Disbelief, Distress, & Distrust: Trending Institution Related Emotional Distress During COVID-19.

The COVID-19 pandemic had an unprecedented impact on the well-being of individuals working in the healthcare sector. Though many studies exist that focus on physician and nurse well-being, few have specifically identified stressors that affect professionals working within the end-of-life interdisciplinary team. The primary objective of this study was to expand research on moral distress and clinician well-being to include healthcare professionals working with patients with chronic and life-limiting illnesses during the COVID-19 pandemic. A survey approach was used with 110 professionals working within one hospital network's palliative and hospice team to identify key indicators of moral distress (using the MMD-HP scale) and professional well-being during the pandemic. Quantitative and qualitative analysis was completed to determine themes related to moral distress and professional well-being. Numerous themes were identified, including the importance of caseload, general support, team support, management, and professional flexibility. Additional end-of-life themes were identified, including the impact of death, lack of personal protective equipment, fear of transmitting the virus, COVID disbelief, and the inability of clinicians and/or family to be with patients in person. From the experience participants had during COVID-19, four areas of change were identified: professional resilience, management/ethics support, professional development, and physical and emotional safety.

Resilience, compassion fatigue, moral distress and moral injury of nurses.

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study.

The Relationship Between Perceived Comfort Level with Moral Sensitivity and Moral Distress Among Oncology Nurses: A Descriptive Correlational Study.

OBJECTIVE: This study aimed to investigate the relationship between perceived comfort level with moral distress and moral sensitivity among oncology nurses METHODS: This is a descriptive-correlational study on 210 oncology nurses. The samples were selected through the convenience method from September 2020 to February 2022 in the oncology centers of Ahvaz, Iran. Data were collected via a demographic form, Lutzen's Modified Moral Sensitivity Questionnaire, Corley's Moral Distress Scale, and Kolcaba's Nurses Comfort Questionnaire (NCQ). Data were analyzed using SPSS V24, descriptive statistics, Independent t, Mann-Whitney-U, Kruskal-Wallis, Pearson's correlation coefficient, ANOVA, and linear regression tests. RESULTS: Nurses experienced a moderate level of perceived comfort (67.91 ± 8.75), moral sensitivity (58.4 ± 13.3), and moral distress (57.54.8 ± 8.9). Moral sensitivity was significantly inversely related to the intensity of moral distress (P < .001). A statistically significant relationship was found between nurses' perceived comfort level with frequency of distress (P < .001) and moral sensitivity (P = .046). Moral distress explained 13.8% of changes in perceived comfort level (R2 = 0.138, F = 6.51, sig < 0.001, R = 0.371). CONCLUSION: Nurses' perceived comfort level, moral sensitivity, and moral distress were at a moderate level and intercorrelated. It is suggested that factors contributing to moral distress should be eliminated. Also, moral sensitivity should be refined as a decisive factor. IMPLICATION FOR NURSING PRACTICE: Oncology nurses are exposed to morally distressing situations that may be a source of discomfort. This study guides nurses, managers, planners, and policymakers to identify the contributing factors and use strategies and solutions to enhance nurses' perceived comfort level.

Peer Support Workers in Mental Health Services: A Qualitative Exploration of Emotional Burden, Moral Distress and Strategies to Reduce the Risk of Mental Health Crisis.

This research aimed to explore the experience of emotional burden among peer support workers (PSWs) in mental health care in Poland. It also examined the issue of moral distress in relation to this professional group and identified institutional sources of support for the well-being of PSWs in the workplace. The data presented in the article are derived from fourteen qualitative in-depth individual interviews with PSWs employed in four mental health centres with different organisational structures. The narratives of PSWs revealed several experiences that could be considered to be moral distress. The inability to assist patients was found to be associated with both individual and institutional barriers. Furthermore, our findings suggest that organisations can implement a number of specific practices to ensure the wellbeing of PSWs, which dissemination would be beneficial to teams employing PSWs.

Burnout and turnover risks for healthcare workers in the United States: downstream effects from moral injury exposure.

