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      A survey of moral distress in certified registered nurse anesthetists: A theoretical perspective for change in ethics education for advance practice nurses

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          Abstract

          Objective

          The aim of this study was to examine the relationship between moral distress that may affect patient safety, and the clinical practice model, assessing ethical decision-making skills of certified registered nurse anesthetists (CRNAs).

          Methods

          A survey using the Ethical Stress Scale (ESS) and the Ethical Assessment Skills Survey (EASS) was conducted with 134 CRNAs.

          Results

          Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge [Wilks's lambda = 0.952, F (6, 256) = 1.068, P = 0.382, n 2  = 0.02]. A statistically significant positive correlation existed between importance and skill ( r = 0.275, P = 0.001). CRNAs felt skilled to manage the actions or activities they deemed important.

          Conclusion

          CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress. Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

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          Framing the Issues: Moral Distress in Health Care

          Bernadette Pauly, Colleen Varcoe, Jan Storch (2012)
          Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care.
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            Dilems of moral distress: moral responsibility and nursing practice

            A Jameton, Jameton, Jameton A (1993)
            Article 0 comments Cited 38 times – based on 0 reviews     Review now
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              Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress.

              Anna Raines (2000)
              Stress related to ethical decision-making is a serious consequence of frequent encounters with ethical dilemmas for oncology nurses. A descriptive, correlational design using survey techniques was used as a study design with a nationwide sample of 229 oncology nurses. The results indicated nurses experienced an average of 32 different types of ethical dilemmas within the past year on a daily basis. Pain management is the most frequently cited ethical dilemma, followed by cost containment issues and making quality of life and other decisions in the patient's best interest. Approximately 80% of respondents rated their ethics stress level as a 6 or above on a scale of 0 to 10. Forty-three percent of the sample indicated they use an independent or "sovereign" style of moral reasoning, 23% rely on or accommodate to the judgment of others, and 34% use characteristics of both moral reasoning styles. Understanding the relationships among style of moral reasoning, coping style, and ethics stress can assist nurses and administrators to deal more effectively with the increased moral distress found in many oncology practice settings today. Findings suggest specific interventions for reducing ethics stress in this population of nurses.
              Article 0 comments Cited 14 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Brenda A. Wands
                Journal
                Journal ID (nlm-ta): Int J Nurs Sci
                Journal ID (iso-abbrev): Int J Nurs Sci
                Title: International Journal of Nursing Sciences
                Publisher: Chinese Nursing Association
                ISSN (Print): 2096-6296
                ISSN (Electronic): 2352-0132
                Publication date PMC-release: 29 March 2018
                Publication date Collection: 10 April 2018
                Publication date (Electronic): 29 March 2018
                Volume: 5
                Issue: 2
                Pages: 121-125
                Affiliations
                [1]Department of Nurse Anesthesia, Virginia Commonwealth University, Virginia, United States
                Article
                Publisher ID: S2352-0132(17)30313-7
                DOI: 10.1016/j.ijnss.2018.03.006
                PMC ID: 6626228
                PubMed ID: 31406813
                SO-VID: 2b285247-1839-4d91-a47c-dc403e9fb40e
                Copyright © © 2018 Chinese Nursing Association. Production and hosting by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 11 October 2017
                Date revision received : 23 March 2018
                Date accepted : 23 March 2018
                Categories
                Subject: Special Issue: Advanced Practice Nursing

                Keywords: advance practice nurse,certified registered nurse anesthetist,moral distress
                Data availability:
                Keywords: advance practice nurse, certified registered nurse anesthetist, moral distress

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