Showing 29 results for Stress
Somayeh Mohammadi, Fariba Borhani, Leili Roshanzadeh, Mostafa Roshanzadeh,
Volume 7, Issue 2 (7-2014)
Abstract
Moral distress is one of the ethical challenges that nurses face due to the nature of their career. Nurses' frequent confrontation with this phenomenon can have different outcomes such as frustration and boredom in providing patient care. This will lead directly to a decline in care quality and can hamper the accomplishment of health goals. Therefore, the present study examined the relationship between moral distress and compassion fatigue in nurses.This cross-sectional study was conducted on 260 nurses of intensive care units in Kerman who were selected through convenience sampling method. In this study, Corley’s moral distress scale and Figley’s Compassion Fatigue Scale were used for data collection. The collected data were analyzed using the SPSS software and descriptive and analytical statistics.The results of this study indicate that there is a significantly positive relationship between moral distress and compassion fatigue (P<0.05). From a total range of 0 to 5, the average score of moral distress was 3.5±0.8 in terms of intensity, and 3.9±0.55 in terms of frequency. The mean of compassion fatigue score was 3.5±0.68 from a range of 0 to 5.Moral distress and its association with compassion fatigue suggest that conditions contributing to moral distress can have an important role in the quality of care. It is clear that strategies should be adopted to prevent the occurrence of these conditions. Informing nurses about moral distress and its consequences as well as periodic consultations will play an important part in the identification and management of moral distress and its consequences.
Elham Fazljoo, Fariba Borhani, Abbas Abbaszadeh, Farideh Razban,
Volume 7, Issue 2 (7-2014)
Abstract
Considering the advances in today's world, the increased complexity of diseases and longer life expectancy, nurses experience a great deal of moral distress. One factor that is likely to contribute to the development of moral distress is the ethical climate prevailing in hospitals. This study aimed to assess the relationship between nurses' perceptions of moral distress and the ethical climate in Shahid Sadoughi University of Medical Sciences in Yazd. This correlational descriptive study used the Moral Distress Scale (MDS) and Hospital Ethical Climate Survey (HECS) to examine 370 nurses working in a number of hospitals including Shahid Sadooghi, Shahid Rahnemun, Shahid Afshar and Savaneh Sukhteghi. Data analysis was performed using SPSS18 and descriptive and analytical statistics. Findings showed that the intensity of perceived moral distress among nurses was 3.41±1.28, and their perceptions of the ethical climate were 3.22±0.78. There was a significant negative relationship between nurses’ perception of moral distress and the ethical climate (P=0.00). The findings of this study suggest that development of plans to improve the ethical climate prevailing in hospitals might decreases nurses’ perceived moral distress.
Somayeh Mohammadi, Fariba Borhani, Mostafa Roshanzadeh,
Volume 7, Issue 3 (9-2014)
Abstract
In the nursing profession, moral distress is a challenge thatc an have different consequences. The nurses’ moral courage to make the right decision can play an important role in the prevention of moral distress, and thus promote moral comfort. The present study examined the relationship between moral distress and moral courage in nurses. In this study, 313 nurses from hospitals in southern Khorasan Province were selected through quota sampling, and Corley’s Moral Distress Scale and the Professional Moral Courage Scale by Sekerka, et al. were used for data collection. The collected data were analyzed by descriptive and analytical statistics. The findings showed a significant relationship between the intensity of moral distress and moral courage (P = 0.03, r = - 0.44). From a range of 0 - 5, the mean of moral distress was 3.7 ± 0.5 in terms of intensity, and 3.55 ± 0.86 in terms of frequency. The mean score of moral courage was calculated at 3.33 ± 0.46 from a range of 1 - 5.The significant correlation between moral distress and moral courage strongly suggests that high levels of moral courage in nurses can play an important role in controlling moral distress. Determining the factors that create moral courage and developing strategies and circumstances such as promoting an appropriate moral climate could play a major role in encouraging moral behavior and controlling moral distress.