Moral injury has emerged as a construct of interest in healthcare workers' (HCW) occupational stress and health. We conducted one of the first multidisciplinary, longitudinal studies evaluating the relationship between exposure to potentially morally injurious events (PMIEs), burnout, and turnover intentions. HCWs (N = 473) completed surveys in May of 2020 (T1) and again in May of 2021 (T2). Generalized Linear Models (robust Poisson regression) were used to test relative risk of turnover intentions, and burnout at T2 associated with PMIE exposure, controlling for T1 covariates. At T1, 17.67% reported they had participated in a PMIE, 41.44% reported they witnessed a PMIE and 76.61% reported feeling betrayed by healthcare or a public health organization. In models including all T1 PMIE exposures and covariates, T2 turnover intentions were increased for those who witnessed a PMIE at T1 (Relative Risk [RR] = 1.66, 95% Confidence Interval [CI] 1.17-2.34) but not those that participated or felt betrayed. T2 burnout was increased for those who participated in PMIE at T1 (RR = 1.38, 95%CI 1.03-1.85) but not those that witnessed or felt betrayed. PMIE exposure is highly prevalent among HCWs, with specific PMIEs associated with turnover intentions and burnout. Organizational interventions to reduce and facilitate recovery from moral injury should account for differences in the type of PMIE exposures that occur in healthcare work environments.

Moral distress and protective work environment for healthcare workers during public health emergencies.

BACKGROUND: Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. OBJECTIVES: The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. METHODS: We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. RESULTS: About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30-2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0-10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. CONCLUSIONS: Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs' work environment.

Moral distress among undergraduate nursing students in clinical practice: A scoping review.

Background: The ethical challenges faced by undergraduate nursing students and nurses may lead to moral distress, negatively affecting learning capacity and self-confidence and potentially influencing the quality of patient care. Objective: To examine the state of knowledge regarding the moral distress among undergraduate nursing students during clinical practice. Methods: This scoping review followed JBI guidelines. First, the LILACS, Web of Science, Scopus, CINAHL, PubMed/MEDLINE, PsycINFO, Embase, and ProQuest databases were consulted. Next, the reference lists of the studies included in the sample were checked. Studies exploring moral distress among undergraduate nursing students during clinical practice were included regardless of language or date of publication. Two independent reviewers simultaneously selected the studies. Results: The sample included 12 articles with different research designs. Three conditions that trigger moral distress among undergraduate nursing students emerged: Interpersonal relationships between students and preceptors/supervisors and multidisciplinary teams; interpersonal relationships between students and patients; and the relationship between students and health services. Conclusions: This review identified the various circumstances that lead to moral distress among undergraduate nursing students. Therefore, these results highlight the importance of preventing moral distress in this group through teaching, especially before students begin their clinical practices.

The relationship between moral distress and clinical care quality among nurses: an analytical cross-sectional study.

BACKGROUND: Nurses constitute the largest group of service providers in the healthcare system and significantly influence the quality of healthcare services. Factors such as ethical considerations may be related to the quality of care. This study aimed to determine the relationship between moral distress and the quality of clinical care among nurses working in Gonabad, Iran. METHODS: An analytical cross-sectional study was conducted on 252 nurses working in emergency, internal medicine, surgery, psychiatry, critical care and maternity wards at Allameh Bohlool Hospital from May to July 2023. This research used demographic information questionnaire, the revised Moral Distress Scale (MDS-R), and the Quality Patient Care Scale (QUALPAC). The significance level for the study was set at p < 0.05. RESULTS: There was a significant relationship between the frequency of moral distress and the quality of clinical care (p = 0.032), as well as between the intensity of moral distress and the quality of clinical care (p = 0.043). Nurses who experienced moral distress more frequently and intensely provided better quality care. However, there was no significant relationship between the effect of moral distress and the quality of clinical care (r = 0.032, p = 0.619). Additionally, a significant statistical relationship was found between the intensity of moral distress and the physical dimension of clinical care quality (r = 0.171, p = 0.007), indicating that increased moral distress intensity was associated with higher quality of physical care. CONCLUSIONS: Nurses who experience higher levels of moral distress, both in terms of frequency and intensity, perform better in the care they provide and deliver it in the best possible manner, particularly in the physical dimension of care.

Health advocacy and moral distress among nurses in organ transplant units.

