Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses. Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses. Research design: This was a descriptive (...) quantitative study to measure moral distress in clinical research nurses using the Measure of Moral Distress – Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected. Participants and research context: Registered nurses working in the clinical research nurse role ( N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson’s correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables. Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman’s University. A consent statement was included, and completion of the questionnaire was construed as consent. Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0–354. Moral distress scores were negatively correlated with clinical research nurse age ( r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach’s alpha of 0.93. Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, (...) class='Hi'>moral sensitivity, and moral courage of undergraduate nursing students.Participants and research context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward “solution.” Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an (...) ethical issue related to patient care that requires deeper exploration, rather than evidencing identification of the “right” course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient’s values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action. (shrink)

Background This manuscript explores the pervasive issue of moral distress among nurses and its impact on their well-being and professional satisfaction. Focusing on diverse factors contributing to moral distress, the review spans various experience levels and patient care settings. Method Utilizing integrative reviews and sourcing from PubMed, CINAHL, SCOPUS, PsycINFO, and ProQuest, the study synthesizes findings from studies worldwide. The conceptual framework by Whittemore & Knafl is employed to comprehensively analyze nurses’ experiences. Results Key factors were (...) identified as contributing to moral distress, including concerns about care quality, team dynamics, and insufficient support. Interventions range from light-touch approaches like mentorship programs to resource-intensive strategies such as staff wellness initiatives. The impact of the COVID-19 pandemic on nurses’ moral distress is also explored. Conclusion Moral distress in nurses leads to burnout and, in some cases, prompts professionals to leave the field. The study emphasizes the need for organizational-level initiatives, support networks, and interventions to address moral distress. Identified gaps in the literature underscore opportunities for future research to better prepare clinicians and advance understanding across experience levels and settings. (shrink)

Background: Critical care nurses have risked their lives and in some cases their families through hazardous duty during the COVID-19 pandemic and have faced multiple ethical challenges. Research/aim: The purpose of our study was to examine how critical care nurses coped with the sustained multi-faceted pressures of the critical care environment during the unchartered waters of the COVID-19 pandemic. It was anticipated that our study might reveal numerous ethical challenges and decision points. Research design: A qualitative descriptive study, utilizing an (...) interpretivist paradigm. Participants and research setting: Critical care nurses, working in either intensive care units or emergency departments (N = 11) who were primarily from Northern California hospitals. Individual in-depth ZOOM® session interviews, guided by semi-structured questions, were used to collect data. Interviews lasted between 18 and 59 min, with an average length of 33 min. Session interviews were transcribed and analyzed. Ethical considerations: This study was approved by the researchers’ university Institutional Review Board. Findings: Five main themes emerged: Fear of the Unknown, Adapting to Practice Changes and Challenges, Patient Advocacy and Moral Distress, Isolation and the Depersonalization of Care, and Professionalism and a Call to Duty. Discussion and conclusion: Fear of becoming ill or bringing COVID-19 home to their families was a constant source of anxiety for nurses. There were numerous changes in policy and challenges to standard practice protocols, including most notably shortages in personal protective equipment, which nurses navigated resourcefully. Most nurses interviewed were motivated by a sense of professional duty. The nurses experienced some moral distress in their inability to advocate as they might like for their patients, especially at end of life. Infection control requirements for isolation. (shrink)

Background:In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, and defined as the shared perception of ethically correct behavior, and how ethical issues should be handled in the organization. Ethical climate as an important element of nursing environment has been the focus of several studies. However, scoping reviews of ethical climate research in nursing have not been conducted to (...) guide further research in this area.Objective:The purpose of this scoping review is to describe and analyze studies focusing on ethical climate in nursing environment to elicit an overall picture of the research in this field.Methods:A scoping review methodology guided by Arksey and O’Malley and Levac et al. was used. Studies were identified by conducting electronic searches on PubMed/MEDLINE, CINAHL, Web of Science Core Collection, PsycINFO, and Scopus and Philosophers’ Index databases. Of 1051 citations, 56 articles matched the inclusion criteria.Ethical considerations:This study was conducted according to good scientific guidelines.Findings:Ethical climate is a topical research area which has been explored with different methods and outcomes, in different environments, and has mainly been perceived positively. The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions. Methodologically, research was rather homogeneous using quantitative, descriptive, and correlative research designs.Conclusion:Novel perspectives and more diverse methodological approaches paying attentions to issues affecting generalizability of the findings could expand our knowledge in this area. (shrink)

Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: Three common (...) themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection. (shrink)