Fariba Keighobadi, Hajar Sadeghi, Farzaneh Keighobadi, Yaser Tabaraei,
Volume 7, Issue 3 (9-2014)
Abstract
The nursing profession is based on ethics. Clinical decisions that most nurses have to deal with include cases that involve moral conflicts. Moral distress is a phenomenon that causes pain, suffering, anxiety, depression and psychological damage. Emotional exhaustion can cause moral distress and is a consequence of job stress that has even been investigated as a reason for the high turnover in nursing. Therefore, the present study investigated the relationship between moral distress and emotional exhaustion among nurses.In this cross-sectional study, 265 nurses who employed in teaching hospitals of Sabzevar University of Medical Sciences were selected through convenience sampling. Data collection tools included a questionnaire on personal information a moral distress scale whose validity and reliability had been measured in previous studies (Cronbach's alpha 0.86) and a scale for emotional exhaustion that had also been tested for validity and reliability through content validity and test-retest (r = 0.84). Data analysis was performed using SPSS version 18.In this study, mean and standard deviation of moral distress and emotional exhaustion of nurses were 4.99 (0.91) and 4.17 (1.58) respectively. A statistically significant correlation was found between moral distress and the nurses’ field of work (rho = 0.338, P = 0.000). There was also a significant correlation between emotional exhaustion and rotating working shifts (rho = 0.385, P = 0.000) and ward (rho = 0.173, P = 0.03).The moral distress and emotional exhaustion of the nurses in this study were found to be higher than average. Education, counseling and raising nurses’ awareness of these concepts seem to be necessary in order to empower them to better deal with ethical issues.
Fateme Poladi, Foroozan Atashzade, Abaas Abaaszade, Azam Moslemi,
Volume 8, Issue 4 (11-2015)
Abstract
Moral distress is a phenomenon that can result in feelings of disappointment, guilt, depression, insecurity, fear, discouragement, and depression in nurses, and can affect their personality and professional performance. Burnout in nurses could cause various complications in their families, personal and social lives, and organizations. The aim of the present study was to determinate the correlation between moral distress and burnout in nurses.
This was a correlative descriptive study conducted on 224 nurses selected by stratified randomized sampling. Data were collected through a demographic characteristics questionnaire Corley’s Moral Distress Scale and the Copenhagen Burnout Inventory. Data analysis was performed by SPSS 20 software and Spearman correlation tests.
In this study, mean of moral distress score, mean of personal burnout score, score of work-related burnout, and mean of client-related burnout were 1.31, 55.97, 54.35 and 51.28 respectively. The findings showed a positive significant correlation (P<0.001) between moral distress and all of its dimensions, and personal burnout, work-related burnout, and client-related burnout, although the correlation was low.
According to these findings, it is recommended to reduce the conditions and situations causing moral distress and burnout in order to promote job satisfaction and quality of nursing care.
Marjan Mardani Hamooleh, Masoomeh Iranshahi, Naimeh Seyedfatemi, Hamid Haghani,
Volume 9, Issue 2 (8-2016)
Abstract
Moral distress has been identified in nursing literature as a major dilemma affecting nurses in all healthcare systems. It is viewed as an important factor threatening the integrity of nurses and ultimately the quality of patient care. The present study attempted to determine levels of moral distress among the nursing staff employed in hospitals across the city of Malayer. This was a descriptive and cross-sectional study conducted on 195 nurses of Malayer hospitals during 2015. Data were collected using a demographic questionnaire and the standard moral distress scale (MDS). Data analysis was performed by descriptive and analytical statistics using SPSS software version 18.
In this study, 88 nurses (45.1%) were found to be suffering from severe moral distress. The most important factors causing moral distress pertained to substandard care and treatment due to a shortage of health professionals and care providers (6.6±0.21), physician orders for unnecessary tests, treatments and care (6±0.12), and measures taken by staff who lacked clinical competency (5.9±0.22). Among the nurses’ demographic data, gender (P=0.001), job experience (P=0.001) and nursing ward (P=0.01) were significantly related to the level of moral distress experienced by the nursing staff. The results imply that in nursing, moral distress is a highly important and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.
Nader Ayadi, Shahriar Dargahi, Hossein Ghamari Givi, Moslem Abbasi,
Volume 9, Issue 2 (8-2016)
Abstract
Job stress is rather common in the nursing profession and affects many areas of nurses’ personal lives such as physical, psychological, social and family aspects. Considering the important role of nurses in the society, it is necessary to identify factors that influence their professional and domestic life, and take preventive measures. The aim of this study was to investigate the impact of job stress on marital stress and subjective well-being of nurses.
