Background

Moral distress is a complex ethical phenomenon that occurs when one is not able to act according to their moral judgement. Consequences of moral distress negatively impact nurses, patient care, and the healthcare system. There is limited evidence on specific approaches to prepare nurses to manage these ethical situations.

Aim

The aim of this scoping review is to identify moral distress interventions for nurses who provide direct patient care, identify gaps in the current moral distress research, and determine areas of focus for future research on this topic.

Methods

We employed the framework outlined by Levac, Colquhoun, and O'Brien and Arksey and O'Malley to conduct a scoping review. These steps included the: identification of the research question, identification of relevant studies, study selection, charting the data, collating, summarizing, and reporting the results. We appraised the quality of included studies using the Mixed Methods Appraisal Tool.

Results

We identified 5206 articles from the selected databases. Once duplicates were removed, two independent reviewers each screened 4043 title and abstracts. We included 554 articles for full-text screening, with 10 studies included based on inclusion and exclusion criteria. Study designs included before-after studies (n = 4), randomized control trials (n = 3), concurrent mixed-methods studies (n = 2), and one controlled before-after study. All studies were conducted in acute care settings. In four studies, interventions focused on informing nurses on moral distress. Two interventions focused on increasing the nurses’ reflexivity on their workplace experiences. One intervention included formal clinical mentoring and clinical ethics support through interprofessional rounds. Two studies utilized a multicomponent intervention. The overall moral distress scores significantly decreased after intervention implementation in three included studies. Three additional studies showed significant differences in specific survey item scores (e.g., “provision of less-than-optimal care” and “caring for patients they did not feel qualified to care for”), as compared to overall scores, after intervention implementation. In 70% of studies the amount of quality criteria met were 60% or higher according to the Mixed Methods Appraisal Tool.

Conclusion

Our review is the first to synthesize intervention studies pertaining to moral distress among nurses. The findings of this review demonstrate that there is no clear pattern regarding which strategies consistently minimize the effects of moral distress among nurses. Future interventions should be tested more broadly by increasing the sample size, assessing length of intervention in relation to moral distress scores, expanding the interventions to other units and institutions, and including other healthcare professionals.

Tweetable abstract: We reviewed interventions to help nurses with moral distress. Findings show no clear pattern of strategies to minimize their moral distress

中文翻译：

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应对道德困境的建议：范围审查

背景

道德困境是一种复杂的伦理现象，当人们无法按照自己的道德判断行事时就会发生。道德困境的后果会对护士、患者护理和医疗保健系统产生负面影响。关于让护士准备好管理这些道德情况的具体方法的证据有限。

目的

本范围审查的目的是为提供直接患者护理的护士确定道德困扰干预措施，确定当前道德困扰研究中的差距，并确定该主题未来研究的重点领域。

方法

我们采用 Levac、Colquhoun、O'Brien、Arksey 和 O'Malley 概述的框架进行范围审查。这些步骤包括：确定研究问题、确定相关研究、研究选择、绘制数据图表、整理、总结和报告结果。我们使用混合方法评估工具评估纳入研究的质量。

结果

我们从选定的数据库中确定了 5206 篇文章。删除重复项后，两名独立审稿人分别筛选了 4043 篇标题和摘要。我们纳入了 554 篇文章进行全文筛选，根据纳入和排除标准纳入了 10 项研究。研究设计包括前后研究 ( n  = 4)、随机对照试验 ( n  = 3)、同时进行的混合方法研究 ( n = 2)，以及一项前后对照研究。所有研究均在急性护理环境中进行。在四项研究中，干预措施侧重于告知护士道德困境。两项干预措施的重点是提高护士对其工作经历的反思。一项干预措施包括通过跨专业轮次进行正式的临床指导和临床伦理支持。两项研究使用了多组分干预。在三项纳入的研究中实施干预后，总体道德困扰得分显着下降。另外三项研究显示，在实施干预后，与总体得分相比，特定调查项目得分（例如，“提供不那么理想的护理”和“护理他们认为没有资格护理的患者”）存在显着差异。

结论

我们的评论是第一个综合有关护士道德困扰的干预研究。本综述的结果表明，对于哪些策略始终如一地最小化护士道德困扰的影响，没有明确的模式。应通过增加样本量、评估与道德困扰评分相关的干预时间长度、将干预措施扩展到其他单位和机构以及包括其他医疗保健专业人员来更广泛地测试未来的干预措施。

Tweetable 摘要：我们回顾了帮助有道德困扰的护士的干预措施。调查结果显示没有明确的策略模式可以最大限度地减少他们的道德困境