Measuring moral distress in Swedish intensive care: Psychometric and descriptive results.

OBJECTIVES: To investigate the construct validity and psychometric properties of the Swedish version of the Moral Distress Scale-Revised and to describe moral distress in an intensive care context. RESEARCH METHODOLOGY/DESIGN: The Italian Moral Distress Scale-Revised was translated and semantically adjusted to the Swedish intensive care context. A web survey with 14 moral distress items, as well as three additional and eight background questions was answered by critical care nurses (N = 71) working in intensive care units during the second year of the coronavirus disease pandemic. Inferential and descriptive statistics were used to investigate the Italian four-factor model and to examine critical care nurses' moral distress. RESULTS: The result shows a factor model of four components differing from the previous model. Critical care nurses demonstrated significant differences in moral distress regarding priorities compared to before the pandemic, type of household; experience as critical care nurses and whether they had supervised students during the pandemic. CONCLUSION: The component structure might have originated from the specific situation critical care nurses perceived during the pandemic. The health care organisations' role in preventing and healing the effects of moral distress is important for managers to understand. IMPLICATIONS FOR CLINICAL PRACTICE: Moral distress is common in intensive care and it is necessary to use valid instrument when measuring it. A psychometrical investigation of the Swedish version of the Moral Distress Scale-Revised, adapted for intensive care shows need for further semantic and cultural adaptation. Perceived priorities during the pandemic, household type, supervising during the pandemic and working experience were related to critical care nurses' experience of moral distress and managers need to be aware of conditions that may trigger such a response.

Learning in intensive care during the COVID-19 pandemic postgraduate critical care nursing students' experiences.

Objectives: This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development. Methods: An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment. Results: The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor.  2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.