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  1. Relationship between ethical work climate and nurses’ perception of organizational support, commitment, job satisfaction and turnover intent.Ebtsam Aly Abou Hashish - 2017 - Nursing Ethics 24 (2):151-166.
    Background: Healthcare organizations are now challenged to retain nurses’ generation and understand why they are leaving their nursing career prematurely. Acquiring knowledge about the effect of ethical work climate and level of perceived organizational support can help organizational leaders to deal effectively with dysfunctional behaviors and make a difference in enhancing nurses’ dedication, commitment, satisfaction, and loyalty to their organization. Purpose: This study aims to determine the relationship between ethical work climate, and perceived organizational support and nurses’ organizational commitment, job (...)
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  • Esteemed connection: creating a mentoring relationship for nurse leadership.Andrea McCloughen, Louise O’Brien & Debra Jackson - 2009 - Nursing Inquiry 16 (4):326-336.
    Mentoring relationships occur across a range of nursing contexts and are shown to have multiple, favourable personal and professional outcomes. Specifically, mentoring has been associated with the development of nurse leaders. This study describes features that are integral to initiating mentoring relationships that focus on nursing leader development. These significant features are addressed in relation to the nursing literature. Thirteen nurse leaders from eastern states of Australia were interviewed during 2005 and 2006 about their understanding and experiences of mentoring for (...)
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  • Moral distress in nursing: contributing factors, outcomes and interventions.Adam S. Burston & Anthony G. Tuckett - 2013 - Nursing Ethics 20 (3):312-324.
    Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications (...)
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  • Empirical Research on Moral Distress: Issues, Challenges, and Opportunities. [REVIEW]Ann B. Hamric - 2012 - HEC Forum 24 (1):39-49.
    Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. (...)
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  • Does ethics education influence the moral action of practicing nurses and social workers?Christine Grady, Marion Danis, Karen L. Soeken, Patricia O'Donnell, Carol Taylor, Adrienne Farrar & Connie M. Ulrich - 2008 - American Journal of Bioethics 8 (4):4 – 11.
    Purpose/methods: This study investigated the relationship between ethics education and training, and the use and usefulness of ethics resources, confidence in moral decisions, and moral action/activism through a survey of practicing nurses and social workers from four United States (US) census regions. Findings: The sample (n = 1215) was primarily Caucasian (83%), female (85%), well educated (57% with a master's degree). no ethics education at all was reported by 14% of study participants (8% of social workers had no ethics education, (...)
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  • Moral distress and avoidance behavior in nurses working in critical care and noncritical care units.Mary Jo De Villers & Holli A. DeVon - 2013 - Nursing Ethics 20 (5):589-603.
    Nurses facing impediments to what they perceive as moral practice may experience moral distress. The purpose of this descriptive, cross-sectional study was to determine similarities and differences in moral distress and avoidance behavior between critical care nurses and non-critical care nurses. Sixty-eight critical care and 28 non-critical care nurses completed the Moral Distress Scale and Impact of Event Scale (IES). There were no differences in moral distress scores ( F = 0.892, p = 0.347) or impact of event scores ( (...)
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  • Nursing Ethics Huddles to Decrease Moral Distress among Nurses in the Intensive Care Unit.Margie Hodges Shaw, Sally A. Norton, Patrick Hopkins & Marianne C. Chiafery - 2018 - Journal of Clinical Ethics 29 (3):217-226.
    BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, and (...)
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  • Moral distress in nurses: Resources and constraints, consequences, and interventions.Mohammad Javad Ghazanfari, Amir Emami Zeydi, Reza Panahi, Reza Ghanbari, Fateme Jafaraghaee, Hamed Mortazavi & Samad Karkhah - 2022 - Clinical Ethics 17 (3):265-271.
    Background Moral distress is a complex and challenging issue in the nursing profession that can negatively affect the nurses’ job satisfaction and retention and the quality of patient care. This study focused on describing the resources and constraints, consequences, and interventions of moral distress in nurses. Methods In a literature review, an extensive electronic search was conducted in databases including PubMed, ISI, Scopus as well as Google Scholar search engine using the keywords including “moral distress” and “nurses” to identify resources, (...)
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  • Effect of moral empowerment program on moral distress in intensive care unit nurses.Safura Abbasi, Somayeh Ghafari, Mohsen Shahriari & Nahid Shahgholian - 2019 - Nursing Ethics 26 (5):1494-1504.
