Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis.
Moral courage
Moral distress
Moral injury
Moral resilience
Nurses
Journal
Journal of religion and health
ISSN: 1573-6571
Titre abrégé: J Relig Health
Pays: United States
ID NLM: 2985199R
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
accepted:
03
07
2023
medline:
29
11
2023
pubmed:
14
7
2023
entrez:
13
7
2023
Statut:
ppublish
Résumé
Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.
Identifiants
pubmed: 37442900
doi: 10.1007/s10943-023-01873-w
pii: 10.1007/s10943-023-01873-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3957-3978Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Antonsdottir, I., Rushton, C. H., Nelson, K. E., Heinze, K. E., Swoboda, S. M., & Hanson, G. C. (2022). Burnout and moral resilience in interdisciplinary healthcare professionals. Journal of Clinical Nursing, 31(1–2), 196–208. https://doi.org/10.1111/jocn.15896
doi: 10.1111/jocn.15896
pubmed: 34145678
Baele, C. A., & Fontaine, J. R. J. (2021). The moral distress-appraisal scale: Scale development and validation study. Journal of Advanced Nursing, 77(10), 4120–4130. https://doi.org/10.1111/jan.14923
doi: 10.1111/jan.14923
pubmed: 34171142
Bandyopadhyay, S., Baticulon, R. E., Kadhum, M., Alser, M., Ojuka, D. K., Badereddin, Y., Kamath, A., Parepalli, S. A., Brown, G., Iharchane, S., Gandino, S., Markovic-Obiago, Z., Scott, S., Manirambona, E., Machhada, A., Aggarwal, A., Benazaize, L., Ibrahim, M., Kim, D., … Khundkar, R. (2020). Infection and mortality of healthcare workers worldwide from COVID-19: A systematic review. BMJ Global Health, 5(12), e003097. https://doi.org/10.1136/bmjgh-2020-003097
doi: 10.1136/bmjgh-2020-003097
pubmed: 33277297
Beck, C. T. (2022). Secondary qualitative analysis of moral injury in obstetric and neonatal nurses. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN, 51(2), 166–176. https://doi.org/10.1016/j.jogn.2021.12.003
doi: 10.1016/j.jogn.2021.12.003
pubmed: 35114167
Brady, C., Fenton, C., Loughran, O., Hayes, B., Hennessy, M., Higgins, A., Leroi, I., Shanagher, D., & McLoughlin, D. M. (2021). Nursing home staff mental health during the Covid-19 pandemic in the Republic of Ireland. International Journal of Geriatric Psychiatry, 37(1), 1–19. https://doi.org/10.1002/gps.5648
doi: 10.1002/gps.5648
Buchan, J., & Catton, H. (2023). Recover to rebuild: Investing in the nursing workforce for health system effectiveness. International Council of Nurses. https://www.icn.ch/system/files/2023-03/ICN_Recover-to-Rebuild_report_EN.pdf
Carey, L. B., Hodgson, T. J., Krikheli, L., Soh, R. Y., Armour, A. R., Singh, T. K., & Impiombato, C. G. (2016). Moral injury, spiritual care and the role of chaplains: An exploratory scoping review of literature and resources. Journal of Religion and Health, 55(4), 1218–1245. https://doi.org/10.1007/s10943-016-0231-x
doi: 10.1007/s10943-016-0231-x
pubmed: 27094705
Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021). Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics, 28(5), 590–602. https://doi.org/10.1177/0969733020966776
doi: 10.1177/0969733020966776
pubmed: 33427020
pmcid: 8366182
Delgado, C., Upton, D., Ranse, K., Furness, T., & Foster, K. (2017). Nurses’ resilience and the emotional labour of nursing work: An integrative review of empirical literature. International Journal of Nursing Studies, 70, 71–88. https://doi.org/10.1016/j.ijnurstu.2017.02.008
doi: 10.1016/j.ijnurstu.2017.02.008
pubmed: 28235694
Ducharlet, K., Trivedi, M., Gelfand, S. L., Liew, H., McMahon, L. P., Ashuntantang, G., Brennan, F., Brown, M., & Martin, D. E. (2021). Moral distress and moral injury in nephrology during the COVID-19 pandemic. Seminars in Nephrology, 41(3), 253–261. https://doi.org/10.1016/j.semnephrol.2021.05.006
doi: 10.1016/j.semnephrol.2021.05.006
pubmed: 34330365
pmcid: 8820914
Escolar-Chua, R. L. (2018). Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nursing Ethics, 25(4), 458–469. https://doi.org/10.1177/0969733016654317
doi: 10.1177/0969733016654317
