Moral Distress During COVID-19: The Importance of Perceived Organizational Support for Hospital Nurses

Overview

Journal J Health Psychol

Publisher Sage Publications

Specialty Psychology

Date 2022 Jul 15

PMID 35837672

Authors

Abigail L Latimer

Melanie D Otis

Gia Mudd-Martin

Debra K Moser

Affiliations

Soon will be listed here.

Abstract

Moral distress, or the inability to act congruent with moral beliefs, has been of concern for healthcare professionals especially since the COVID-19 pandemic. Hospital nurses are particularly affected in their roles with mounting administrative pressures and demands. We examined whether general and COVID-specific support in employing healthcare organizations predicted moral distress in a sample of inpatient hospital nurses. A total of 248 nurses completed the Measure of Moral Distress for Healthcare Professionals, Survey of Perceived Organizational Support, COVID Organizational Support survey, and the Hospital Ethical Climate Scale. We found that general and COVID-related organizational support were predictors of moral distress after controlling for age, gender, working in an intensive care unit setting, and ethical climate. Findings support the need for a comprehensive strategy to address moral distress, including institutional efforts to convey support and commitment. Strategies moral distress may be experienced differently based on gender identity.

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References

Epstein E, Haizlip J, Liaschenko J, Zhao D, Bennett R, Marshall M . Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community. AACN Adv Crit Care. 2020; 31(2):146-157. DOI: 10.4037/aacnacc2020285. View

Olson L . Hospital nurses' perceptions of the ethical climate of their work setting. Image J Nurs Sch. 1998; 30(4):345-9. DOI: 10.1111/j.1547-5069.1998.tb01331.x. View

Latimer A, Otis M, Flaherty C, Ross M . A survey of moral distress and end of life care in mechanical circulatory support nurses. Heart Lung. 2020; 50(1):65-70. PMC: 7370912. DOI: 10.1016/j.hrtlng.2020.06.010. View

Donkers M, Gilissen V, Candel M, van Dijk N, Kling H, Heijnen-Panis R . Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study. BMC Med Ethics. 2021; 22(1):73. PMC: 8211309. DOI: 10.1186/s12910-021-00641-3. View

Zhang S, Sun S, Afshar Jahanshahi A, Alvarez-Risco A, Ibarra V, Li J . Developing and testing a measure of COVID-19 organizational support of healthcare workers - results from Peru, Ecuador, and Bolivia. Psychiatry Res. 2020; 291:113174. PMC: 7284268. DOI: 10.1016/j.psychres.2020.113174. View

Rushton C . Defining and addressing moral distress: tools for critical care nursing leaders. AACN Adv Crit Care. 2006; 17(2):161-8. View

Hiler C, Hickman Jr R, Reimer A, Wilson K . Predictors of Moral Distress in a US Sample of Critical Care Nurses. Am J Crit Care. 2018; 27(1):59-66. DOI: 10.4037/ajcc2018968. View

Altaker K, Howie-Esquivel J, Cataldo J . Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses. Am J Crit Care. 2018; 27(4):295-302. DOI: 10.4037/ajcc2018252. View

Mohammed S, Peter E, Killackey T, Maciver J . The "nurse as hero" discourse in the COVID-19 pandemic: A poststructural discourse analysis. Int J Nurs Stud. 2021; 117:103887. PMC: 9749900. DOI: 10.1016/j.ijnurstu.2021.103887. View

10.

Faul F, Erdfelder E, Lang A, Buchner A . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2):175-91. DOI: 10.3758/bf03193146. View

11.

Epstein E, Hamric A . Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2010; 20(4):330-42. View

12.

Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I . Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic. Int J Nurs Stud. 2020; 111:103637. PMC: 7206441. DOI: 10.1016/j.ijnurstu.2020.103637. View

13.

Baker L, Egan-Lee E, Martimianakis M, Reeves S . Relationships of power: implications for interprofessional education. J Interprof Care. 2010; 25(2):98-104. DOI: 10.3109/13561820.2010.505350. View

14.

Cacchione P . Moral Distress in the Midst of the COVID-19 Pandemic. Clin Nurs Res. 2020; 29(4):215-216. DOI: 10.1177/1054773820920385. View

15.

Pearman A, Hughes M, Smith E, Neupert S . Mental Health Challenges of United States Healthcare Professionals During COVID-19. Front Psychol. 2020; 11:2065. PMC: 7438566. DOI: 10.3389/fpsyg.2020.02065. View

16.

Robaee N, Atashzadeh-Shoorideh F, Ashktorab T, Baghestani A, Barkhordari-Sharifabad M . Perceived organizational support and moral distress among nurses. BMC Nurs. 2018; 17:2. PMC: 5763610. DOI: 10.1186/s12912-017-0270-y. View

17.

Lamiani G, Borghi L, Argentero P . When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol. 2015; 22(1):51-67. DOI: 10.1177/1359105315595120. View

18.

Lamiani G, Dordoni P, Argentero P . Value congruence and depressive symptoms among critical care clinicians: The mediating role of moral distress. Stress Health. 2017; 34(1):135-142. DOI: 10.1002/smi.2769. View

19.

Marjanovic Z, Greenglass E, Coffey S . The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey. Int J Nurs Stud. 2006; 44(6):991-8. PMC: 7094220. DOI: 10.1016/j.ijnurstu.2006.02.012. View

20.

Tolomiczenko G, Kahan M, Ricci M, Strathern L, Jeney C, Patterson K . SARS: coping with the impact at a community hospital. J Adv Nurs. 2005; 50(1):101-10. DOI: 10.1111/j.1365-2648.2005.03366.x. View