Background The field of formal nursing ethics is not new, with literature primarily from North America, dating back to the 1880s. The establishment of the international journal Nursing Ethics in 1994 served to stimulate, curate and disseminate research and scholarship in this evolving field. Three decades on, it is timely to review progress and to make recommendations for the future focus of the field. Purpose This article reviews 182 issues of Nursing Ethics over 30 years, focusing on: regions of origin (...) of published articles; methodologies; and topic themes. Research design The process involved documentary analysis, by hand, summarising: (1) regions of origin; (2) most common methodologies - qualitative; quantitative; mixed methods; argument-based; and reviews; and (3) themes relating to topic areas. Ethical considerations The manuscript was reviewed by members of the Nursing Ethics Editorial Board and revised in accord with reviewers’ feedback. The research did not involve human participants nor require consent from individuals. Findings There has been an escalation of scholarship in nursing ethics with significant shifts over 3 decades, as evidenced in the journal Nursing Ethics. This paper focuses on trends relating to: (1) Regions of origin of published papers – initially manuscripts were primarily from Europe and North America and there is now more geographical diversity; (2) Methodologies – there is strong evidence of the ‘empirical turn’ from an initial focus on philosophical perspectives to empirical research, particularly quantitative research; and (3) Topic areas – whilst there is rich diversity, there has been increasing focus on areas such as moral distress, ethical climate and ethics education. Conclusion This review is intended to stimulate reflection on progress made and approaches to future directions. This includes more critical focus on: the meaning and purpose of nursing ethics; impact on practice, education and research; and potential to respond to care challenges. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deepening and Expanding Both–And ApproachesTasia Scrutton, PhDExcitingly for the topic of religion and mental health, both Gipps’ and Finley’s commentaries point to the emergence of a both-and consensus. Finley does this in a number of ways, for example by pointing to the ways in which her own brilliant research has provided further and more specific support for a “honeysuckle on a broken fence” model, and also inviting a (...) renewed examination of Model 3 in response to studies on absorption, psychosis and religious experience. Gipps does this by putting forward an additional both-and model, according to which a potential or early-stage instance of mental illness, responded to by a grace-ful engagement with psychotherapy, becomes instead an instance of metanoia through which the person’s drives and emotions are integrated into a more rounded adult psyche.As well as pointing to the emergence of a both-and consensus, Finley and Gipps’ commentaries importantly reflect the fact that both-and accounts are likely to be diverse, complex and multi-faceted. As Gipps notes, my account focuses on spiritual guidance and medication, especially psychiatric medication; the therapeutically informed psychological perspective that Gipps provides is a very welcome addition to the discussion. In addition to both-and accounts being diverse, different psychiatric conditions and symptoms may invite different models, and multiple models may be in play in one person’s life at the same time. Finley gives an example of this possibility when she posits that a version of model 3 might fruitfully by understood as part of, or perhaps combined with, Model 4.Hopefully this paper and the two commentaries on it open the door to a deeper account of the “honeysuckle on a broken fence” model and potentially to other both-and models too. I want to see that door open—but perhaps not too open, and I think less open certainly than Finley and perhaps also Gipps would like. This is because of my view of the relationship between suffering and psychopathology, and suffering and evil (or badness), which I want to discuss in more detail below.Suffering, Badness, and PathologyThe first thing I want to say is that I think that suffering is bad, by which I mean that it is undesirable. This is true to the way we talk about suffering (if someone tells us that they are suffering, we express regret, not joy), and it is important [End Page 265] morally to remember that suffering is an evil if we are to work to prevent and overcome it (including in ways relevant to mental illness, such as through social justice, peace-building and medical care). It can be tempting to romanticize suffering and to try to justify its romanticization on the basis that sometimes good things come out of situations of suffering. However, to do this is to conflate what something is with other things it may become intertwined with. It is also to encourage masochistic and socially and politically conservative forms of spirituality that are antithetical to the Christian Gospel, since it baptizes suffering rather than seeing suffering as something people are called to be liberated from.The second thing I want to say is that I think that pathology, including psychopathology, involves suffering, and that if it does not involve suffering (either in a specific moment or over time) then it is not pathology. The centrality of suffering to pathology is indicated by the fact that the term ‘distress,’ which denotes suffering, appears in the DSM-5 618 times. The presence of either distress or impairment in social, occupational or important other areas of functioning (which, over time, is likely to lead to suffering) is a prerequisite of many psychiatric conditions, according to DSM-5. Homosexuality was rightly removed from the DSM and other psychiatric manuals when it became clear that same-sex attraction does not inherently involve distress (and so suffering). Significant for the shift towards demythologizing homosexuality was Evelyn Hooker’s 1957 study, which showed no similarities in the well-being and happiness of 30 homosexual and 30 heterosexual men (Ebacioni, 2014, p. 4). To take another example, hearing voices (with no... (shrink)