BACKGROUND: Health advocacy is crucial for both patients and healthcare professionals. However, nurses who recognize the importance of health advocacy may experience heightened moral distress, particularly in complex donation and transplantation cases where patient autonomy, respect, and advocacy are paramount. AIM: To identify the factors contributing to moral distress among nurses working in solid organ transplant units at a university hospital in São Paulo, with a focus on health advocacy. RESEARCH DESIGN: This descriptive, cross-sectional study employs both quantitative and qualitative methods. For this, the quantitative phase of the study was conducted utilizing the Moral Distress Scale, while the qualitative phase was executed through focus group discussions. PARTICIPANTS AND RESEARCH CONTEXT: The quantitative phase involved 15 nurses using the Moral Distress Scale. The qualitative phase consisted of a focus group with 5 nurse managers/coordinators from the transplant units. Quantitative data were analyzed using R® software, while qualitative data were analyzed using Bardin's Content Analysis. ETHICAL CONSIDERATIONS: The study was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing, University of São Paulo. Participation was voluntary and confidentiality was ensured. RESULTS: A significant correlation was found between moral distress and the factors of "disregard for patient autonomy" (p = .0100) and "therapeutic obstinacy" (p = .0492). CONCLUSION: The primary determinants associated with moral distress in the context of health advocacy were identified as "disregard for patient autonomy" and "therapeutic obstinacy."

The relationship between teamwork and moral distress among NICU nurses.

BACKGROUND: In the demanding environment of the neonatal intensive care unit (NICU), quality nursing care hinges on effective teamwork and communication among nurses. However, this requirement for close cooperation can expose nurses to significant levels of moral distress. This study aims to explore the connection between the quality of teamwork and the experience of moral distress among NICU nurses. METHODS: Employing a cross-sectional, multicenter descriptive correlational design, this study surveyed female NICU nurses across the cities of Khorramabad and Semnan. Census sampling was utilized over five months, from July to November 2023, resulting in the participation of 190 nurses. Tools for data collection included demographic questionnaires, the Team-STEPPS Teamwork Perception Questionnaire (T-TPQ), and the Moral Distress Scale-Revised (MDS-R) for nurses. RESULTS: The findings revealed an average teamwork score of 3.73 ± 0.78, denoting an acceptable level, and an average moral distress score of 91.2 ± 56.7, indicating a low level. In multiple linear regression, marital status showed a direct positive correlation (ß = 38.5, SE (ß) = 9.3, p < 0.001), while the number of children (ß = -14.6, SE (ß) = 4.9, p = 0.003) and the teamwork score (ß = -1.1, SE (ß) = 0.12, p < 0.001) were inversely correlated with moral distress. CONCLUSION: The study's results suggest that stronger teamwork among nurses correlates with reduced moral distress. Enhancing teamwork within NICUs could lead to policy development focused on the safety and quality of newborn care, also potentially alleviating moral distress experienced by nurses.

Survey of Moral Distress and Self-Awareness among Health Care Professionals.

Health care professionals experience moral distress due to challenging ethical decision-making during patient care. Self-awareness can be associated with moral distress. This study determined the levels of and relationship between moral distress and self-awareness of health care professionals. A convenience sample of physicians and nurses was recruited. Data were collected using the Moral Distress and Self-Awareness Scales. In total, 168 physicians and 201 nurses participated with a mean age of 30.54 ± 7.87 and clinical experience of 6.40 ± 6.22 years. Moderate levels of moral distress (127.07 ± 71.90) and high levels of self-awareness (70.20 ± 11.37) were found. A weak positive correlation was found between self-awareness and moral distress (r = 0.21, p < 0.001) and weak negative correlation between moral distress (r = - 0.115, p = 0.03) and age. Nurses were more self-aware, but no differences were observed in moral distress based on sex and clinical settings. A weak correlation between self-awareness and moral distress may suggest that self-awareness can increase intrapersonal tensions, contributing to distress. Further research is needed to support any conclusive relationship between moral distress and self-awareness.

Causes of moral distress among midwives: A scoping review.

Numerous studies have evidenced moral distress among midwives; however, to date no research synthesis on causes of moral distress among midwives has been conducted. A scoping review was carried out to identify, comprehensively map, and categorize possible causes of moral distress among midwives, and to identify knowledge gaps. Six data bases were searched using Boolean logic. To be included, studies had to (a) present empirical findings on (b) causes of moral distress (c) among midwives (d) in English, German, French, or Italian. We included a final set of 43 studies. The vast majority of studies came from high-income countries (83.7%) and used a qualitative approach (69.8%); 48.8% of the studies were published in the past 5 years. Identified single reasons of moral distress were grouped into eight broader clusters, forming a coherent framework of reasons of moral distress: societal disregard, contemporary birth culture, resources, institutional characteristics, interprofessional relationships, interpersonal mistreatment of service users, defensive practice, and challenging care situations. These clusters mostly capture moral distress resulting from a conflict between external constraints and personal moral standards, with a smaller proportion also from an intraindividual conflict between multiple personal moral standards. Despite projected increases in demand for midwives, the midwifery workforce globally faces a crisis and is experiencing substantial strain. Moral distress further exacerbates the shortage of midwives, which negatively affects birth experiences and birth outcomes, ultimately rendering it a public health issue. Our findings offer points of leverage to better monitor and alleviate moral distress among midwives, contributing to reducing attrition rates and improving birth experiences and birth outcomes. Further research is essential to explore the issue of ecological moral distress, develop evidence-based interventions aimed at alleviating moral distress among midwives, and evaluate the effects of both individual and system-level interventions on midwives, intrapartum care, and service users' outcomes.

