling group in order to determine whether students have enough understanding of common ethical problems. Ozet Etik dersinde ogrencinin, etik degerleri, etik sorunlari diger sorun kumelerinden ayirmasini, bir etik degerin harcanma gerekcesini ve etik karar verme surecini ogrenebilmesinin onemli bir yolu vaka analizi ile calismaktir. Arastirma, Hemsirelikte Etik Dersi’nin ogretiminde vaka analizi yonteminin kullanilmasinin ogrencilerin etik sorunu degerlendirme becerilerine etkisini belirlemek amaciyla tanimlayici olarak yapilmistir. Arastirmanin orneklemini, 2009-2010 egitim-ogretim yilinda bir universitenin Saglik Bilimleri Fakultesi Hemsirelik Bolumu lisans programinda yer alan Hemsirelikte Etik Dersi’ne devam eden 58 ogrenci olusturmustur. Arastirmanin verileri, veri toplama formu ile elde edilmistir. Veri toplama formu; arastirmacilar tarafindan hazirlanmis dort vaka ve bunlara iliskin iki soru, ogrencilerin akademik ortalamasi ve etik ile ilgili bilimsel bir programa katilma durumlarina iliskin iki soru olmak uzere toplam 10 sorudan olusmustur. Veri toplama formu, Hemsirelikte Etik Dersi’nde farkli zamanlarda 3 defa uygulanmistir. Verilerin degerlendirilmesinde sayi, yuzdelikler ve Cochran Testi kullanilmistir. Ogrencilerin birinci vakada, etik ilke ihlalini ve etik ilke ihlalinin niteligini bilme durumlarinin zamanla arttigi ancak, farkin istatistiksel acidan anlamli olmadigi saptanmistir. Ogrencilerin ikinci vakada, harcanan etik degeri ve etik karar vermede rehber alacaklari kaynaklari bilme durumlari incelenmis ve farkin istatistiksel acidan anlamli oldugu belirlenmistir. Ogrencilerin ucuncu ve dorduncu vakada, etik ikilemin varligini ve etik ikilemin ozelligini bilme durumlarinin her uygulamada giderek arttigi ancak, farkin istatistiksel acidan anlamli olmadigi bulunmustur. Bu sonuclar dogrultusunda, etik derslerinde, ogrencilerin etik sorunlari ve ikilemleri kavrayabilmeleri icin vaka analizi yonteminin kullanilmasi ve bu calismanin genis orneklem grubu uzerinde tekrarlanmasi onerilmektedir.

Background: In 2020, the novel coronavirus pneumonia (COVID-19) broke out around the world. In order to reduce close contact between people, Taiwan's clinical education practice shifted to online and classroom teaching. Since our school is located in the south of Taiwan, the school's only internship courses were withdrawn from the hospital to the school's technical practice. Nursing ethics courses can still be taught, but if you want to serve in the community, most institutions politely refuse.Aim: The aim of the study was to service-learning teaching strategies to improve students' use of nursing ethical principles to serve people of the community, and the objective was that improve students’ moral sensitivity and capability of service- learning through learning by doing.Methods: This study adopted a quasi-experimental research design with a pre-test and post-test method. Teachers assisted students in planning the application of ethical nursing principles and integrating them into their service-learning plans. Two hundred and forty three third year nursing students, aged 18-19 years, participated in this study.Results: Nursing students' moral sensitivity and service learning increased significantly after 16 weeks (Pair-t=-6.589***; Pair-t=-6.994***). Moral sensitivity and service learning showed a significant positive correlation in the pre-test and post test (r=.248**, r=.512**), and students’ reflection diaries reflected the application of nursing ethical principles and achievement of the nursing ethics course objectives.Discussion: Nursing students' moral sensitivity and service learning increased significantly after 16 weeks (Pair-t=-6.589***; Pair-t=-6.994***). Moral sensitivity and service learning showed a significant positive correlation in the pre-test and post test (r=.248**, r=.512**), and students’ reflection diaries reflected the application of nursing ethical principles and achievement of the nursing ethics course objectives.

BackgroundMoral distress among healthcare staff is associated with emotional strain and workforce attrition but remains insufficiently explored in child and adolescent psychiatry (CAP). We investigated the experiences and factors contributing to moral distress among staff in inpatient CAP.MethodsWe conducted a 2023 nationwide mixed-methods survey with 106 staff members from CAP inpatient units in Sweden. Quantitative data on moral distress were collected using the Stress of Conscience Questionnaire, while open-ended questions provided qualitative data on perceptions of moral distress and the impact of working with coercive measures. Findings were integrated using triangulation.ResultsStaff reported high levels of moral distress, with physicians experiencing the highest. Triangulation revealed converging findings with younger and less experienced staff experiencing more moral distress. Aligning with the qualitative theme “Providing care one does not believe in”, moral distress was also strongly associated with quantitative data of a demanding work environment, low social support, and intention to resign from job. The theme “Ethical dilemmas about coercive measures” indicated how coercive measure use could contribute to moral distress, while a more positive attitude to coercive measures was associated with lower moral distress.ConclusionsMoral distress among CAP inpatient staff in Sweden was pronounced, particularly among younger, less experienced professionals, and physicians. Addressing moral distress appears critical in supporting staff well-being, promoting workforce retention, and maintaining high-quality patient care.