This was a descriptive correlation research. Study population consisted of 120 nurses employed in the city of Ardabil during 2013 and 2014 selected through available sampling. To collect data, Job Stress Questionnaire (Tufts and Gary Anderson), a subjective well-being questionnaire, and Stockholm-Tehran Marital Stress Scale (STMSS) were used. Data analysis was performed by Pearson’s correlation coefficient and regression analysis.
The results of Pearson’s correlation coefficient demonstrated a negative correlation between job stress and subjective well-being in nurses. Moreover, a positive correlation was discovered between job stress and marital stress. Additionally, regression analysis showed that nursing job stress could predict 25 percent of variance of subjective well-being, 27 percent of variance of marital stress and 29 percent of variance of empathy.
It can be concluded that due to the nature of the nursing profession, nurses’ physical, mental and personal lives are influenced by the stress of the workplace. This will in turn lead to increased marital stress and reduced subjective well-being, which may intensify the risk of developing psychological problems and marital issues in the long run.
Shahriar Dargah, Mojtaba Haghani Zemydani, Hossein Ghamari Givi, Mostafa Ghalavand,
Volume 10, Issue 0 (3-2017)
Abstract
Due to the great importance that the nurses health and job engagement have in the health of their, colleagues and patients, this study aimed to investigate the the relationship between work-family conflict and work ethics with mediating role of job stress in nurses. The design of this study was descriptive and correlation cross-sectional design. The study population included all male and female nurses working in hospitals and clinics in the Gachsaran city during 2016-2017 . To select participants, cluster sampling method was used. A total 150 nurses were selected. To collect information from the Carlson et al work - family conflict questionnaire, work ethics questionnaire of Gregory. C. Petty (1990) and revised French et al. nursing stress scale was used. The results showed that there is a negative significant correlation between job stress with work ethic (P<0.01). Also, there was a negative significant correlation between the work-family conflict with work ethics (P<0.05). In addition, this study showed that job stress plays mediating role between work-family conflict and work ethics in nurses. In general, the interaction between family and work issues influence nurces' performance. As family and work interactions and job stress are predictors of work ethics of nurses. Education about managing and improving quality of nurses' marital and family life and training the stress management can improve nurses' work ethics.
Masoumeh Hasanlo, Arezo Azarm, Parvaneh Asadi, Azar Avazeh, Mitra Hojt Ansari, Hossein Ebrahimi, Mohammad Asghari Jafarabadi,
Volume 10, Issue 0 (3-2017)
Abstract
Stressful ethical situations are considered as one of the problems of nursing profession, which disrupts the competence of simultaneous application of knowledge, skills, attitudes, and values in patient care. Since clinical nurses are more exposed to ethical distress due to their nature of job, especially in in critical care and psychiatric wards, this study was conducted to analyze the relationship between three dimensions of moral distress. In this descriptive-correlational study 545 nurses from Tabriz educational centers were selected by census method in 2013-2014. The moral distress scale (MDS) questionnaire was distributed among partcipants and data was collected during nine months. Data were analyzed by SPSS V13, descriptive statistics, Chi-square test, and Kendall's tau-b correlation coefficient. According to the findings, the mean of moral distress was 141.89 ± 29.6 (in the intermediate range). Chi-square test showed the relationship between the dimensions of moral distress (the relation between patient's ignorance, decision-making power, and professional competence) (P <0.05). According to the Kendall's tau-b correlation coefficient test, there was a direct and significant correlation between the dimensions of moral distress (P <0.05). There was a meaningful correlation between the moral distress and the demographic characteristic of the educational level (P <0.05). Considering the direct and meaningful relationship between three dimensions of moral distress (patient's ignorance, decision-making power, and professional competence), each dimension of moral distress affects another as aggravating or modifying factor. Therefore, it is recommended that planners and health care administrators at the macro level provide appropriate programs to increase the nurse's attention and support to patients and reinforce decision-making power and professional competence by increasing the number of nurses and other controlling programs.
