Volume 20, Issue 2 (May 2022)
Nursing and Midwifery Journal 2022, 20(2): 137-146 |
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Tahmasebi S, Sabeti F, Hagani H, Mohammadi R. INVESTIGATING THE RELATIONSHIP BETWEEN CLINICAL DECISION MAKING AND MORAL DISTRESS OF NURSES WORKING IN PEDIATRIC INTENSIVE CARE UNIT. Nursing and Midwifery Journal 2022; 20 (2) :137-146
URL: http://unmf.umsu.ac.ir/article-1-4586-en.html
URL: http://unmf.umsu.ac.ir/article-1-4586-en.html
1- Department of Pediatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- Department of Pediatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran; Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
3- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
4- Department of Pediatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran; Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran (Corresponding Author) ,mohammadirr1357@gmail.com
2- Department of Pediatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran; Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
3- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
4- Department of Pediatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran; Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran (Corresponding Author) ,
Abstract: (2443 Views)
Background & Aim: Timely and rational clinical decision making is one of the most important characteristics of nurses working in intensive care units. The decision-making process while caring the children can lead to moral distress in the nurses. Due to the importance of complications resulted from the lack of proper decision making and from creating moral distress in the nurses and its direct effect on their professional performance, the present study was conducted to determine the relationship between clinical decision making and moral distress of nurses working in pediatric intensive care units.
Materials & Method: This research is a cross-sectional correlational study. The research sample consisted of 200 nurses working in PICU Educational and Medical Centers of Tehran University of Medical Sciences who were included in the study by continuous sampling method. Data were collected using demographic questionnaire, Corelli Demographic and Moral Distress questionnaire (2002), and Laurie's Clinical Decision questionnaire (2001). Research data were analyzed by SPSS16 software using descriptive statistics (frequency, mean and standard deviation) as well as one-way analysis of variance, Kruskal Wallis, and t-test.
Results: Clinical decision-making in 43% of the researched nurses was of systematic analytical type and in 57% of them was of intuitive analytical type. The mean score of clinical decision making in the nurses was 68.71±4.01. None of the studied nurses had interpretive/intuitive clinical decision-making. The mean value for moral distress was at a medium level of 109.36±22.41. In this study, no statistically significant relationship was found between clinical decision making and moral distress. Clinical decision making had a statistically significant relationship with work shift (p=0.05) and with work experience (p=0.045) in the researched nurses. There was a statistically significant relationship between moral distress and marital status (p=0.032) and number of children (p=0.04).
Conclusion: Clinical decision making in more than half of the nurses of the PICU. Considering the importance of systematic and interpretive clinical decision making in the PICU, it is necessary to take efficient steps to improve clinical decision making in the nurses. Also, the moral distress in the studied nurses was at an average level, and due to its effect on the care behaviors of the nurses in the PICU, it is necessary to design and compile training programs and workshops to help reduce the level of moral distress in the nurses.
References
1. Gagnon M. Moral distress in pediatric intensive care nurses: experiences with the death and dying of child patients. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Nursing. Faculty of Nursing University of Alberta.2020. [Google Scholar]
2. Ramezani BF, Nikbakht NA, Parsa YZ, Taleghani F. Intellectual reasoning and clinical decision making criteria of critical care nurses: a qualitative study. Adv Nurs Midwifery 2010,20(68):11-19. [Google Scholar]
3. Ghafourian-Abadi S, Kamrani F. Critical care nurses' participation in clinical decision making with physicians. Cardiovas Nurs J 2016;5(2):22-9. [Google Scholar]
4. Rostamniya L, Ghanbari V, Kazemnejad Leili E, Pasha A, Karimi Rozveh A, Pariyad E. Factors associated with nurses' participation in clinical decision making. Iran J Nurs 2014;27(88):66-76. [DOI:10.29252/ijn.27.88.66]
5. Mirsaeedi G, Lackdizagi S, Ghoojazadeh M. Demographic factors involved in nurses' clinical decision making. Iran J Nurs 2011;24(72):29-36. [URL]
6. Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017;45(1):103-28. [DOI:10.1097/CCM.0000000000002169] [PMID]
