Nurses' moral distress in end-of-life care: A qualitative study

Background:Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff.Research question:The primary outcome of this study was to explore the causes of morally distressing events, feelin...

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Authors: De Brasi, Elvira Luana (Author) ; Giannetta, Noemi (Author) ; Ercolani, Sara (Author) ; Gandini, Elena Lucia Maria (Author) ; Moranda, Dina (Author) ; Villa, Giulia (Author) ; Manara, Duilio Fiorenzo (Author)
Format: Electronic Article
Language:English
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Published: Sage 2021
In: Nursing ethics
Year: 2021, Volume: 28, Issue: 5, Pages: 614-627
Further subjects:B End-of-life
B Nursing Staff
B Qualitative Study
B Moral Distress
B Psychological Stress
Online Access: Volltext (lizenzpflichtig)
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Summary:Background:Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff.Research question:The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events.Research design:A hermeneutic-phenomenological qualitative study was performed.Participants and research context:Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim.Ethical considerations:Ethical approval was obtained from the Institutional Review Hospital Board.Findings:Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured.Discussion:In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients’ last requests. According to our findings, the concept of ‘good’ end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events.Conclusion:Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.
ISSN:1477-0989
Contains:Enthalten in: Nursing ethics
Persistent identifiers:DOI: 10.1177/0969733020964859