Important situations that capture moral distress in paediatric oncology.
Healthcare professionals
Hospital settings
Medical doctors
Moral distress
Nursing assistants
Paediatric oncology
Registered nurses
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
13 01 2020
13 01 2020
Historique:
received:
27
08
2019
accepted:
06
01
2020
entrez:
15
1
2020
pubmed:
15
1
2020
medline:
25
11
2020
Statut:
epublish
Résumé
The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology. In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21. In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.
Sections du résumé
BACKGROUND
The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology.
METHODS
In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned.
RESULTS
Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21.
CONCLUSION
In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.
Identifiants
pubmed: 31931787
doi: 10.1186/s12910-020-0447-x
pii: 10.1186/s12910-020-0447-x
pmc: PMC6958740
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
6Références
BMJ Qual Saf. 2018 Oct;27(10):766-770
pubmed: 29669857
J Health Psychol. 2017 Jan;22(1):51-67
pubmed: 26220460
J Pediatr Oncol Nurs. 2015 Jul-Aug;32(4):240-52
pubmed: 25556105
Prev Chronic Dis. 2005 Jan;2(1):A13
pubmed: 15670466
Am J Crit Care. 2010 Nov;19(6):543-52
pubmed: 20026650
BMC Med Ethics. 2018 May 10;19(1):35
pubmed: 29747639
AJOB Empir Bioeth. 2019 Apr-Jun;10(2):113-124
pubmed: 31002584
Nurs Ethics. 2012 Mar;19(2):183-95
pubmed: 22457383
Jpn J Clin Oncol. 2014 Aug;44(8):729-35
pubmed: 24903853
Nurs Ethics. 2015 Feb;22(1):103-16
pubmed: 25106456
Pediatrics. 2012 Apr;129(4):e975-82
pubmed: 22392177
Pediatrics. 2004 Nov;114(5):1248-52
pubmed: 15520103
Acta Oncol. 2019 Jul;58(7):1015-1020
pubmed: 30958083
Crit Care Nurs Clin North Am. 2012 Mar;24(1):91-100
pubmed: 22405714
Nurs Ethics. 2019 Nov-Dec;26(7-8):2351-2363
pubmed: 30411660
J Palliat Med. 2018 Jun;21(6):862-878
pubmed: 29775556
Crit Care Med. 2007 Feb;35(2):422-9
pubmed: 17205001
Am J Nurs. 2016 Jul;116(7):40-9
pubmed: 27294668
Int J Nurs Stud. 2013 Jan;50(1):100-8
pubmed: 22989404
Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91
pubmed: 11124735
J Clin Oncol. 2014 Sep 20;32(27):3005-11
pubmed: 25024073
Arch Dis Child. 2016 Aug;101(8):701-8
pubmed: 26801075
J Adv Nurs. 2001 Jan;33(2):250-6
pubmed: 11168709
Int J Nurs Stud. 2010 Jun;47(6):723-31
pubmed: 20004395
Intensive Crit Care Nurs. 2016 Oct;36:42-8
pubmed: 27209561
Cancer Nurs. 2015 Mar-Apr;38(2):125-32
pubmed: 24945260
Acta Paediatr. 2016 Sep;105(9):1094-9
pubmed: 27272911
J Clin Ethics. 2009 Winter;20(4):330-42
pubmed: 20120853
BMC Med Ethics. 2017 Feb 20;18(1):14
pubmed: 28219363
Nurs Ethics. 2019 Apr 11;:969733019832941
pubmed: 30975034
Nurs Forum. 2018 Apr;53(2):259-266
pubmed: 29034962
Soc Work Health Care. 2008;46(3):29-51
pubmed: 18551828
J Nurs Scholarsh. 2015 Mar;47(2):117-25
pubmed: 25440758
Cancer Nurs. 2017 Mar/Apr;40(2):E47-E57
pubmed: 27044058
Pediatr Blood Cancer. 2010 Sep;55(3):478-84
pubmed: 20658619
J Pediatr Nurs. 2015 Nov-Dec;30(6):908-14
pubmed: 25869472
Arch Dis Child Fetal Neonatal Ed. 2018 Sep;103(5):F441-F445
pubmed: 28970316