Building Social Support and Moral Healing on Nursing Units: Design and Implementation of a Culture Change Intervention.

The healthcare industry continues to experience high rates of burnout, turnover, and staffing shortages that erode quality care. Interventions that are feasible, engaging, and impactful are needed to improve cultures of support and mitigate harm from exposure to morally injurious events. This quality improvement project encompassed the methodical building, implementation, and testing of RECONN (Reflection and Connection), an organizational intervention designed by an interdisciplinary team to mitigate the impact of moral injury and to increase social support among nurses. This quality improvement project was conducted in a medical intensive care unit (MICU) in a rural, academic medical center. We employed an Evidence-Based Quality Improvement (EBQI) approach to design and implement the RECONN intervention while assessing the feasibility, acceptability, and preliminary effectiveness via surveys (n = 17). RECONN was found acceptable and appropriate by 70% of nurses who responded to surveys. Preliminary effectiveness data showed small to moderate effect sizes for improving social support, moral injury, loneliness, and emotional recovery. Further evaluation is warranted to establish the effectiveness and generalizability of RECONN to other healthcare settings.

Confronting moral injury across health systems: Enhancing medical social workers' resilience and well-being.

Research has demonstrated that encounters of potentially moral injurious events (PMIEs) may result in longstanding psychological trauma that impact healthcare workers' mental health and well-being. In this paper, we explore strategies to alleviate PMIEs for medical social workers. In-depth semi-structured interviews (30-60 min) were conducted with medical social workers (n = 75) across the state of Texas. Supported by directed content analysis, textual data were coded and categorised to finalize emerging themes. Findings demonstrate that multilevel strategies ought to be implemented into daily healthcare practice. PMIEs that impact frontline healthcare delivery can be alleviated by having formal and informal support systems (e.g., mentorship, supervision, counselling) as well as honest and transparent interprofessional collaborative care to facilitate psychological team safety. PMIEs across the healthcare organisation, perhaps due to internal policies and practices, may be reduced by implementing educational initiatives and building ethical workplace cultures that serve to explicitly reduce stigma associated with mental health and enhance worker well-being. PMIEs that derive from macro-level social policies (e.g., insurance, health disparities) may be alleviated by instituting patient advocacy initiatives and dismantling systems of oppression to lessen psychological stress and trauma. Hospital leadership ought to understand how the United States healthcare industry triggers PMIEs across the healthcare workforce. Multi-tiered practices and policies that addresses frontline delivery care, leadership and administrative responsibilities, and the healthcare industry can enhance psychologically safe workplaces and elicit macro-level institutional reform in how health systems function. These findings have important implications for healthcare policy makers, practitioners, educators, and researchers to inform future research and practice development.

"Moral spaces": A feasibility study to build nurses' ethical confidence and competence.

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses' ethical knowledge and confidence to respond to ethical challenges in practice. Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest "always agree" (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses' ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method.

Medical Student Perspectives on Professionalism in a Third-Year Surgery Clerkship - A Mixed Methods Study.

OBJECTIVE: The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors. DESIGN: We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods. SETTING: Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics. PARTICIPANTS: Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys. RESULTS: Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001). CONCLUSIONS: With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development.

When Fulfilling a Professional Obligation Causes Moral Distress: A New Evaluative Approach.

PURPOSE: The term 'moral distress' was coined by Andrew Jameton to name the anguish that clinicians feel when they cannot pursue what they judge to be right because of institutional constraints. We argue that moral distress in critical care should also be addressed as a function of the constraints of ethics and propose an evaluative approach to the experience considering its implications for professional identity. METHOD: We build on a selective review of the literature and analyze a paradigmatic example of moral distress, namely, clinicians who feel compelled to perform procedures on patients that seem futile. Such cases are commonly cited by clinicians as among the most morally distressing. RESULTS: Our analysis shows that (1) physicians' experiences of moral distress can stem not only from toxic workplace cultures and institutional constraints on their time and resources for patient care but also from the limits of ethical reasoning and (2) an emotion-based evaluative approach to analyzing moral distress is needed to address its hazards for professional identity. CONCLUSION: We propose a new evaluative approach to moral distress with implications for professional identity and the need for institutional education and support.

