Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy

Papathanassoglou, Elizabeth De; Karanikola, Maria N.K.; Albarran, John; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z.

Abstract

Aim: To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Background: Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. Methods: A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. Results: The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001). Conclusion: Moral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Implications for nursing management: Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.

• Journal Article Type: Article
• Publication Date: Jan 1, 2014
• Journal: Journal of Nursing Management
• Print ISSN: 0966-0429
• Electronic ISSN: 1365-2834
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 4
• Pages: 472-484
• DOI: https://doi.org/10.1111/jonm.12046
• Keywords: moral distress, intensive care, autonomy, intensive care nurses
• Public URL: https://uwe-repository.worktribe.com/output/818162
• Publisher URL: http://dx.doi.org/10.1111/jonm.12046
• Additional Information: Additional Information : Article first published online: 14 MAR 2013