Mohammad Aminizadeh, Mansoor Arab, Roghieh Mehdipour,
Volume 10, Issue 0 (3-2017)
Abstract
Nurses in the intensive care unit face a variety of ethical issues that can lead to moral distress. Nurses need moral courage for correct moral performance in a state of moral distress. The aim of this study was to investigate the relationship between moral courage and moral distress in nurses. The descriptive-analytic study of correlation type which aimed to investigate the relationship between moral courage and moral distress in nurses. A total of 310 nurses from special units of educational hospitals in Kerman were selected by census method. The tools Sekerka's moral courage and Corley's moral distress were used to collect data. Data were analyzed by descriptive and analytical tests of SPSS version 24. Mean score of moral courage of nurses was 42.71 ± 9.67. Moral courage was the highest in moral agent. The mean of moral distress was 56.03 ± 18.21 and the most moral distress was in the dimension of errors. There was a significant and negative relationship between moral courage and moral distress (R = -0.166; p = 0.003). Moral courage was different in position, type of department, and marital status. Moral distress differed only from type of department. The results of study indicated a significant and negative relationship between moral courage and moral distress. Strengthening the moral courage of nurses plays an important role in controlling and reducing moral distress. Therefore, nurses can reduce their moral distress by reinforcing moral courage and, instead, increasing the quality of care for patients.
Majid Ramezan, Mohammad Ebrahim Sanjaghi, Hossein Tajabadi, Zahra Sajadi,
Volume 11, Issue 0 (3-2018)
Abstract
The increasing number of social and individual problems caused by occupational stress have been indicative of the ineffectiveness of the previous models despite many attempts. This article is intended to measure the current status of organizations in order to correct and reduce staff stress. After obtaining the reliability and validity of the model derived from the review of literature and interviews and the questionnaire of expert opinion, the model test required a field study, so a researcher-made questionnaire was developed with the allocation of 90 items. The questionnaire was prepared for distribution in the high-stress zone of six hospitals including public, military, and private hospitals. After receiving the opinions of the employees in the high-stress zones and analyzing the findings of the statistical population, the conceptual model of occupational stress management from the point view of Islam was obtained and it was based on "God-belief, continuity of life after death and centrality of ethics". Considering that hospitals are one of the most important occupational organizations, the model test was used in the high-stress zones of hospitals' and proved the researchers’ hypothesis. So, the obligation to strengthen religious beliefs was explained in these organizations and the model of occupational stress management of employees from the Islamic point of view was confirmed by assessing the status of organizations. The indicators, components, and dimensions of the above model can be used by authorities of health policy such as Iranian medical council, the ministry of health and medical education, and medical sciences’ universities.
Zahra Mahmoodzadeh, Tahereh Ashktorab, Seid Mohammad Kazem Naeeni,
Volume 12, Issue 0 (3-2019)
Abstract
One of the most common ethical issues in nursing profession is moral distress which causes discomfort and impedes nurses proper moral performance, despite having sufficient knowledge. Moral distress disturbs the relationship between nurse and patient which leads to the decreased quality of care. Caring behaviors greatly contribute to improving the quality of care and patient safety. The present study aimed to determine the correlation between moral distress and caring behaviors of nurses in intensive care units of Bandar Abbas hospitals in 2018. This was a descriptive correlational study that was performed on 173 nurses working in ICU and NICU departments of Bandar Abbas hospitals. The data collection tools were demographic information questionnaire, the moral distress scale of nurses of intensive care units, and nursing Caring Behaviors Inventory. Data were analyzed using IBM SPSS 20. Moral distress in nurses in the intensive care unit was in the middle range (1.75 ± 0.81 of 4 score). Also, the mean score of nurses' caring behavior was 5.28 ± 0.48 of 6 score which was considered as an acceptable level. There was a significant negative correlation between moral distress and caring behavior (r = -0.150, P = 0.049). Regarding the importance of moral distress, as well as the role of caring behaviors in improving the quality of care of nurses and satisfaction of patients, it seems necessary that nurses get more familiarized with this concept and attempts to provide solutions for coping and reducing moral distress and improving nurses' caring behaviors.
