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Korean Society of Muscle and Joint Health (대한근관절건강학회)
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A Structural Model on the Moral Distress in Clinical Nurses

임상간호사의 도덕적 고뇌 구조모형 구축

  • Received : 2022.10.30
  • Accepted : 2022.11.27
  • Published : 2022.12.31
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Abstract

Purpose: This study was to build a path model geared toward explaining the relationships of influential variables for the moral distress of clinical nurses by analyzing literatures of earlier studies. Methods: Data were collected from four hospitals with 300 beds or more. The participants were 257 nurses with more than 1 year of clinical experience. The data collection period was from June 14 to October 24, 2017. The questionnaire included general and ethical education-related characteristics, personality type, moral dilemma experience, moral sensitivity, moral climate and moral distress. Results: The direct influencing factors of moral distress were the individual's experience of moral dilemma, moral sensitivity, and the moral climate of the organization. Factors that indirectly affected via moral sensitivity were personality type, experience in ethical education, and moral climate. The explanatory power was 40.3%. Conclusion: It is necessary to develop an intervention program that can reduce moral distress by considering the factors influencing the moral distress of clinical nurses. In addition, it is necessary to identify additional influencing factors of moral distress.

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References

  1. Bae, B. R. (2017). Amos 24 structural equation modeling. Seoul: Cheongram.
  2. Chae, Y., Yu, S., Lee, E. J., & Park, E. H. (2017). The relation among moral distress, physical symptoms and burnout of hospital nurses. The Journal of Korean Academic Society of Nursing Education, 23(4), 430-440. https://doi.org/10.5977/jkasne.2017.23.4.430
  3. Chae, Y., Yu, S., Lee, E. J., Kang, K., Park, M. S., & Yu, M. (2016). Validity and reliability of the Korean version of the moral distress scale-revised for Korean hospital nurses. The Journal of Korean Academic Society of Nursing Education, 22(2), 228-239. https://doi.org/10.5977/jkasne.2016.22.2.228
  4. Chang, H. Y., Song, Y. E., Kim, Y. S., & You, M. A. (2013). Moral sensitivity, attitude, and nursing practices for older people among nurses in long term care hospitals. Korean Journal of Medical Ethic, 16(2), 216-230. https://doi.org/10.35301/ksme.2013.16.2.216
  5. Cho, H. N., An, M., & So, H. S. (2015). Differences of turnover intention by moral distress of nurses. The Journal of the Korea Contents Association, 15(5), 403-413. https://doi.org/10.5392/JKCA.2015.15.05.403
  6. Corley, M. C. (2002). Nurse moral distress: A proposed theory and research agenda. Nursing Ethics, 9(6), 636-650. https://doi.org/10.1191/0969733002ne557oa
  7. Corley, M. C., Minick, P., Elswick, R., & Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381-390. https://doi.org/10.1191/0969733005ne809oa
  8. Friedman, M., & Rosenman, R. H. (1974). Type A behavior and your heart. New York: Knopf.
  9. Ha, E. H., & Hyun, K. S. (2014). Nurses' self-image perceived by clinical nurses: An application of Q-methodology. Korean Journal of Adult Nursing, 26(1), 117-128. https://doi.org/10.7475/kjan.2014.26.1.117
  10. Hamric, A. B., Borchers, C. T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. Acta Biomaterialia Odontologica Scandinavica Primary Research, 3(2), 1-9. https://doi.org/10.1080/21507716.2011.652337
  11. Han, S. J. (2012). Relationship between moral distress and turnover intention among hospital nurses. The Journal of the Korea Contents Association, 12(3), 276-284. https://doi.org/10.5392/JKCA.2012.12.03.276
  12. Han, S. S. (2005). The moral distress experienced by hospital nurses. Journal of Korean Bioethics Association, 6(2), 31-47.
  13. Han, S. S., Kim, J., Kim, Y. S., & Ahn, S. (2010). Validation of a Korean version of the moral sensitivity questionnaire. Nursing Ethics, 17(1), 99-105. https://doi.org/10.1177/0969733009349993
  14. Haynes, S. G., Levine, S., Scotch, N., Feinleib, M., & Kannel, W. B. (1978). The relationship of psychosocial factors to coronary heart disease in the Framingham study: I. Methods and risk factors. American Journal of Epidemiology, 107(5), 362-383. https://doi.org/10.1093/oxfordjournals.aje.a112556
  15. Hong, S. H., Park, Y. H., & Moon, J. S. (2016). Relationship between moral sensitivity and elderly nursing practice of nurses. Journal of the Korean Bioethics Association, 17(1), 75-87.
  16. Hooper, D., Coughlan, J., & Mullen, M. (2008). Evaluating model fit: a synthesis of the structural equation modelling literature (7th ed.). London: Regent's College.
  17. Hwang, J. I., & Park, H. A. (2014). Nurses' perception of ethical climate, medical error experience and intent-to-leave. Nursing Ethics, 21(1), 28-42. https://doi.org/10.1177/0969733013486797
