An educational program of reducing moral distress (PRMD) in nurses; designing and evaluating.

BACKGROUND: Moral distress is common phenomenon that has negative consequences on nurses, patients, and healthcare systems. This study aims to design and evaluate an educational program to reduce moral distress in nurses. METHODS: This multiphase mixed-method study was done in three stage on February 2021 in Shiraz/Iran. In pre-implementation stage, a content analysis study was conducted on 12 participants were interviewed using purposive sampling and then the program was designed according to qualitative data, panel of expertise and literature review according the seven steps of Ewles and Sminett's model and implemented in one group on 40 nurses using a quasi-experimental design. In Post-Implementation stage, effectiveness of program was evaluated through quantitative and qualitative methods. Quantitative data were gathered by Hamric's 21-question moral distress questionnaire analyzed via SPSS v.25 and analysis of variance repeated measures test. Also, a content analysis study was conducted on 6 PRMD participants using purposive sampling. In Program evaluation stage, convergence of quantitative and qualitative data and the effects of the program were examined. Trustworthiness of qualitative data was accomplished by Lincoln and Guba criteria. RESULTS: First quantitative study revealed the causes of moral distress consisted of deficiency in professional competency, unsuitable organizational culture, personal factors, environmental and organizational factors, management factors, insufficiencies in proficient and efficient communication and nurses' observation of moral dilemma. Results of quantitative stage showed that there was a significant difference (p < 0.05) between the mean score of moral distress before, after, 1 and 2 months after the intervention. The participants in secondary qualitative stage, reported increasing their moral knowledge and skills, improving ethical climate, and moral empowerment. CONCLUSION: The use of different educational tools and teaching methods and the participation of managers in designing strategies had a very effective role in the effectiveness of this educational program.

Strategies of Iranian Psychiatric Nurses to Deal with Moral Distress.

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.

Moral distress in psychiatric nurses in Covid-19 crisis.

BACKGROUND: The COVID-19 pandemic 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 Iranian psychiatric nurses during the COVID-19 pandemic. METHOD: This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. RESULTS: By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies). CONCLUSION: New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. 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.

Effect of education based on the "4A Model" on the Iranian nurses' moral distress in CCU wards.

Complexity of health care has caused ethical dilemmas and moral distress to be quite unavoidable for nurses. Moral distress is a major, highly prevalent problem in the nursing profession. The study aims to investigate the effect of education based on the "4A model" on the rate of moral distress among the nurses working in Cardiac Care Units (CCU). The participants consisted of 60 nurses working in Cardiac Care Units (CCU), 30 in the control and 30 in the intervention group. Those in the intervention group took part in the educational workshop about "moral distress" and "4A model". The moral distress questionnaire was completed by both study groups 1 and 2 months after the intervention. After the intervention, the results of repeated measures analysis of variance revealed a significant difference in the moral distress mean scores between the intervention and the control groups (P<0.001) and within the two groups (P<0.001). Moreover, a significant difference was found between the two study groups regarding the mean score of moral distress 1 and 2 months after the intervention. The findings of the current study revealed a decreasing trend in the moral distress mean score in the intervention group, while there was an increasing trend in the control group after the intervention. It can be concluded that the "4A model" can be used for reducing moral distress and educational interventions can reduce the rate of moral distress among nurses. Authors of this study recommend that more studies with larger sample sizes be conducted in different hospital wards as well.