Farshid Shamsaei, Marzieh Jahani Sayad Noveiri, Naser Mohammadgholimezerji, Shirin Ranjbar, Mehdi Khazaei, Zahra Maghsoudi,
Volume 13, Issue 0 (3-2020)
Abstract
Undesirable experience as “moral distress” is one of the major issues faced by nurses when making moral decisions. The spiritual dimension is one of the dimensions that influences their moral distress; therefore, this study was conducted with the aim of determining the relationship between spiritual health and the moral distress of nurses working in the emergency departments. In this descriptive-analytic study, 140 nurses working in the emergency departments of the educational and medical centers of Hamedan participated by census sampling. Data were collected through a three-part questionnaire, including demographic information, Paloutzian and Ellison spiritual health questionnaires and Corly moral distress questionnaire. The data was analyzed by Chi-square test and Pearson correlation coefficients using SPSS software, version 16. The mean age of participants was 31.9 ± 7.31 years. The spiritual health score and moral distress of most nurses were moderate. A negative and significant correlation was observed between spiritual health and the severity of nurses' moral distress, (r = -0.200, p = 0.05), meaning that the higher the nurse's spiritual health score, the lower their moral distress. The results indicate that spiritual health is an effective parameter in reducing moral distress in nurses, so it is suggested to pay attention to spiritual’s dimension in promotion of nurses' health.
Esmatsadat Hashemi, Maasoumeh Barkhordari-Sharifabad , Mohammad Mehdi Salaree,
Volume 13, Issue 0 (3-2020)
Abstract
Turnover and moral distress are considered as one of the challenges in health care systems. Nursing leaders are one of the factors influencing the thoughts and behaviors of nurses in organizational environments. The aim of this study was to determine the relationship between ethical leadership, moral distress and the turnover intention of nurses working in hospitals affiliated to Kerman University of Medical Sciences in 2019-2020. The research method was descriptive-correlation. A total of 130 participants were enrolled by stratified sampling method from 3 hospitals. Data were collected using demographic information questionnaires, Ethical Leadership in Nursing, moral distress, and turnover intention. Then data were analyzed using descriptive and inferential statistics by SPSS software version 16. The results showed that ethical leadership and all its components were at the desired level. Also, moral distress and intention to leave were moderate. There was a significant negative correlation between ethical leadership and all its dimensions with the turnover intention and moral distress. Also, there was a significant positive correlation between the variables of turnover intention and the moral distress. Therefore, considering the significant relationship between ethical leadership, moral distress, and the turnover, by adopting this type of leadership approach by nursing managers, moral distress and the turnover intention among nurses can be reduced.
Dariush Azimi,
Volume 14, Issue 0 (3-2021)
Abstract
The widespread and increasing number of deaths due to the Corona virus has caused many psychological injuries, including stress. Therefore, the aim of this study was to study the relationship between perceived stress and coping strategies of the family members of patients with Corona virus admitted to the Intensive Care Unit (ICU) of Ardabil medical centers. The present study is a descriptive-analytical study. Sampling was done by available method among the companions of patients with Corona virus infection admitted to the ICU (between May and September 2020). The number of research samples according to the results of a pilot study was estimated at 462 people. Available sampling method was used for sampling. Data collected included patient demographics, Cohen's Perceived Stress Questionnaire, and the Blinges-Moss Coping Styles Questionnaire. The collected data were analyzed using independent t-test, Mann-Whitney, Spearman and Chi-square tests and one-way analysis of variance by SPSS software version 24. The results showed that the mean and standard deviation of perceived stress were 44.80 ± 5.92 and emotion-oriented and problem-oriented coping styles were 19.08 ± 3.02 and 32.35 ± 5.54, respectively. Spearman correlation coefficient test showed a significant relationship between perceived stress with problem-oriented coping style (r = 0.321) and emotion-oriented coping style (r = 0.113) (p <0.05). This study showed that the companions of coronary patients admitted to the intensive care unit use more emotional coping methods, which results in increased emotional behaviors. Therefore, in order to help the psychological health of coronary patients, it is possible to strengthen the application of problem-oriented coping style by designing and implementing educational and supportive-care programs.