    Background: Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system. Objective: The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care. Methods: This research (...)
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  • Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU.Lucia Wocial, Veda Ackerman, Brian Leland, Brian Benneyworth, Vinit Patel, Yan Tong & Mara Nitu - 2017 - HEC Forum 29 (1):75-91.
    This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...)
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  • Situating moral distress within relational ethics.Sadie Deschenes & Diane Kunyk - 2020 - Nursing Ethics 27 (3):767-777.
    Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this topic that we do (...)
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  • Moral distress in critical care nursing: The state of the science.Natalie Susan McAndrew, Jane Leske & Kathryn Schroeter - 2018 - Nursing Ethics 25 (5):552-570.
    Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. (...)
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  • Consequences of clinical situations that cause critical care nurses to experience moral distress.Debra L. Wiegand & Marjorie Funk - 2012 - Nursing Ethics 19 (4):479-487.
    Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...)
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  • Moral distress in healthcare assistants: A discussion with recommendations.Daniel Rodger, Bruce Blackshaw & Amanda Young - 2019 - Nursing Ethics 26 (7-8):2306-2313.
    Background: Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants. Objective: This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures. Research Design: (...)
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  • 'Moral distress' - time to abandon a flawed nursing construct?Megan-Jane Johnstone & Alison Hutchinson - 2015 - Nursing Ethics 22 (1):5-14.
    Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the ultimate purpose and (...)
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  • Effects of ethics education on moral sensitivity of nursing students.Hye-A. Yeom, Sung-Hee Ahn & Su-Jeong Kim - 2017 - Nursing Ethics 24 (6):644-652.
    Background: While nursing ethics education is commonly provided for undergraduate nursing students in most nursing colleges, consensus on the content and teaching modules for these ethics courses have still not been established. Objectives: This study aimed to examine the effects of nursing ethics education on the moral sensitivity and critical thinking disposition of nursing students in Korea. Research design: A one-group pre- and post-test design was used. Moral sensitivity was measured using the Korean version of the Moral Sensitivity Questionnaire. Critical (...)
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  • Nurse Moral Distress and Ethical Work Environment.Mary C. Corley, Ptlene Minick, R. K. Elswick & Mary Jacobs - 2005 - Nursing Ethics 12 (4):381-390.
    This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...)
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  • Moral distress experienced by nurses.Younjae Oh & Chris Gastmans - 2015 - Nursing Ethics 22 (1):15-31.
    Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position. Further research is required (...)
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  • Moral distress: Developing strategies from experience.Andrew Helmers, Karen Dryden Palmer & Rebecca A. Greenberg - 2020 - Nursing Ethics 27 (4):1147-1156.
    Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as (...)
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  • The effectiveness of narrative writing on the moral distress of intensive care nurses.Smat Saeedi, Leila Jouybari, Akram Sanagoo & Mohammad Ali Vakili - 2019 - Nursing Ethics 26 (7-8):2195-2203.
    Background: Nursing is a profession that has always been accompanied with common ethical concerns. There are some evidences which indicate that narrative writing on traumatic experiences may improve an individual’s emotional health. Objective: This study aimed to determine the effectiveness of narrative writing on moral distress of nurses working in intensive care unit. Research design: This study was a clinical trial with pre- and post-test design. The frequency and intensity of moral distress was measured by a valid and reliable questionnaire (...)
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  • Gender and the experience of moral distress in critical care nurses.Christopher B. O’Connell - 2015 - Nursing Ethics 22 (1):32-42.
    Background: Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether. Research question: Do significant gender (...)
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  • Toward interventions to address moral distress.Lynn C. Musto, Patricia A. Rodney & Rebecca Vanderheide - 2015 - Nursing Ethics 22 (1):91-102.
    Background: The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience. Discussion: Some researchers suggest that a closer examination of how socio-political structures influence healthcare (...)
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  • Moral distress: A concept clarification.Sadie Deschenes, Michelle Gagnon, Tanya Park & Diane Kunyk - 2020 - Nursing Ethics 27 (4):1127-1146.
    Background Over the past few decades, moral distress has been examined in the nursing literature. It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature. This lack of cohesion has led to complications for study of the phenomenon, along with its effects to nursing practice, education and targeted policy development. Objectives The aim of this (...)
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