7. Austin W, Kelecevic J, Goble E, Mekechuk J. An overview of moral distress and the pediatric intensive care team. Nurs Ethics 2009;16(1):57-68. [DOI:10.1177/0969733008097990] [PMID]
8. Vanderspank-Wright B, Efstathiou N, Vandyk AD. Critical care nurses' experiences of withdrawal of treatment: A systematic review of qualitative evidence. Int J Nurs Stud 2018;77:15-26. [DOI:10.1016/j.ijnurstu.2017.09.012] [PMID]
9. Beckstrand RL, Rawle NL, Callister L, Mandleco BL. Pediatric nurses' perceptions of obstacles and supportive behaviors in end-of-life care. Am J Commit Cancer 2010;19(6):543-52. [DOI:10.4037/ajcc2009497] [PMID]
10. Shafiei A, Ravani Pur M, Yazdankhah Fard M, Mirzaee K. The relationship between moral distress and burnout among nurses of Shahid Ganji Hospital, Borazjan in 1394. Nurs Vulnerable J 2016;2(5):15-26. [URL]
11. Molazem Z, Tavakol N, Sharif F, Keshavarzi S, Ghadakpour S. Effect of education based on the "4A Model" on the Iranian nurses' moral distress in CCU wards. J Med Ethics Hist Med 2013;6:5. [PMID] [PMCID]
12. Trotochaud K, Coleman JR, Krawiecki N, McCracken C. Moral distress in pediatric healthcare providers. Pediatr Nurs 2015;30(6):908-14. [DOI:10.1016/j.pedn.2015.03.001] [PMID]
13. Naboureh A, Imanipour M, Salehi T, Tabesh H. The relationship between moral distress and self-efficacy among nurses in critical care and emergency units in hospitals affiliated to Ahvaz Jundishapur university of medical sciences in 2015. J Rafsanjan Univ Med Sci 2015;14(6):443-54. [Google Scholar]
14. Corley. MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics 2002;9(6):636-50. [DOI:10.1191/0969733002ne557oa] [PMID]
15. Beikmoradi A, Rabiee S, Khatiban M, Cheraghi, M. A. Nurses distress in intensive care unit: a survey in teaching hospitals. J Med Ethics Hist Med 2012;5(2):58-69. [URL]
16. Lauri S, Salanterä S, Chalmers K, Ekman S, Kim H, Käppeli S, et al. An exploratory study of clinical decision‐making in five countries. J Nurs Scholarsh 2001;33(1):83-90. [DOI:10.1111/j.1547-5069.2001.00083.x] [PMID]
17. Paryad. E, Javadi N, Fadakar K AS. Relationship between critical thinking and clinical decision making in nursing students. Iran J Nurs 2011;24(73):63-71. [URL]
18. Maharmeh M, Alasad J, Salami I, Saleh Z, Darawad M. Clinical decision-making among critical care nurses: A qualitative study. Health 2016;8:1807-19. [DOI:10.4236/health.2016.815173]
19. Shahraki Moghaddam E, Sadat Manzari Z, Ghandehari Motlagh Z. The evaluation of nurse,s clinical decision making in intensive care unit at the teaching hospitals of Mashhad. J Semnan Univ Med Sci 2017;24(2):107-13 (Persian). [URL]
20. Behbodi M, Shafipour V, Amiri M. Comparison of moral distress severity between pediatric ward and pediatric intensive care unit nurses. J Religion Health 2018;6(1):19-28 (Persian). [Google Scholar]
21. Mahdiyoun S, Pooshgan Z, Imanipour M RZ. Correlation between the Nurses, Moral Sensitivity and the observance of patients' rights in ICUs original article. Med Ethics J 2017;11(40):7-14. (Perisian). [DOI:10.21859/mej-11407]
22. Ozden D, Karagozoglu S, Yildirim G. Intensive care nurses' perception of futility: job satisfaction and burnout dimensions. Nurs Ethics 2013;20:436-47. [DOI:10.1177/0969733012466002] [PMID]
23. Escolar-Chua RL. Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nurs Ethics 2018;25(4):458-69. [DOI:10.1177/0969733016654317] [PMID]
24. Mehlis K, Bierwirth E, Laryionava K, Mumm, F H, Hiddemann W, Heußner P, Winkler E C. High prevalence of moral distress reported by oncologists and oncology nurses in end of life decision making. Psycho-Oncol 2018;27(12):2733-9. [DOI:10.1002/pon.4868] [PMID]
25. Truglio-Londrigan M, Slyer JT. Shared decision-making for nursing practice: an integrative review. Open Nurs J 2018;12(1):1-10. [DOI:10.2174/1874434601812010001] [PMID] [PMCID]
26. Amoroso S, Chalela JA. Perception of provision of futile care among clinicians in the neuroscience intensive care unit. J Neurosci Nurs 2019;51(5): 249-52. [DOI:10.1097/JNN.0000000000000462] [PMID]
27. Mosavi nasab M, Shojaei Kh, Azodi P, Jahanpour F J. Barriers and facilitators of clinical decision making among nurses. Q J Nurs Manag 2015;4(3):9-17 (Perisan). [Google Scholar]
28. Taghavi Larijani T, Jodaki K. The Relationship between moral distress and nurses' turnover intention in intensive care unit nurses. Med Ethics J 2020;13(45):6. (Persian). [Google Scholar]
29. Altaker KW, Howie-Esquivel J, Cataldo JK. Relationships among palliative care, ethical climate, empowerment, and moral distress in intensive care unit nurses. Am J Crit Care 2018;27(4):295-302. [DOI:10.4037/ajcc2018252] [PMID]
30. Shahryari E, Vahedian M, Adeli SH, Jangholi E, Gharehbeglou M, Mesgaranzadeh M, Qasemzadeh MJ, Ahdi GH, Shahrzad ME. Attitudes of physicians to futile treatment at the end of life care. Life Sci J 2013;10:1-10. (Persian). [URL]
31. Jeon KB, Park M. Relationship of ICU nurses' difficulties in end-of-life care to moral distress, burnout and job satisfaction. J Korean Acad Nurs Adm 2019;25(1): 42-51. [DOI:10.11111/jkana.2019.25.1.42]
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