Maryam Kashani, Mansoureh Ashqli Farahani, Fatemeh Golestan,
Volume 17, Issue 0 (12-2024)
Abstract
The intensive care unit (ICU) environment presents numerous ethical challenges, contributing to significant levels of moral distress among ICU nurses. This distress negatively impacts their well-being and job satisfaction. Recognizing this critical issue, researchers have investigated the potential of moral empowerment programs to alleviate moral distress. This scoping review aimed to systematically synthesize existing literature on these programs and evaluate their efficacy in mitigating moral distress among ICU nurses. A comprehensive search of PubMed, Scopus, and CINAHL databases was conducted, utilizing keywords such as "moral empowerment," "moral distress," and "intensive care unit nurses." Fifteen articles meeting predefined inclusion criteria, including publication between 2010 and 2022 and a specific focus on moral empowerment programs for ICU nurses, were selected for analysis. The scoping review revealed that moral empowerment programs demonstrated positive outcomes in reducing moral distress among ICU nurses. These programs, encompassing workshops, case-based discussions, reflective exercises, and role-playing simulations, were designed to enhance moral reasoning, ethical decision-making, and moral resilience. Consistent findings indicated a significant decrease in moral distress among nurses who participated in these programs. Participants reported increased confidence in navigating ethical dilemmas, making sound clinical decisions, and effectively advocating for patients' rights. Moreover, moral empowerment programs fostered a sense of moral agency, empowering nurses to address ethical challenges proactively. Moral distress poses a significant challenge for ICU nurses, impacting their well-being and potentially compromising the quality of patient care. Moral empowerment programs offer a promising approach to mitigating this distress and enhancing ethical decision-making capabilities. The successful implementation of these programs requires a supportive work environment that fosters open dialogue and ethical reflection. Nurse leaders and educators play a crucial role in collaborating with ethics committees to develop and implement tailored interventions, including integrating moral empowerment modules into new nurse orientations and ongoing professional development programs. Continuous support through follow-up sessions, mentoring, and debriefing is essential to sustain the long-term benefits of these programs. Ethical consultation services and interprofessional collaboration further contribute to the ethical well-being of ICU nurses. While this review provides valuable insights, further research is warranted to investigate the long-term effects and broader implications of moral empowerment programs in the ICU setting.
Sepide Ghavidel, Sajedeh Ghaani, Seyedehghodsieh Bahreinitousi, Mohaddeseh Mohsenpour,
Volume 17, Issue 0 (12-2024)
Abstract
Moral distress is a common topic in medical ethics, referring to a state where individuals, despite possessing knowledge and the ability to act ethically, are unable to perform the right ethical actions due to external constraints. Ethical courage is a crucial virtue for conscientious performance by healthcare providers, particularly nurses and nursing students. It facilitates the delivery of nursing care and is especially important in today’s healthcare environment, where factors such as increased patient awareness, evolving health needs, social justice issues, and access to healthcare services have contributed to heightened levels of moral distress among nurses and nursing students. This study aims to investigate the relationship between ethical courage and moral distress in nursing students. This descriptive, cross-sectional study was conducted in 2023 in Mashhad, Iran. The study population consisted of third-semester nursing students at Mashhad University of Medical Sciences. A total of 40 third-semester nursing students, both male and female, participated in the study. Data were collected using two questionnaires: the Moral Distress Scale (Corley) and the Ethical Courage Questionnaire (designed by Sekerka and colleagues). The data were analyzed using SPSS version 25, employing descriptive statistics and Pearson correlation tests. The majority of the students were female (51.2%), while 36.6% were male. The average age of the participants was 21.14 years. Among the students, 75.6% were single, and 4.9% were married. The findings revealed a weak, non-significant negative correlation between moral distress and ethical courage (r = -0.055, p > 0.05). The average moral distress score was 75.34 ± 10.81 (range: 12–16), while the average ethical courage score was 85 ± 9.33 (range: 60–103). The study found a weak, non-significant negative correlation between moral distress and ethical courage among nursing students. Based on these findings, it is recommended to implement workshops focused on ethical motivation and educational programs designed to reduce moral distress and enhance ethical courage among nursing students. Additionally, the non-significant correlation may be attributed to the small sample size. Therefore, future studies with larger sample sizes are suggested to validate these findings.
