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Strategies to cope with moral distress of mental health nurses
Source publication
Objective: The purpose of this study was to explore the strategies used by Thai mental health nurses to cope with the moral distress that often results from their work. Material and Methods: The study was performed using a qualitative, narrative method. Participants were recruited into the study using a purposive snowball method. A total of 41 ment...
Context in source publication
Context 1
... this study, six strategies used by the MHNs to cope with their moral distress were discussed, namely releasing tension by talking to others, exercising positive self-talk, //believe myself to diminishing the problems//, using knowledge to self-help, autonomy, and participating in a case conference group. While some of the participants used only one, two, or three of these strategies, some used five or all six of them to cope with their moral distress, depending on individual differences and the support needed ( Figure 1). ...
Citations
... Although, they have been trained to deliver quality care and improve the quality of life of their patients, their personal needs and quality of nursing work life (QNWL) have been mostly overlooked 3 . Furthermore, evidence has recently revealed that registered nurses have a negative attitude toward work 4 . As a result, patient care quality and productivity might be affected 5 . ...
Objective: The Brooks Quality of Nursing Work Life Survey has been widely used to assess the quality of nursing work life. In Thailand, this scale was translated and used by nurse practitioners. However, many items designed for use have contextual differences from the hospital and have never been tested for their construct; including issues of cultural differences. Therefore, such a scale must be revised. This study aimed to translate and test the psychometric properties to justify its use in a hospital context.Material and Methods: This was methodological research. The process consisted of two phases; including: 1) translation using the forward-backward translation method, and 2) psychometric properties testing; content validity, cognitive interview, construct validity, and reliability would be used to evaluate psychometric properties. Content validity was considered by a panel of experts. Ten registered nurses were asked to participate in a cognitive interview. Two hundred and fourteen registered nurses were recruited, using convenience sampling for conducting the construct validity and reliability testing.Results: The findings revealed excellent content validity. Twenty-three items were revised in the phase of cognitive interviews. Internal consistency was calculated: Cronbach’s alpha was 0.959. Confirmatory factor analysis yielded four factors, and was consistent with the original version.Conclusion: The scale may be utilized by registered nurses working in Thailand’s hospital context to assess the quality of nursing work life. Further study needs to test this in larger and heterogeneous samples.
... Entretanto, quando estes aspectos são violados por algum membro da equipe multiprofissional, os enfermeiros podem vivenciar o distresse moral. Nesta direção, vale destacar que o desrespeito à autonomia dos usuários está diretamente correlacionado ao fenômeno e atinge enfermeiros de saúde mental (10,13,15,16) . No presente estudo, o fator supramencionado teve os valores mais baixos de mediana para intensidade e frequência de distresse moral, mesmo resultado apresentado por um estudo brasileiro de distresse moral em enfermeiros de outros contextos de trabalho (2) . ...
... Entretanto, respeitar a lei do exercício profissional e os princípios éticos constitui a base do agir eticamente, que pode minimizar situações causadoras do fenômeno. Nesse sentido, a construção da prática apoiada em preceitos éticos, técnicos e legais da profissão é um elemento que contribui para a visibilidade e empoderamento do enfermeiro em diferentes contextos de trabalho (16,24) e está relacionado ao fator "Segurança e autonomia profissional". ...
... Nesta concepção, as relações conflituosas que perpassam os limites das relações éticas, a fragilidade das relações interpessoais, o desrespeito, a falta de autonomia profissional e as práticas institucionais que inviabilizam um cuidado qualificado contribuem para um ambiente gerador de sofrimento. Neste ponto, destaca-se que os gestores possuem papel significativo na disponibilização de recursos e construção de um clima ético institucional (15) , promovendo a autonomia profissional por meio de processos de educação permanente em saúde e implementação de tecnologias assistenciais (16) . Destaca-se, portanto, que, se a gestão é dinâmica e eficiente, o processo de trabalho do enfermeiro na RAPS tende a ser mais organizado, promovendo maior autonomia e segurança para os processos decisórios, minimizando-se assim as situações geradoras de distresse moral (17) . ...
Objective
To assess the intensity and frequency of moral distress in mental health nurses in Brazil.
Method
Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used.
Results
Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 – 3.73 and 2.00 – 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts.
Conclusion
The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.
DESCRIPTORS
Psychological Distress; Mental Health; Ethics, Nursing; Working Conditions
... There is a certain limitation of Brazilian studies covering the theme in mental health nurses, and only an integrative literature review (8) and a qualitative study (9) were identified. Studies on moral distress in this specific population predominate in the international scenario, where countries such as Japan (10) , South Korea (11) , Jordan (12) , U.S.A (13) , Italy (14) , Norway (15) , Thailand (16) , and Iran (17) devoted more attention to this issue. ...
... However, when these aspects are violated by a member of the multidisciplinary team, nurses can experience moral distress. In this sense, it is worth noting that disrespect for users' autonomy is directly correlated to the phenomenon and affects mental health care nurses (10,13,15,16) . In the present study, the factor aforementioned had the lower median values for intensity and frequency of moral distress, the same result presented by a Brazilian study on moral distress in nurses from other work settings (2) . ...
... However, respecting the law of professional practice and ethical principles constitutes the basis of acting ethically that can minimize situations leading to the phenomenon. In this regard, the construction of practice based on ethical, technical, and legal precepts of the profession is an element that contributes to the visibility and empowerment of nurses in different work contexts (16,24) and is related to the factor "Safety and professional autonomy". ...
Objective
To assess the intensity and frequency of moral distress in mental health nurses in Brazil.