Moral distress and compassion fatigue among nursing interns: a cross-sectional study on the mediating roles of moral resilience and professional identity.

BACKGROUND: Nursing interns often faced moral distress in clinical practice, similar to registered nurses, which can lead to compassion fatigue. The roles of moral resilience and professional identity in influencing the psychological well-being of nursing interns are recognized, but the interrelationships among moral distress, moral resilience, professional identity, and compassion fatigue in this group remain unclear. OBJECTIVES: This study aimed to investigate the impact of moral distress on compassion fatigue among nursing interns and to explore the mediating role of moral resilience and professional identity. METHODS: A quantitative cross-sectional study was conducted with 467 nursing interns. Data were collected using Compassion Fatigue Short Scale, Moral Distress Scale-revised, Rushton Moral Resilience Scale, and Professional Identity Scale. Data analyses were performed using SPSS 22.0 and Amos 21.0, adhering to the STROBE statement. RESULTS: The mean scores for compassion fatigue, moral distress, moral resilience, and professional identity were 35.876, 44.887, 2.578, and 37.610, respectively. Moral distress was positively correlated with compassion fatigue. Structural equation modeling showed that moral resilience and professional identity partially mediated the relationship between moral distress and compassion fatigue (ß = 0.448, P < 0.001). CONCLUSION: The findings suggest that moral distress directly influences compassion fatigue among nursing interns and also exerts an indirect effect through moral resilience and professional identity. Interventions aimed at enhancing moral resilience and fostering a strong professional identity may help mitigate the adverse effects of moral distress on compassion fatigue among nursing interns.

Being a psychiatrist in the evaluation process of a gun license report: morally challenging experience - a qualitative study from Turkey.

Many psychiatrists in Turkey participate in evaluating health board reports regarding gun licensing in their daily practice. There is no relevant study on the experiences of psychiatrists in this process. In addition, there is no other country where psychiatrists participate in the gun licensing process as in Turkey. In this context, the psychiatrists' relevant experiences, their views on their roles in this process and their understanding of the ethical dimension are considered important issues. To investigate the experiences of psychiatrists, a qualitative study has been conducted. The study included 19 psychiatrists who actively participated in evaluating gun license reports. Taking part in the gun license report process for psychiatrists is a highly challenging experience professionally, morally and emotionally. Psychiatrists resort to various functional and dysfunctional strategies to address problems in this process. However, there are structural and general solutions suggested for the future.

Moral Distress and Its Determinants among Nursing Students in an Italian University: A Cross-Sectional Study.

BACKGROUND: Moral Distress (MD) is a unique form of distress that occurs when people believe they know the ethically correct action to take but are constrained from doing so. Limited clinical experience and insufficient ethical knowledge contribute to nursing students' MD, which can potentially cause negative outcomes. The aims of this study are: (1) to describe the MD intensity of nursing students, and (2) to analyze differences and associations between MD intensity and socio-demographic and academic variables. METHODS: A cross-sectional study design with a convenience sample of the second, third, and delayed graduation students was included; only students willing to participate and who had attended their scheduled internships in the last six months were eligible for inclusion. To measure the level of MD, we used the It-ESMEE. We collected socio-demographic and academic variables. The data collection occurred from January 2024 to March 2024. RESULTS: The students who adhered to the collection were N = 344. The findings reveal that the students perceived a high level of MD in situations related to clinical internship and class. They perceived higher levels of MD when nursing was not their first career choice, were separated or divorced, did not have children, and were not an employed student. The overall MD score is statistically significantly lower among students who had nursing as their first career choice (ß = -0.267, p < 0.05), have children (ß = -0.470, p < 0.01), and are employed (ß = -0.417, p < 0.01). In contrast, being separated or divorced (ß = 0.274, p < 0.01) was associated with a higher MD score. CONCLUSIONS: This study has some limitations: data reflect a local context, and the findings may not be generalizable to other regions or educational environments. Additionally, students' recollections of their experiences could be influenced by the passage of time, and there may be a selection bias since only students willing to participate were included. The findings suggest that nursing education programs should incorporate more robust training in ethical decision-making and stress management to better prepare students for the moral challenges in their professional practice.