Leila Masoudiyekta, Ehsan Hassanpour Pazevar , Alireza Parsapour, Ehsan Shamsi Gooshki, Mohammd Jalili, Amirahmad Shojaei,
Volume 18, Issue 1 (3-2025)
Abstract
Moral distress constitutes a significant challenge for healthcare professionals, arising when individuals find themselves unable to act in accordance with their personal and professional values due to both internal and external pressures. Healthcare professionals may face scenarios that prompt them to question the ethical acceptability of their decisions and treatment practices, often feeling powerless in the face of perceived unethical changes. This study sought to explore the experiences of moral distress encountered by emergency medicine physicians and nurses in the emergency department. This study was conducted using qualitative content analysis. Data were collected through semi-structured interviews with 25 healthcare providers selected via purposive sampling. Data analysis was conducted using MAXQDA 2018 software. The results indicated that the experiences of moral distress among emergency medicine physicians and nurses in the emergency department can be classified into four primary categories including those related to: 1. patient rights, 2. medical staff and colleagues, 3. management, and 4. professionals. Notably, factors such as overcrowding, inadequate staffing, discrepancies between salaries and workloads, and poor management of human and physical resources emerge as significant contributors to moral distress in the emergency department of Imam Khomeini Hospital. To improve patient care quality, it is essential to implement strategies that enhance triage processes, prioritize human resources, align resources with patient needs, monitor patient attendance, and develop a comprehensive protocol for staff.
Reza Abdollahi, Haleh Ghavami,
Volume 18, Issue 1 (3-2025)
Abstract
Due to the inherently demanding nature of their profession, nurses face significant job-related stress that can adversely affect their lives and the quality of nursing care. Moral courage may serve as a key factor influencing occupational stress among nurses. Accordingly, this study aimed to examine the relationship between moral courage and occupational stress among nurses. This descriptive-analytical cross-sectional study was conducted in 2024 with 120 nurses from emergency departments of educational and therapeutic hospitals in Urmia, Iran, who were selected via two-stage sampling. Data were collected through a demographic information form, Sekerka’s Moral Courage Scale, and Gray-Toft and Anderson’s Nursing Stress Scale. Data were analyzed using Pearson correlation coefficient, multiple linear regression, independent t-test, and one-way ANOVA in SPSS software version 23. The results showed the mean scores for professional moral courage and occupational stress were 85.93 ± 15.68 and 10.77 ± 0.23, respectively. Moreover, there was a significant negative relationship between moral courage and occupational stress in nurses (r = -0.33 and P< 0.05). Specific dimensions of moral courage, such as moral factor, threat tolerance, and moral purpose, had a significant negative effect on occupational stress (P< 0.05). These findings suggested that moral courage plays a significant role in mitigating occupational stress among nurses, which can influence their performance and, consequently, the quality of nursing care. Therefore, by fostering an environment that promotes moral courage, nursing managers can play a vital role in decreasing and mitigating the occupational stress experienced by nurses as well as enhancing the quality of care.
Mohammadmahdi Pazhavand, Maasoumeh Barkhordari-Sharifabad, Khadijeh Nasiriani,
Volume 18, Issue 1 (3-2025)
Abstract
Identifying an effective coping strategy for moral distress, as an important and common phenomenon among intensive care unit nurses, seems essential. The knowledge-to-action model aims to identify effective methods for implementing evidence into clinical practice. The present study sought to determine the effect of an intervention based on the knowledge-to-action model on moral distress among nurses working in intensive care units. This was an experimental study, and the statistical population included nurses working in the intensive care units of Namazi Hospital in Shiraz, Iran. A total of 100 eligible nurses were selected through convenience sampling and then randomly assigned to intervention and control groups. For the intervention group, the knowledge-to-action model was implemented. Data were collected using the Hamric Moral Distress Scale before and one month after the intervention. Both groups completed the questionnaire at these time points. Data were analyzed using descriptive and inferential statistics with SPSS version 19. The findings showed that the two groups were similar in terms of demographic characteristics and mean moral distress scores before the intervention. After the intervention, the mean scores of moral distress in the intervention group were significantly reduced in the frequency dimension (2.12±0.34) and severity dimension (2.32±0.46) compared to the control group (frequency: 2.51±0.43; severity: 2.57±0.55) (p<0.001). The results indicated that implementing the knowledge-to-action model reduces moral distress in intensive care unit nurses. Therefore, it is recommended that nursing managers adopt this model to improve the quality of care.