  18. Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONN's Clinical Issues in Perinatal and Women's Health Nursing, 4(4), 542-551. http://hdl.handle.net/10822/860982 10822/860982
  19. Jeon, Y. (2019). Ethical climate and moral distress among neonatal intensive care unit RNs. Unpublished master's thesis, Pusan National University, Busan.
  20. Jo, H., & Kim, S. (2017). Moral sensitivity, empathy and perceived ethical climate of psychiatric nurses working in the national mental hospitals. Journal of Korean Academy of Psychiatric and Mental Health Nursing, 26(2), 204-215. https://doi.org/10.12934/jkpmhn.2017.26.2.204
  21. Kang, H. (2013a). Discussions on the suitable interpretation of model fit indices and the strategies to fit model in structural equation modeling. Journal of the Korean Data Analysis Society, 15(2), 653-668.
  22. Kang, H. (2013b). A guide on the use of factor analysis in the assessment of construct validity. Journal of Korean Academy of Nursing, 43(5), 587-594. https://doi.org/10.4040/jkan.2013.43.5.587
  23. Kim J. A. (2016). Moral distress and moral sensitivity of nurses working in long term care hospitals. Unpublished master's thesis, Gyeongsang National University, Jinju.
  24. Kim, G. S. (2010). AMOS 18.0 Analysis structural equation modeling. Seoul: Hannara Academy.
  25. Kim, H., & Ahn, S. (2010). Moral sensitivity and moral distress among Korean hospital nurses. Korean Journal of Medical Ethics, 13(4), 321-336. https://doi.org/10.35301/ksme.2010.13.4.321
  26. Kim, J. A., & Kang, Y. S. (2018). Moral distress and moral sensitivity of nurses working in long term care hospitals. Journal of the Korea Academia-Industrial cooperation Society, 19(6), 240-251. https://doi.org/10.5762/KAIS.2018.19.6.240
  27. Lutzen, K., Blom, T., Ewalds-Kvist, B., & Winch, S. (2010). Moral stress, moral climate and moral sensitivity among psychiatric professionals. Nursing Ethics, 17(2), 213-224. https://doi.org/10.1177/0969733009351951
  28. Lutzen, K., Evertzon, M., & Nordin, C. (1997). Moral sensitivity in psychiatric practice. Nursing Ethics, 4(6), 472-482. https://doi.org/10.1177/096973309700400604
  29. Ma, M. (2008). Moral distress and depression of clinical nurses. Unpublished master's thesis, The Catholic University of Korea, Seoul.
  30. Noh, D., Kim, S., & Kim, S. (2013). Moral distress, moral sensitivity and ethical climate of nurses working in psychiatric wards. Journal of Korean Academy of Psychiatric and Mental Health Nursing, 22(4), 307-319. https://doi.org/10.12934/jkpmhn.2013.22.4.307
  31. Olson, L. L. (1998). Hospital nurses' perceptions of the ethical climate of their work setting. Image: The Journal of Nursing Scholarship, 30(4), 345-349. https://doi.org/10.1111/j.1547-5069.1998.tb01331.x
  32. Omery, A. (1989). Values, moral reasoning, and ethics. Nursing Clinics of North America, 24(2), 499-508. https://doi.org/10.1016/S0029-6465(22)01502-X
  33. Park, M. Y. (2015). Effects of moral sensitivity and self-assertiveness of a hospital nurse to recognize sexual harassment. Unpublished master's thesis, Kyungpook National University, Daegu.
  34. Schluter, J., Winch, S., Holzhauser, K., & Henderson, A. (2008). Nurses' moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics, 15(3), 304-321. https://doi.org/10.1177/0969733007088357
  35. Sin, S. (2008). Analysis of the relationship of type A/B behavior to job stress and mental health in elementary school teachers. Unpublished master's thesis, Chuncheon National University of Education, Chuncheon.
  36. Sohn, Y., Yang, Y., Kwon, H., Lee, Y., Lee, J., Lee, E., et al. (2001). The association between type A behavior pattern and hypertension among adults in a rural area. Korean Journal of Public Health, 38(1), 72-83.
  37. Stevens, J. P. (2009). Applied multivariate statistics for the social sciences. NJ: Lawrence Erlbaum Associates.
  38. Victor, B., & Cullen, J. B. (1988). The organizational bases of ethical work climates. Administrative Science Quarterly, 33(1), 101-125. https://doi.org/10.2307/2392857
  39. Woo, J. (2012). Structural Equation Model Concept and Understanding. Seoul: Hannarae Publishing Co.
  40. Yi, K. (2015). A Study on influencing factors on the moral distress of nurses in neonatal intensive care unit. Unpublished master's thesis, The Catholic University of Korea, Seoul.
  41. Yoo, M. (2003). The development of a measurement tool for moral distress in nurses. Unpublished doctoral dissertation, Yonsei University, Seoul.
  42. Yoo, M. S., & Shon, K. C. (2011). Effects of nursing ethics education on biomedical ethics awareness, moral sensitivity and moral judgment of nursing students. Journal of the Korea Bioethics Association, 12(2), 61-78.
  43. Yoon, H. S., Kim, H. l., Kwon, I. S., & Cho, Y. C. (2008). Type A behavior pattern and its association with stress, depression and fatigue in nurses. Korean Journal of Occupational Health Nursing, 17(2), 180-190.