pubmed: 27364536
Escolar-Chua, R. L., & Magpantay, J. C. J. (2019). Moral distress of undergraduate nursing students in community health nursing. Nursing Ethics, 26(7–8), 2340–2350. https://doi.org/10.1177/0969733018819130
doi: 10.1177/0969733018819130
pubmed: 30590994
Gherman, M. A., Arhiri, L., Holman, A. C., & Soponaru, C. (2022). Injurious memories from the COVID-19 frontline: The impact of episodic memories of self-and other-potentially morally injurious events on Romanian nurses’ burnout, turnover intentions and basic need satisfaction. International Journal of Environmental Research and Public Health, 19(15), 9604. https://doi.org/10.3390/ijerph19159604
doi: 10.3390/ijerph19159604
pubmed: 35954961
pmcid: 9368272
Giannetta, N., Villa, G., Bonetti, L., Dionisi, S., Pozza, A., Rolandi, S., Rosa, D., & Manara, D. F. (2022). Moral distress scores of nurses working in intensive care units for adults using Corley’s scale: A systematic review. International Journal of Environmental Research and Public Health, 19(17), 10640. https://doi.org/10.3390/ijerph191710640
doi: 10.3390/ijerph191710640
pubmed: 36078353
pmcid: 9517876
Guttormson, J. L., Calkins, K., McAndrew, N., Fitzgerald, J., Losurdo, H., & Loonsfoot, D. (2022). Critical care nurse burnout, moral distress, and mental health during the COVID-19 pandemic: A United States survey. Heart and Lung: tHe Journal of Critical Care, 55, 127–133. https://doi.org/10.1016/j.hrtlng.2022.04.015
doi: 10.1016/j.hrtlng.2022.04.015
pubmed: 35561589
Guzys, D. (2021). Moral distress: A theorized model of influences to facilitate mitigation and resilience. Nursing and Health Sciences, 23(3), 658–664. https://doi.org/10.1111/nhs.12827
doi: 10.1111/nhs.12827
pubmed: 33683801
Hauhio, N., Leino-Kilpi, H., Katajisto, J., & Numminen, O. (2021). Nurses’ self-assessed moral courage and related socio-demographic factors. Nursing Ethics, 28(7–8), 1402–1415. https://doi.org/10.1177/0969733021999763
doi: 10.1177/0969733021999763
pubmed: 34100317
Heinze, K. E., Hanson, G., Holtz, H., Swoboda, S. M., & Rushton, C. H. (2021). Measuring health care interprofessionals’ moral resilience: Validation of the Rushton moral resilience scale. Journal of Palliative Medicine, 24(6), 865–872. https://doi.org/10.1089/jpm.2020.0328
doi: 10.1089/jpm.2020.0328
pubmed: 33196347
Hodgson, T. J., & Carey, L. B. (2017). Moral injury and definitional clarity: Betrayal, spirituality and the role of chaplains. Journal of Religion and Health, 56(4), 1212–1228. https://doi.org/10.1007/s10943-017-0407-z
doi: 10.1007/s10943-017-0407-z
pubmed: 28526912
Holtz, H., Heinze, K., & Rushton, C. (2018). Interprofessionals’ definitions of moral resilience. Journal of Clinical Nursing, 27(3–4), e488–e494. https://doi.org/10.1111/jocn.13989
doi: 10.1111/jocn.13989
pubmed: 28771909
Hossain, F., & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic. Nursing Ethics, 28(1), 23–32. https://doi.org/10.1177/0969733020961825
doi: 10.1177/0969733020961825
pubmed: 33124492
Hu, K., Liu, J., Zhu, L., & Zhou, Y. (2022). Clinical nurses’ moral courage and related factors: An empowerment perspective. BMC Nursing, 21(1), 321. https://doi.org/10.1186/s12912-022-01093-9
doi: 10.1186/s12912-022-01093-9
pubmed: 36419129
pmcid: 9685865
Huang, M., Dong, W., Zhao, Q., & Mo, N. (2023). Factors associated with the moral courage of nurses in China: A cross-sectional study. Nursing Open. https://doi.org/10.1002/nop2.1672
doi: 10.1002/nop2.1672
pubmed: 37823429
pmcid: 10563427
International Council of Nurses. (2021). The ICN Code of Ethics. Geneva, Switzerland. Retrieved February 26, 2022, from https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf
Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., Haynes, K., Erickson, Z. D., Arnold, I., O’Garo, K., & Pearce, M. (2018). The moral injury symptom scale-military version. Journal of Religion and Health, 57(1), 249–265. https://doi.org/10.1007/s10943-017-0531-9
doi: 10.1007/s10943-017-0531-9
pubmed: 29196962
