Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study.

AIM: To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care. DESIGN: A qualitative descriptive study design was used. METHODS: A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis. FINDINGS: Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care. CONCLUSIONS: The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk. IMPACT: Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution.

Towards improved management of tropical invertebrate fisheries: including time series and gender.

Invertebrate harvesting is an important livelihood in tropical settings providing income and food for numerous populations throughout the world. However, the lack of research, policy and management directed towards this livelihood hinders the analysis of time trends to evaluate invertebrate resources status. Another missing aspect is the consideration of gender analysis, i.e., the different roles and interests of men and women engaged in this activity. Based on interviews, catch assessments and inventories this multi-disciplinary study from Chwaka Bay (Zanzibar, Tanzania) shows how unregulated harvesting of invertebrates may result in sharp declines in animal abundance over a relatively short period of time (2005 to 2010), threatening the sustainability of the fishery. Specifically, the results show that catches in general, and prime target species of gastropods and bivalves in particular, had been significantly reduced in number and size. Interviews revealed gender disparities; female harvesters experienced less access to good fishing/collecting grounds and species of high value, which subsequently resulted in lower individual income. This is tightly linked to women's reproductive roles, which not only leads to limited mobility but also lessen their chances to accumulate livelihood assets (natural, physical, financial, social and human capital) thus impacting livelihood strategies. To protect invertebrate resources from overexploitation, and assure a constant flow of income and food for future generations, this case study illustrates the need for formal monitoring to assess changes in invertebrate resources, and possible ecological consequences, over time. Managers and policy-makers must also address gender to evaluate the contribution of all resource users, their capacity to cope with changing conditions, as well as specific interests.