Moral Distress, Moral Sensitivity and Ethical Climate of Nurses Working in Psychiatric Wards

Dabok Noh; Sunah Kim; Sanghee Kim

doi:10.12934/jkpmhn.2013.22.4.307

Journal List > J Korean Acad Psychiatr Ment Health Nurs > v.22(4) > 1057986

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Noh, Kim, and Kim: Moral Distress, Moral Sensitivity and Ethical Climate of Nurses Working in Psychiatric Wards

Original Article

Journal of Korean Academy of Psychiatric and Mental Health Nursing 2013; 22(4): 307-319.

Published online: 31 December 2013

DOI: https://doi.org/10.12934/jkpmhn.2013.22.4.307

Moral Distress, Moral Sensitivity and Ethical Climate of Nurses Working in Psychiatric Wards

Dabok Noh¹, Sunah Kim², Sanghee Kim²

¹Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea.

²College of Nursing, Yonsei University, Seoul, Korea.

Corresponding author: Kim, Sunah. College of Nursing, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-3220, Fax: +82-2-364-5027, PSY0962@yuhs.ac

Received 16 August 2013 Revised 5 December 2013 Accepted 23 December 2013

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to explore level of moral distress, moral sensitivity, and ethical climate of nurses working in psychiatric wards and identify factors that influence moral distress. Also this study was done to describe the content of moral distress.

Methods

Data were collected through self-report questionnaires and focus group interviews. A survey was conducted with 108 psychiatric nurses and 8 volunteers were interviewed. Instruments used in this study were the Moral Distress Scale for Psychiatric Nurses, Korean version of the Moral Sensitivity Questionnaire, and Ethical Climate Questionnaire. Data were analyzed using SPSS/WIN 20.0 program and content analysis.

Results

The mean score for moral distress was 3.74 and for moral sensitivity, 4.67. The significant factors influencing moral distress were clinical career in psychiatric wards, moral sensitivity, personal profit and friendship. As a result of content analysis, 3 domain of moral distress were found: moral distress situations, responses in moral distress situations, factors to overcome moral distress and resources that enable ethical nursing.

Conclusion

The results suggest that in the development of interventions to decrease moral distress for nurses working in psychiatric wards, factors identified as influencing moral distress and content of moral distress should be considered.

Keywords: Psychiatric nurses, Moral distress, Moral sensitivity, Ethical climate

Figures and Tables

Table 1

Level of Moral Distress according to the General Characteristics (N=108)

^†More than 100 beds; ^‡More than 30 beds.

Table 2

Level of Moral Distress, Moral Sensitivity and Ethical Climate (N=108)

Table 3

Factors influencing on Moral Distress (N=108)

Table 4

Characteristics of Focus Group Interview Participants (N=8)

GC=graduate course; GH=general hospital.

Table 5

Content Analysis on Moral Distress in Psychiatric Nurses

Notes

This manuscript is a revision of the first author's master's thesis from Yonsei University.

References

1. Austin W, Bergum V, Goldberg L. Unable to answer the call of our patients: Mental health nurses' experience of moral distress. Nurs Inq. 2003; 10:177–183.

2. Cha ES, Kim KH, Erlen JA. Translation of scales in cross-cultural research: Issues and techniques. J Adv Nurs. 2007; 58:386–395.

3. Cho MJ. Case analysis on ethical problems perceived by nurses at psychiatric inpatient setting. Seoul: Ewha Womans University;2005. Unpublished doctoral dissertation.

4. Corley MC. Nurse moral distress: A proposed theory and research agenda. Nurs Ethics. 2002; 9:636–650.

5. Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs. 2001; 33:250–256.

6. Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics. 2005; 12:381–390.

7. Deady R, McCarthy J. A study of the situations, features, and coping mechanisms experienced by Irish psychiatricnurses experiencing moral distress. Perspect Psychiatr Care. 2010; 46:209–220.

8. Han SS. The moral distress experienced by hospital nurses. J Korean Bioethics Assoc. 2005; 6(2):31–47.

9. Han SS, Kim J, Kim YS, Ahn S. Validation of a Korean version of the Moral Sensitivity Questionnaire. Nurs Ethics. 2010; 17:99–105.

10. Jameton A. Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993; 4:542–551.

11. Joo YS. Ensure the right to health and human rights. Mon Welf Trends. 2005; 79:27–32.

12. Kang MJ, Lee HJ. The effect of assertiveness training on communication related factors and personnel turnover rate among hospital nurses. J Korean Acad Nurs. 2006; 36:681–690.

13. Kim HR, Ahn SH. Moral sensitivity and moral distress among Korean hospital nurses. Korean J Med Ethics. 2010; 13:321–336.

14. Krueger RA, Casey MA. Focus groups: A practical guide for applied research. 4th ed. Los Angeles: SAGE;2009.

15. Lee KJ, Yoo SY. Relationships between nurses' ethical dilemma, coping types, job satisfaction and turnover intention in Korea. J Korean Clin Nurs Res. 2011; 17:1–15.

16. Lützén K, Blom T, Ewalds-Kvist B, Winch S. Moral stress, moral climate and moral sensitivity among psychiatric professionals. Nurs Ethics. 2010; 17:213–224.

17. Lützén K, Evertzon M, Nordin C. Moral sensitivity in psychiatric practice. Nurs Ethics. 1997; 4:472–482.

18. Lützén K, Johansson A, Nordstrom G. Moral sensitivity: Some differences between nurses and physicians. Nurs Ethics. 2000; 7:520–530.

19. Nam JE. Relationship among ethical climate, job stress and career involvement of nurse. Seoul: Hanyang University;2010. Unpublished master's thesis.

20. National Human Rights Commission of Korea. A survey on the mentally disorders in mental health facilities. Seoul: Author;2008.

21. National Human Rights Commission of Korea. Case studies of countries and advanced model building to improve human rights of mental disabled. Seoul: Author;2009.

22. Ohnishi K, Ohgushi Y, Nakano M, Fujii H, Tanaka H, Kitaoka K, et al. Moral distress experienced by psychiatric nurses in Japan. Nurs Ethics. 2010; 17:726–740.

23. Park JH. Psychiatric nurse's perception in ethical conflict situation. Seoul: Yonsei University;2003. Unpublished master's thesis.

24. Patton M. Qualitative evaluation and research methods. Beverly Hills, CA: SAGE;1990.

25. Pauly B, Varcoe C, Storch J, Newton L. Registered nurses' perceptions of moral distress and ethical climate. Nurs Ethics. 2009; 16:561–573.

26. Schluter J, Winch S, Holzhauser K, Henderson A. Nurses' moral sensitivity and hospital ethical climate: A literature review. Nurs Ethics. 2008; 15:304–321.

27. Victor B, Cullen JB. The organizational bases of ethical work climates. Adm Sci Q. 1988; 33:101–125.

28. Waltz C, Strickland O, Lenz E. Measurement in nursing research. Philadelphia: F.A. Davis Co;1984.

29. Yoo MS. The development of a measurement tool for moral distress in nurses. Seoul: Yonsei University;2003. Unpublished doctoral dissertation.

30. Yoo MS, Shon KC. Effects of nursing ethics education on biomedical ethics awareness, moral sensitivity and moral judgment of nursing students. J Korean Bioethics Assoc. 2012; 12(2):61–76.

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