Jones, K. A., Freijah, I., Carey, L., Carleton, R. N., Devenish-Meares, P., Dell, L., Rodrigues, S., Madden, K., Johnson, L., Hosseiny, F., & Phelps, A. J. (2022). Moral injury, chaplaincy and mental health provider approaches to treatment: A scoping review. Journal of Religion and Health, 61(3), 2632–2633. https://doi.org/10.1007/s10943-022-01560-2
doi: 10.1007/s10943-022-01560-2
pubmed: 35429280
pmcid: 9142428
Kalani, Z., Barkhordari-Sharifabad, M., & Chehelmard, N. (2023). Correlation between moral distress and clinical competence in COVID-19 ICU nurses. BMC Nursing, 22(1), 107. https://doi.org/10.1186/s12912-023-01277-x
doi: 10.1186/s12912-023-01277-x
pubmed: 37029367
pmcid: 10080174
Khoshmehr, Z., Barkhordari-Sharifabad, M., Nasiriani, K., & Fallahzadeh, H. (2020). Moral courage and psychological empowerment among nurses. BMC Nursing, 19, 43. https://doi.org/10.1186/s12912-020-00435-9
doi: 10.1186/s12912-020-00435-9
pubmed: 32489315
pmcid: 7247179
Koenig, H. G., & Al Zaben, F. (2021). Moral injury: An increasingly recognized and widespread syndrome. Journal of Religion and Health, 60(5), 2989–3011. https://doi.org/10.1007/s10943-021-01328-07
doi: 10.1007/s10943-021-01328-07
pubmed: 34245433
pmcid: 8270769
Kubitza, J., Große, G., Schütte-Nütgen, K., & Frick, E. (2023). Influence of spirituality on moral distress and resilience in critical care staff: A scoping review. Intensive and Critical Care Nursing, 76, 103377. https://doi.org/10.1016/j.iccn.2022.103377
doi: 10.1016/j.iccn.2022.103377
pubmed: 36669436
Labrague, L. J., & de Los Santos, J. A. A. (2021). Resilience as a mediator between compassion fatigue, nurses’ work outcomes, and quality of care during the COVID-19 pandemic. Applied Nursing Research: ANR, 61, 151476. https://doi.org/10.1016/j.apnr.2021.151476
doi: 10.1016/j.apnr.2021.151476
pubmed: 34544570
Lopez, S. J., O’Byrne, K. K., & Petersen, S. (2003). Profiling courage. In S. J. Lopez & C. R. Snyder (Eds.), Positive psychological assessment: A handbook of models and measures (pp. 185–197). American Psychological Association. https://doi.org/10.1037/10612-012
doi: 10.1037/10612-012
Mantri, S., Lawson, J. M., Wang, Z., & Koenig, H. G. (2020). Identifying moral injury in healthcare professionals: The moral injury symptom scale-HP. Journal of Religion and Health, 59(5), 2323–2340. https://doi.org/10.1007/s10943-020-01065-w
doi: 10.1007/s10943-020-01065-w
pubmed: 32681398
pmcid: 7366883
Moore, R. C., Straus, E., & Campbell, L. M. (2020). Stress, mental health, and aging. In N. Hantke, A. Etkin, & R. O’Hara (Eds.), Handbook of Mental Health and Aging (pp. 37–58). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-800136-3.00004-1
doi: 10.1016/B978-0-12-800136-3.00004-1
Morley, G., Bradbury-Jones, C., & Ives, J. (2022). The moral distress model: An empirically informed guide for moral distress interventions. Journal of Clinical Nursing, 31(9–10), 1309–1326. https://doi.org/10.1111/jocn.15988
doi: 10.1111/jocn.15988
pubmed: 34423483
Numminen, O., Katajisto, J., & Leino-Kilpi, H. (2019). Development and validation of nurses’ moral courage scale. Nursing Ethics, 26(7–8), 2438–2455. https://doi.org/10.1177/0969733018791325
doi: 10.1177/0969733018791325
pubmed: 30185132
Numminen, O., Repo, H., & Leino-Kilpi, H. (2017). Moral courage in nursing: A concept analysis. Nursing Ethics, 24(8), 878–891. https://doi.org/10.1177/0969733016634155
doi: 10.1177/0969733016634155
pubmed: 27005953
Ortiga, Y. Y., Diño, M. J., & Macabasag, R. L. A. (2022). Clocking out: Nurses refusing to work in a time of pandemic. Social Science and Medicine, 305, 115114. https://doi.org/10.1016/j.socscimed.2022.115114
doi: 10.1016/j.socscimed.2022.115114
pubmed: 35691211
Pajakoski, E., Rannikko, S., Leino-Kilpi, H., & Numminen, O. (2021). Moral courage in nursing: An integrative literature review. Nursing and Health Sciences, 23(3), 570–585. https://doi.org/10.1111/nhs.12805
doi: 10.1111/nhs.12805
pubmed: 33389792
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Wolters Kluwer Health.
