Volume 32, Issue 121 (December 2019)                   IJN 2019, 32(121): 41-53 | Back to browse issues page

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Mohamadi N, Fakoor F, Haghani H, Khanjari S. The Association of Moral Distress and Demographic Characteristics in the Nurses of Critical Care Units in Tehran, Iran. IJN 2019; 32 (121) :41-53
URL: http://ijn.iums.ac.ir/article-1-3082-en.html
1- Associate Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- MS Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: 0912776635 Email: fakoorfaezeh@gmail.com
3- Instructor, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (3476 Views)
Background & Aim: Nurses need peace of mind in the workplace in order to provide proper patient care and accurately perform their complicated responsibilities. On the other hand, workplace stress and ethical issues affect the nursing profession. Moral distress is an inevitable issue in the nursing profession and occurs when nurses want to operate based on knowledge and what is morally accepted. Nurses experience moral distress based on their occupational role and professional status, and various factors are involved in the emergence of moral distress, including organizational factors, collaborative and group relationships, and factors related to patients and their treatment processes. However, nurses working in intensive care units (ICUs) are more at risk of moral distress due to stressful situations. In addition, the highest level of moral distress in ICU is due to nonstandard care and treatment caused by a shortage of staff. Another factor that contributes to this issue is working with the unqualified staff at various nursing and medical levels. Moral distress can affect nurses’ work-life and have various impacts on the life of staff, patients, and health organizations. This could lead to confusion, fear, anxiety, and lack of power in nurses, which results in job dissatisfaction and intention to leave in nurses. Therefore, the present study aimed to determine the relationship between moral distress and demographic characteristics of nursing in ICUs of medical training centers of Tehran, Iran.
Materials & Methods: This cross-sectional, correlational, and descriptive research was performed on 200 nurses working in ICUs of medical training centers in Tehran, affiliated with Iran and Shahid Beheshti universities of medical sciences in 2018. A stratified sampling method with proportional allocation was used to enroll participants, and CCU, ICU, and ICU-OH were considered as categories. Data were collected using a demographic characteristics questionnaire, which included background information of nursing staff. In addition, a 24-item moral distress scale by Corly was applied, which assessed the frequency and intensity of moral distress, and its items were scored based on a five-point Likert scale. In this regard, the mean of 24 items was calculated to estimate the moral distress score. In addition, the score range was 0-96. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution, mean, and estimation of numerical indicators), and inferential statistics such as independent t-test and (to evaluate the relationship between intensity and frequency of moral distress with demographic characteristics of the participants), analysis of variance (for pairwise comparison) and Scheffé's method.
Results: In this research, 79.5% of the participants working in intensive care units (n=200) were female, and the age range of 30-39 years had the highest frequency (46.5%). In addition, 57.5% of the subjects were married, 22% of whom had no children. Most subjects (55%) had a work experience of more than 10 years, which showed the presence of experienced nurses in these wards. Regarding the level of education, 87.5% of the subjects had a BSc and the rest had an MSc. Moreover, 56.5% of the participants were permanently employed. The majority of the participants (78.5%) worked in rotating shifts, and nurses with 10-14 night shifts per month (27.5%) had the highest frequency in the number of night shifts. The results of the analysis of variance and t-test showed no significant relationship between the frequency of moral distress and variables of gender, age, marital status, number of children, level of education, work experience, employment status, work shift, number of night shifts per month and ethics training. Overall, there was no significant relationship between the frequency of moral distress and the demographic characteristics of nurses. According to the results, the mean and standard deviation of the frequency of moral distress was estimated at 48.96 ± 18.21, which was near the medium score of the tool (49), and the mean and standard deviation of intensity of moral distress was reported at 52.04 ± 18.43, which was higher than the medium score (49). Meanwhile, we found a significant relationship between the frequency of moral distress and the type of ward (P=0.014). However, the frequency of moral distress was significantly lower in the ICU-OH ward, compared to CCU (P=0.040) and ICU (P=0.018). Nonetheless, this difference was not significant between ICU and CCU. In addition, there was a significant difference between the intensity of moral distress and ward (P=0.030). Furthermore, moral distress intensity was significantly lower in ICU-OH, compared to CCU (P=0.005) and ICU (P=0.008), and no significant difference was found between ICU and CCU.
Conclusion: In the present research, we observed a moderate frequency and intensity of moral distress in nurses working in intensive care units, which could have a negative impact on patient care and the health of personnel. According to the results, there was a significant relationship only between the ward and moral distress. In addition, there was no significant association between moral distress and ethics training. According to our findings, there was no significant relationship between the demographic characteristics of the participants and their moral distress. Therefore, other factors such as organizational support, socioeconomic factors, and other predisposing factors of moral distress should be assessed in this regard. In addition, training the staff and familiarizing them with factors of moral distress could play a role in decreasing this issue in nurses working in intensive care units. In this respect, training could be carried out by nursing managers and instructors in the form of researcher, counselor, and planner to familiarize nurses with moral distress and decrease this factor in these individuals. It is recommended that our findings be used by nursing managers and authorities to develop proper treatment policies to decrease moral distress in nurses working in intensive care units.
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Type of Study: Research | Subject: nursing
Received: 2019/09/11 | Accepted: 2019/12/10 | Published: 2019/12/10

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