Spanish psychometric properties of the moral distress scale-revised: a study in healthcare professionals treating COVID-19 patients.

BACKGROUND: Moral distress appears when a healthcare professional is not able to carry out actions in accordance with their professional ethical standards. The Moral Distress Scale-Revised is the most widely used to assess levels of moral distress, but it is not validated in Spanish. The aim of the study is to validate the Spanish version of the Moral Distress Scale - utilised within a sample of Spanish healthcare professionals treating COVID-19 patients. METHODS: The original (english) and the portuguese and french versions of the scale were translated into spanish by native or bilingual researchers and reviewed by an academic expert in ethics and moral philosophy as well as by a clinical expert. RESEARCH DESIGN: Descriptive cross-sectional study carried out using a self-reporting online survey. The data was collected between June- November 2020. A total of 661 professionals responded to the survey (N = 2873). PARTICIPANTS: healthcare professionals with more than two weeks of experience treating COVID-19 patients at the end of their life and working in the public sector of the Balearic Islands Health Service (Spain). Analyses included descriptive statistics, competitive confirmatory factor analysis, evidence on criterion-related validity and estimates of reliability. The study was approved by the Research Ethics Committee at the University of Balearic Islands. RESULTS: An unidimensional model in which a general factor of moral distress explained by 11 items of the Spanish version of the MDS-R scale was an adequate representation of the data: χ2(44) = 113.492 (p 0.001); Comparative Fit Index = 0.965; Root Mean Square Error of Approximation = 0.079[0.062,0.097]; and Standarized Root Mean-Square = 0.037. Evidence of reliability was excellent: Cronbach's alpha = 0.886 and McDonald's omega = 0.910. Moral distress was related to discipline, with nurses having statistically significant higher levels than physicians. Additionally, moral distress successfully predicted professional quality of life, with higher levels of moral distress being related to poorer quality of life. CONCLUSIONS: The Spanish version of Moral Distress Scale-Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by health professionals. This tool will be highly useful for managers and applicable to a variety of healthcare professionals and settings.

Mejorando el cuidado a los familiares del paciente crítico: estrategias consensuadas / Improving the case of critical patient family members: Agreed on strategies

Introducción: En el contexto de una investigación-acción participativa (IAP), con el objetivo general de promover un cambio para mejorar los cuidados que se ofertan a los familiares del paciente ingresado en la unidad de cuidados intensivos (UCI), se estableció un proceso en 4 fases: diagnóstico de situación, propuestas de cambio, diseño e implementación de las propuestas y evaluación. Este trabajo presenta las 2 primeras fases.ObjetivosConocer las características de la atención a los familiares en la unidad. Alcanzar el consenso sobre las áreas de acción-intervención en esta unidad.Material y métodoMetodología cualitativa. Diseño: IAP. Técnica de recogida de datos: 4 grupos focales y consenso con grupos de apoyo. Participaron 10 profesionales en los grupos focales y 30 en los grupos de apoyo. Se realizó análisis de contenido. Se alcanzó el punto de saturación teórica.ResultadosSe elaboraron 2 documentos: 1) diagnóstico de situación en el que se describe la situación actual de la atención de los familiares y 2) 10 propuestas de cambio, de las que se priorizaron 5, que eran: difusión entre los profesionales de la evidencia sobre familiares en la UCI a través de una sesión y la entrega de trípticos informativos, mejora de los procesos de información (enfermera-familia e intraequipo), protección de la intimidad de los pacientes y disminución del ruido ambiental, plan de formación para los profesionales y cambio en la política de visitas.ConclusiónEl uso de metodologías de consenso permiten priorizar y diseñar estrategias de cambio adecuadas al contexto en el que se van a aplicar(AU)

Introduction: Within the context of participatory action research (PAR), a 4-stage process was established with the general aim of promoting improvements in the care offered to families of patients in the Intensive Care Unit (ICU). The 4 stages consisted of a situational diagnosis, proposals for change, the design and implementation of the proposals, and an evaluation. This paper presents the first 2 stages.ObjectivesTo define the attention given to families of patients in the Intensive Care Unit. To reach a consensus on areas for action/intervention in the unit.Materials and methodA qualitative methodology. Design: PAR. Data-collection technique: 4 focus groups made up of 10 professionals, and consensus with support groups made up of 30 members. Content analysis was performed. The theoretical saturation point was reached.ResultsTwo documents were drawn up: 1) A situational diagnosis, describing the current situation of the attention given to families and 2) 10 proposals for change, 5 of which were given priority. They were: a session to familiarize professionals with evidence concerning families of patients in the ICU and the handing out of informative leaflets, the improvement of (nurse-family and intra-team) informative procedures, more privacy for patients and a reduction in environmental noise, a training plan for professionals, and change in the visiting policy.ConclusionBy using consensus-based methodologies, strategies for change can be prioritized and designed, adapted to the context in which they will be applied(AU)

[Improving the care of critical patient family members: Agreed on strategies]. / Mejorando el cuidado a los familiares del paciente crítico: estrategias consensuadas.

INTRODUCTION: Within the context of participatory action research (PAR), a 4-stage process was established with the general aim of promoting improvements in the care offered to families of patients in the Intensive Care Unit (ICU). The 4 stages consisted of a situational diagnosis, proposals for change, the design and implementation of the proposals, and an evaluation. This paper presents the first 2 stages. OBJECTIVES: To define the attention given to families of patients in the Intensive Care Unit. To reach a consensus on areas for action/intervention in the unit. MATERIALS AND METHOD: A qualitative methodology. DESIGN: PAR. Data-collection technique: 4 focus groups made up of 10 professionals, and consensus with support groups made up of 30 members. Content analysis was performed. The theoretical saturation point was reached. RESULTS: Two documents were drawn up: 1) A situational diagnosis, describing the current situation of the attention given to families and 2) 10 proposals for change, 5 of which were given priority. They were: a session to familiarize professionals with evidence concerning families of patients in the ICU and the handing out of informative leaflets, the improvement of (nurse-family and intra-team) informative procedures, more privacy for patients and a reduction in environmental noise, a training plan for professionals, and change in the visiting policy. CONCLUSION: By using consensus-based methodologies, strategies for change can be prioritized and designed, adapted to the context in which they will be applied.