Characteristics of moral distress from nurses’perspectives:An integrative review  

护士视角下道德困境的特征:整合性综述

作　　者：Mohannad Aljabery Isabel Coetzee-Prinsloo Annatjie van der Wath Nathira Al-Hmaimat Mohannad Aljabery;Isabel Coetzee-Prinsloo;Annatjie van der Wath;Nathira Al-Hmaimat

机构地区：[1]Department of Nursing,University of Pretoria,Pretoria,South Africa [2]Department of Nursing,Fatima College of Health Sciences,Abu Dhabi,United Arab Emirates

出　　处：《International Journal of Nursing Sciences》2024年第5期578-585,I0004,共9页国际护理科学（英文）

摘　　要：Objective:This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’perspectives in the literature.These insights will help update existing tools and create new ones to capture moral distress better,guiding the development and implementation of strategies to support nurses in addressing this challenge.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases(EBSCO Medline,CINAHL,and PubMed).Additionally,two journals,Bioethics and Nursing Ethics,were manually searched to reduce search bias.The included studies were primary resources published in English between 2018 and 2023,utilizing quantitative,qualitative,or mixed methods to examine moral distress’s characteristics,components,and definitions.All of identified studies were screened,extracted,and analyzed independently by two researchers.Results:Nineteen studies were included.The results were grouped into five themes shaping the main characteristics of moral distress:1)experiencing a moral situation,with five ethically conflicted situations identified,including treatment plans,professional and personal moral values,team dynamics,complex contexts,clinical practices,and patient-centered care;2)making a moral judgment,where nurses experience moral distress when they cannot act consistently with their values,ethical principles,and moral duties;3)the presence of constraints,categorized at three levels:individual factors related to the nurse,patient,and patient’s family;team factors related to the team or unit involved;and system factors,including institutional and policy elements;4)moral wrongdoing,which occurs when nurses are unable to perform the right moral action;and 5)moral suffering,with studies showing that moral distress impacts physical,emotional,and psychological well-being.Conclusion:The findings enhance the understanding of moral distress characteristics among nursing目的通过分析文献中护士的观点,识别护理中道德困扰的共同特征,并将其与其他类型的困扰区分开。这些见解将有助于更新现有工具并创建新的工具,以更好地捕捉道德困境,指导制订和实施支持护士应对道德因素的措略。方法采用Whittemore和Knafl提出的整合性综述方法框架,在EBSCO Medline、CINAHL和PubMed等数据库中进行检索,并检索生物伦理学和护理伦理学2种期刊,以减少检索偏差。检索文献发表时间限定为2018年-2023年,仅纳入经过同行评审的英文文献,包括采用定量、定性或混合方法来确定道德困境的特征、组成部分和定义。由2名研究员独立进行文献的筛选、提取和分析。结果共纳入19项研究。分为5个主题:1)经历道德情境,确定了五种道德冲突情境,包括治疗方案、职业和个人道德价值观、团队动态、复杂情境、临床实践和以患者为中心的护理;2)做出道德判断,当护士不能按照自己的价值观、伦理原则和道德义务行事时,会遇到道德困境;3)存在约束,分为3个层面:与护士、患者和患者家属相关的个体因素;与所涉及的团队因素;制度因素和政策因素;4)错误的道德行为,即护士无法履行正确的道德行为;5)道德痛苦,研究显示道德痛苦会影响身体、情感和心理健康。结论该结果加深了对护士道德困扰特征的理解,突出了渐强效应的概念,强调了积极解决道德冲突的必要性,以防止对护士道德操守和职业满意度的影响。

关 键 词：CHARACTERISTICS DEFINITION Ethical conflict Moral conflict Moral distress Nurses 

分 类 号：R192.6[医药卫生—卫生事业管理]