Background Global health systems operate amid dynamic factors, including demographic shifts, economic variations, political changes, technological progress, and societal trends that lead to VUCA reality (Volatility, Uncertainty, Complexity, and Ambiguity). To address these challenges, healthcare organizations are increasingly turning to Strategic Technological Processes and digital transformation. Research objective Against this background, the current study examined the personal experiences, conflicts, difficulties, and moral dilemmas attendant upon accommodating this digital transformation of healthcare professionals. Participants The study involved 27 healthcare professionals working in (...) Israeli hospitals, whose experiences and perspectives were central to understanding the impact of digital transformation in healthcare settings. Research design The study methodology rested on in-depth interviews, which were analyzed through the prism of the Listening Guide analytical technique. Ethical considerations The research obtained pre-approval from the Ethics Committee at the researcher’s institution. Findings The study revealed that the healthcare professionals are indeed facing ethical conflicts and personal challenges related to digitalization (such as providing the best quality of care, being the best caregiver, and acting for the betterment of the hospital). It also identified dilemmas resulting from conflicts between the needs and demands of the health system and the healthcare professionals’ values and resources. Discussion The study findings highlight the impact of ethical and moral challenges accompanying strategic organizational and digital transformation changes implemented by healthcare organizations worldwide. These challenges arise as healthcare institutions adapt to the demands of the 21st century, potentially leading to burnout and moral distress among healthcare professionals, further exacerbating the already stressful reality they face. Conclusion In conclusion, the study emphasizes the critical necessity for comprehensive support strategies to alleviate stress and burnout among healthcare professionals. As healthcare organizations and personnel navigate significant organizational changes to address contemporary challenges, prioritizing the well-being of healthcare workers through effective support mechanisms becomes imperative. (shrink)

Background Home care nurses are central in providing holistic and compassionate care to patients in home-based palliative care. Ethical caring competency is essential for home care to sustain nurses’ integrity in the face of moral adversity. Interprofessional collaboration is vital for ensuring ethical decision-making and providing patient-centered care in home-based palliative care settings. Aim This study explored the predictive roles of interprofessional collaboration and moral resilience on ethical caring competency among home care nurses in home-based palliative care. Methods A cross-sectional (...) survey of 400 nurses was conducted from October to December 2023, utilizing standardized scales to measure interprofessional collaboration, moral resilience, and ethical caring competency. A convenience sample of 400 home care nurses was also included in this study. Correlation and linear regression analysis were used to clarify the associative and predictive findings. Ethical Considerations Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection. Results Correlation analysis showed significant positive correlations between the ethical caring competency, interprofessional collaboration, and moral resilience constructs, with coefficients ranging from 0.482 to 0.967. Linear regression revealed that management of collaborative systems and total moral resilience significantly predict ethical caring competency, explaining 14.6% and 36.6% of its variance, respectively. Other variables, such as the effects of collaboration and communication, did not significantly influence ethical caring competency. Conclusion The study highlights the significant impact of interprofessional collaboration, particularly the management of collaborative systems and moral resilience, on enhancing ethical caring competency among nurses. Implications Enhancing interprofessional collaboration and moral resilience through targeted strategies in nursing practice and education can significantly improve ethical caring competencies. These efforts are essential for delivering high-quality, patient-centered care and for fostering a healthcare environment that respects the ethical principles guiding nursing practice. (shrink)

Background Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL’s experience. Research aim The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design A qualitative descriptive (...) design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions The UBCCNL’s experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. (shrink)

Background: The relationship between moral resilience, moral distress, and moral injury among nurses during the COVID-19 pandemic has been widely investigated; however, the literature in the post-COVID-19 era is scarce. Research aim: To examine the impact of moral resilience on moral distress and moral injury among nurses after the COVID-19 pandemic. Research design: Cross-sectional study. Participants and research context: We obtained a convenience sample of 1118 nurses in Greece. We collected demographic data (gender, age) and work-related data (understaffed wards, shift (...) work, clinical experience). We measured moral resilience with the revised “Rushton Moral Resilience Scale”, moral distress with the “Moral Distress Thermometer”, and moral injury with the “Moral Injury Symptom Scale-Healthcare Professionals” version. We adjusted all multivariable models for demographic variables. Ethical considerations: The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens approved our study protocol (approval number; 474, approved: November 2023). Our study followed the Declaration of Helsinki. Findings/results: Multivariable linear regression analysis showed that moral resilience reduced moral distress and moral injury. In particular, we found that increased response to moral adversity was associated with decreased moral distress (adjusted coefficient beta = −1.81, 95% confidence interval [CI] = −2.07 to −1.54). Moreover, we found that increased response to moral adversity (adjusted coefficient beta = −8.24, 95% CI = −9.37 to −7.10) and increased moral efficacy (adjusted coefficient beta = −3.24, 95% CI = −5.03 to −1.45) were associated with reduced moral injury. Conclusions: Moral resilience can reduce the level of moral distress and moral injury among nurses. However, the persistence of moderate moral resilience among Greek nurses does not guarantee its sustainability. To ensure that this resilience is maintained and potentially enhanced, it is imperative for nurse leaders and policymakers to strategically design interventions to address issues at the organizational, team, and individual levels. (shrink)