Rakhshan, M., Mousazadeh, N., Hakimi, H., & Hosseini, F. A. (2021). Iranian nurses’ views on barriers to moral courage in practice: A qualitative descriptive study. BMC Nursing, 20(1), 221. https://doi.org/10.1186/s12912-021-00728-7
doi: 10.1186/s12912-021-00728-7
pubmed: 34742288
pmcid: 8571867
Robredo, J. P., Ong, B., Eala, M. A., & Naguit, R. J. (2022). Outmigration and unequal distribution of Filipino physicians and nurses: An urgent call for investment in health human resource and systemic reform. The Lancet Regional Health. Western Pacific, 25, 100512. https://doi.org/10.1016/j.lanwpc.2022.100512
doi: 10.1016/j.lanwpc.2022.100512
pubmed: 35845816
pmcid: 9283652
Romero-García, M., Delgado-Hito, P., Gálvez-Herrer, M., Ángel-Sesmero, J. A., Velasco-Sanz, T. R., Benito-Aracil, L., & Heras-La Calle, G. (2022). Moral distress, emotional impact and coping in intensive care unit staff during the outbreak of COVID-19. Intensive and Critical Care Nursing, 70, 103206. https://doi.org/10.1016/j.iccn.2022.103206
doi: 10.1016/j.iccn.2022.103206
pubmed: 35120794
Rushton, C. H. (2018). Moral resilience: Transforming moral suffering in health care. Oxford University Press.
doi: 10.1093/med/9780190619268.001.0001
Sala Defilippis, T. M. L., Curtis, K., & Gallagher, A. (2019). Conceptualising moral resilience for nursing practice. Nursing Inquiry, 26(3), e12291. https://doi.org/10.1111/nin.12291
doi: 10.1111/nin.12291
pubmed: 30817074
Salari, N., Shohaimi, S., Khaledi-Paveh, B., Kazeminia, M., Bazrafshan, M. R., & Mohammadi, M. (2022). The severity of moral distress in nurses: A systematic review and meta-analysis. Philosophy, Ethics, and Humanities in Medicine: PEHM, 17(1), 13. https://doi.org/10.1186/s13010-022-00126-0
doi: 10.1186/s13010-022-00126-0
pubmed: 36348378
pmcid: 9644548
Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Scribner.
Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31, 182–191. https://doi.org/10.1037/a0036090
doi: 10.1037/a0036090
Soper, D. S. (2021). A-priori sample size calculator for multiple regression [Software]. Accessed 8 Oct 2021, from https://www.danielsoper.com/statcalc
Spilg, E. G., Rushton, C. H., Phillips, J. L., Kendzerska, T., Saad, M., Gifford, W., Gautam, M., Bhatla, R., Edwards, J. D., Quilty, L., Leveille, C., & Robillard, R. (2022). The new frontline: Exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatry, 22(1), 19. https://doi.org/10.1186/s12888-021-03637-w
doi: 10.1186/s12888-021-03637-w
pubmed: 34991514
pmcid: 8734541
Stutzer, K., & Rodriguez, A. M. (2020). Moral resilience for critical care nurses. Critical Care Nursing Clinics of North America, 32(3), 383–393. https://doi.org/10.1016/j.cnc.2020.05.002
doi: 10.1016/j.cnc.2020.05.002
pubmed: 32773180
Taber, K. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2
doi: 10.1007/s11165-016-9602-2
Tolksdorf, K. H., Tischler, U., & Heinrichs, K. (2022). Correlates of turnover intention among nursing staff in the COVID-19 pandemic: A systematic review. BMC Nursing, 21(1), 174. https://doi.org/10.1186/s12912-022-00949-4
doi: 10.1186/s12912-022-00949-4
pubmed: 35787700
pmcid: 9252069
Vig, E. K. (2022). As the pandemic recedes, will moral distress continue to surge? American Journal of Hospice and Palliative Medicine, 39(4), 401–405. https://doi.org/10.1177/10499091211030456
doi: 10.1177/10499091211030456
pubmed: 34192886
Wamsley, L. (2017). Utah Nurse Arrested For Doing Her Job Reaches $500,000 Settlement. Retrieved 3 June 2023, accessed from https://www.npr.org/sections/thetwo-way/2017/11/01/561337106/utah-nurse-arrested-for-doing-her-job-reaches-500-000-settlement
Wu, Y., Yu, W., Wu, X., Wan, H., Wang, Y., & Lu, G. (2020). Psychological resilience and positive coping styles among Chinese undergraduate students: A cross-sectional study. BMC Psychology, 8(1), 79. https://doi.org/10.1186/s40359-020-00444-y
doi: 10.1186/s40359-020-00444-y
pubmed: 32762769
pmcid: 7406959
Young, P. D., & Rushton, C. H. (2017). A concept analysis of moral resilience. Nursing Outlook, 65(5), 579–587. https://doi.org/10.1016/j.outlook.2017.03.009
doi: 10.1016/j.outlook.2017.03.009
pubmed: 28434608