Title: Moral Distress in Nurses Providing Direct Patient Care on Inpatient Oncology Units

1. Education: 0 = Diploma in nursing; 1 = AD in nursing; 2 = BSN; 3 = BS, other field; 4 = Graduate degree, nursing; 5 = Graduate degree, other field. Title: Moral Distress in Nurses Providing Direct Patient Care on Inpatient Oncology Units • Janet Sirilla DNP, RN, OCN®, NE-BC Topic Significance & Background Analysis Only the type of unit variable showed a statistically significant difference (p=0.029). There was also a statistically significant inverse relationship between education and MDS-R (p=0.02). The nurses who worked on surgical units had the highest mean scores (124.2) with the nurses on the Blood & Marrow Transplant Unit having the next highest (108.3). To develop a model to predict which nurses may be at risk for moral distress, a multiple regression of MDS-R was fit using unit and education. Moral distress describes the struggle between a nurse’s moral encompass and institutional constraints. These constraints limit the nurse’s ability to pursue a course of action that is in alignment with his/her beliefs. Many authors have described the psychological, social, and professional impact of nurses who have had a prolonged exposure to ethically challenging situations. As a result of moral distress, some nurses withdraw from patients that may lead to lower quality and decreased patient satisfaction. In some situations, nurses leave their position and/or profession. Most studies have focused on nurses working in critical care settings but a few have focused on medical/surgical units. Descriptive statistics were used to summarize the distribution demographics and the MDS-R scores. Pearson’s and Spearman’s correlations among age, years of experience in nursing and oncology, and the continuous measure of moral distress were estimated. ANOVA was used to examine the differences between the mean scores of the units with the highest mean scores and the mean scores of the other units. Findings & Interpretation Study Purpose Response rate = 20 % (73/363) • To examine the level of moral distress in nurses who work on inpatient oncology units. • To compare moral distress by the demographic of nurses and work experience variables. • To identify demographic characteristics and type of clinical setting that may predict which nurses are at risk for moral distress. Demographics 0 = Diploma in nursing; 1 = AD in nursing; 2 = BSN; 3 = BS, other field; 4 = Graduate degree, nursing; 5 = Graduate degree, other field. Methods Discussion & Implications Nurses who work on inpatient oncology units at this institution report low to moderate moral distress. The mean score was 81.36 which is slightly lower than the level of moral distress reported in the literature for nurses who work in critical care settings (91.53). Age and experience did not correlate with the moral distress scores. The level of education and the type of unit where the nurse works may be useful predictors of the level of moral distress. Repeating this project with nurses working on inpatient oncology unit s in other cancer hospitals may provide interesting outcomes. Strategies to diminish moral distress should also be studied. Age Education • Cross-sectional design • Inclusion criteria: • Direct care Registered Nurses (RNs) working on an inpatient oncology unit at one comprehensive cancer hospital. • Working at least 50% • Exclusion criteria: Nurses in a management or advanced practice role • Instrument: The Moral Distress Scale – Revised (MDS-R) • E-mailed the recruitment letter and the link to the survey using an OSUMC Outlook group for the Inpatient RNs. The letter included: • Purpose of the survey • The risks, benefits, and alternatives • The process to ensure confidentiality • Who to contact for questions or assistance • The consent statement: “You indicate your voluntary agreement to participate by completing and returning this questionnaire”. • Data was collected through REDCap (Research Electronic Data Capture) Experience • MDS-R score • Mean = 81.36 • Median = 77.0 • Standard Deviation = 50.8 • Range = 4.0 – 266 • 21 (28.7%) nurses had moderate to high MDS-R scores. Selected References Hamric, A. B., Borchers, C.T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3(2). Huffman, D. M., & Rittenmeyer, L. (2012). How professional nurses working in hospital environments experience moral distress: a systematic review. Crit Care NursClin North Am, 24(1), 91-100. doi: 10.1016/j.ccell.2012.01.004. Rice, E. M., Rady, M. Y., Hamrick, A., Verheijde, J. L., & Pendergast, D. K. (2008). Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. J NursManag, 16(3), 360-373. doi: 10.1111/j.1365-2834.2007.00798.x Varcoe, C., Pauly, B., Storch, J., Newton, L., & Makaroff, K. (2012). Nurses' perceptions of and responses to morally distressing situations. Nurs Ethics, 19(4), 488-500. doi: 10.1177/0969733011436025