Method
Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used.
Results
Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 – 3.73 and 2.00 – 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts.
Conclusion
The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.
DESCRIPTORS
Psychological Distress; Mental Health; Ethics, Nursing; Working Conditions
... Moral causing factors in psychiatric nurses include physical restraint of patients, enforcing them to take their medication, isolating them in the isolation room, and giving them medicines to aggressive patients (20,21). Deady and McCarthy (2010) have identi ed three dominant situations causing moral distress in psychiatric nurses: professional and legal con icts, professional independence, and the scope of authority and standards of care (10). ...
Background:
The COVID-19 epidemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols.
This study has been conducted to explore and describe factors that caused moral distress in psychiatric nurses during the COVID-19 epidemic.
Method:
This qualitative study with a conventional content analysis approach involved 12 nurses at Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by unstructured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.
Results:
From the data analysis, 252 initial codes were extracted, which were obtained by continuous comparison and integration of subcategories of 4 main categories including emotional responses, relational factors, Institutional factors, and management factors caused by Moral Distress in psychiatric nurses.
Conclusion: new dimensions of the causes of moral distress associated with the COVID-19 pandemic are discovered. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.
... Moral causing factors in psychiatric nurses include physical restraint of patients, enforcing them to take their medication, isolating them in the isolation room, and giving them medicines to aggressive patients (20,21). Deady and McCarthy (2010) have identi ed three dominant situations causing moral distress in psychiatric nurses: professional and legal con icts, professional independence, and the scope of authority and standards of care (10). ...
Background: The COVID-19 epidemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols.
This study has been conducted to explore and describe factors that caused moral distress in psychiatric nurses during the COVID-19 epidemic.
Method: This qualitative study with a conventional content analysis approach involved 12 nurses at Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by unstructured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.
Results: From the data analysis, 252 initial codes were extracted, which were obtained by continuous comparison and integration of subcategories of 4 main categories including emotional responses, relational factors, Institutional factors, and management factors caused by Moral Distress in psychiatric nurses.
Conclusion: new dimensions of the causes of moral distress associated with the COVID-19 pandemic are discovered. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.
... Seeking support from colleagues has been identified as a common strategy for coping with moral distress. 14,[30][31][32][33] This is in line with some of our findings. Especially on one ward, the nurses reported that they habitually shared thoughts, feelings and experiences. ...
Background
Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.
Methods
Qualitative individual and focus group interviews were conducted.
Ethical considerations
Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.
Participants and research context
Thirty nurses working within acute psychiatric wards in two mental health hospitals.
Results
Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make oneself immune. Colleagues and work climate were important for choice of coping strategies.
Discussion
Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.
Conclusions
It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience.
... The participants in this study were 34 females and 7 males. The details are presented in the article of Upasen et al. [16] and also in Table 1 Data collection Data collection was performed from November 2017 -September 2018. The data collection took place at the selected psychiatric hospitals in Thailand. ...
... Face-to-face interviews were conducted by the 1 st author in Thai to collect the data. The length of the interview was approximately 45 min for each participant [16]. The interviews were audio-taped and transcribed verbatim. ...
Mental health nurses have to confront distressing situations in caring for patients and families, in which several predicaments can lead to moral distress. This study explored moral distress experienced by mental health nurses. A qualitative narrative inquiry was used to gain a better understanding of moral distress Together with purposive sampling and snowball methods. The data were collected from 41 mental health nurses who met the inclusion criteria through in-depth interviews and then, the data were analyzed by using content analysis. This narrative study revealed that experiences from keeping the patient safe is a significant core theme among mental health nurses, involving five themes: (1) frustration in giving best work performance, (2) concerning the patient safe, (3) being stressed at work, (4) experiencing self-condemnation, and (5) sleeping difficulty. Support needed to face moral distress was also presented in this study. The stories of moral distress from this study may contribute to the understanding of health professionals concerning how it occurs and what attributes are involved. Situations leading to moral distress and support needed can shed light on the development of policy that can prevent and help relieve moral distress among mental health nurses for a greater quality of healthcare in Thailand.
Context:
Moral distress is a common phenomenon in nurses that causes feelings of anger, fatigue, reduced quality of patient care, and leaving the nursing profession. To reduce the negative effects of this phenomenon, it is necessary to study the strategies and mechanisms to deal with it.
Aims:
It has been less studied in psychiatric nurses, so this study was conducted to investigate the mechanisms and strategies of psychiatric nurses in dealing with situations of moral distress.
Settings and design:
This qualitative study was conducted based on a conventional content analysis of 12 psychiatric nurses selected by a purposive sampling method in the 2020 winter in Shiraz, Iran, considering the maximum diversity. Data were collected through semi-structured interviews with participants for an average of 40-60 minutes per interview until data saturation.
Results:
We obtained strategies for dealing with moral distress in psychiatric nurses in four categories. The categories included "Coping strategies," "Establish therapeutic and professional communication," "Managerial support for nurses," and "Commitment to religious beliefs."
Conclusions:
Psychiatric nurses use personal, team, and management strategies to reduce moral distress in themselves and their colleagues and reduce its adverse effects on patients. Management support and organizational cooperation are necessary for the better implementation of these strategies.
Background
It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.
Objectives
To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.
Methods
A cross-sectional descriptive design was used, employing self-administered questionnaire.
Results
Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R ² = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R ² = .243.
Conclusion
Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.
Background
It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.
Objectives
To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.
Methods
A cross-sectional descriptive design was used, employing self-administered questionnaire.
Results
Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R ² = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R ² = .243.
Conclusion
Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.