To propose two NANDA diagnoses--ethical dilemma and moral distress--and to distinguish between the NANDA diagnosis decisional conflict and the proposed nursing diagnosis of ethical dilemma. Journal articles, books, and focus group research findings. Moral/ethical situations exist in health care. Nurses' experiences of ethical dilemmas and moral distress are extrapolated to the types and categories of ethical dilemmas and moral distress that patients experience and are used as the basis for development of two new nursing diagnoses. The two proposed NANDA diagnoses fill a void in current standardized terminology. It is important that nurses have the ability to diagnose ethical or moral situations in health care. Currently, NANDA does not offer a means to document this important phenomenon. The creation of two sets of nursing diagnoses, ethical dilemma and moral distress, will enable nurses to recognize and track nursing care related to ethical or moral situations.

A proactive, team-based, psychological solution to burnout

Nurse moral distress: A survey identifying predictors and potential interventions

Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers. To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict. The Ethical Dilemmas in Nursing-Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel. Middle managers report low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas. Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation.

BackgroundWorldwide, nurses have been at the frontline of the Covid-19 pandemic response and central to its effectiveness. They faced numerous ethical dilemmas which in turn resulted in considerable moral distress. However, there are knowledge gaps on the experiences of critical care nurses in South Africa during the pandemic.AimExplore the experiences, specifically the ethical dilemmas and moral distress, of critical care nurses working in South African hospitals.MethodsGilligan’s ethic of care theory informed this exploratory, qualitative descriptive study with nurses who had experience of taking care of individuals with Covid-19 and working in intensive (critical) care units in the Gauteng province of South Africa. We recruited eligible nurses through a combination of social media adverts, snowballing, and referral from professional associations or trade unions. Following voluntary informed consent, we conducted in-depth interviews with nurses using an interview guide that focused on personal and professional experiences during the pandemic, ethical dilemmas, relationships with other colleagues and/or management, and the availability of support systems. Data was analysed thematically.ResultsThe participants comprised 21 nurses, 16 females and 5 males with a mean age of 38 years. The majority were professional nurses (20/21 = 95%) and from the public health sector (17/21 = 81%). Nurses highlighted the tension between their deep caring for patients and the realities of taking care of patients during the Covid-19 pandemic that necessitated pragmatic compromises, such as doing the bare minimum. They expressed ambivalence about the Nursing Oath because they were acutely aware of the moral obligation to put the health of their patients as their first consideration, yet they faced the personal risk of infections and disease exposure. The uncertainty and fear of the pandemic, of infection, of the unknown, and of being in the frontline of health care provision resulted in considerable moral distress. Simultaneously, the perceived lack of appreciation for their work and for risking their lives as health care providers, and the resource constraints intersected with and exacerbated both ethical dilemmas and moral distress.ConclusionsThis study highlights the ethical dilemmas that nurses experienced during the pandemic, and their perceived moral distress. It contributes to the discourse on healthcare ethics, particularly in crisis situations, and highlights the need for robust support systems for nurses.

To describe intensive care unit nurses' experiences of moral distress during the COVID-19 pandemic, and their recommendations for mitigative interventions. Interpretive description. Data were collected with a purposeful sample of 40 Canadian intensive care unit nurses between May and September 2021. Nurses completed a demographic questionnaire, the Measure of Moral Distress-Healthcare Professionals survey and in-depth interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were categorized and synthesized using reflexive thematic analysis and rapid qualitative analysis. Half of the nurses in this sample reported moderate levels of moral distress. In response to moral distress, nurses experienced immediate and long-term effects across multiple health domains. To cope, nurses discussed varied reactions, including action, avoidance and acquiescence. Nurses provided recommendations for interventions across multiple organizations to mitigate moral distress and negative health outcomes. Nurses reported that moral distress drove negative health outcomes and attrition in response to moral events in practice. To change these conditions of moral distress, nurses require organizational investments in interventions and cultures that prioritize the inclusion of nursing perspectives and voices. Nurses engage in a variety of responses to cope with moral distress. They possess valuable insights into the practice issues central to moral distress that have significant implications for all members of the healthcare teams, patients and systems. It is essential that nurses' voices be included in the development of future interventions central to the responses to moral distress. This study adheres to COREQ guidelines. What Problem did the Study Address? Given the known structural, systemic and environmental factors that contribute to intensive care unit nurses' experiences of moral distress, and ultimately burnout and attrition, it was important to learn about their experiences of moral distress and their recommendations for organizational mitigative interventions. Documentation of these experiences and recommendations took on a greater urgency during the context of a global health emergency, the COVID-19 pandemic, where such contextual influences on moral distress were less understood. What Were the Main Findings? Over half of the nurses reported a moderate level of moral distress. Nurses who were considering leaving nursing practice reported higher moral distress scores than those who were not considering leaving. In response to moral distress, nurses experienced a variety of outcomes across several health domains. To cope with moral distress, nurses engaged in patterns of action, avoidance and acquiescence. To change the conditions of moral distress, nurses desire organizational interventions, practices and culture changes situated in the amplification of their voices. Where and on Whom Will the Research Have an Impact on? These findings will be of interest to: (1) researchers developing and evaluating interventions that address the complex phenomenon of moral distress, (2) leaders and administrators in hospitals, and relevant healthcare and nursing organizations, and (3) nurses interested in leveraging evidence-informed recommendations to advocate for interventions to address moral distress. What Does this Paper Contribute to the Wider Global Community? This paper advances the body of scientific work on nurses' experiences of moral distress, capturing this phenomenon within the unique context of a global health emergency. Nurses' levels of moral distress using Measure of Moral Distress-Healthcare Professional survey were reported, serving as a comparator for future studies seeking to measure and evaluate intensive care unit nurses' levels of moral distress. Nurses' recommendations for mitigative interventions for moral distress have been reported, which can help inform future interventional studies. No patient or public contribution.

Living with conflicts-ethical dilemmas and moral distress in the health care system

To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. This study is an integrative review of published research from 2000 to 2017. The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies. Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.