Contenuto dell'articolo principale
Abstract
RIASSUNTO
Il fenomeno del distress morale nella pratica infermieristica è descritto come una situazione di sofferenza che sorge quando l'infermiere riconosce l'azione eticamente appropriata da adottare e tuttavia impedimenti istituzionali gli rendono impossibile seguire il giusto corso d'azione. L'obiettivo è descrivere situazioni di pratica infermieristica che generano distress morale a causa dell'impossibilití di intraprendere l'azione riconosciuta come eticamente appropriata; descrivere come gli infermieri gestiscono tali situazioni e le strategie identificate per affrontarle. È stato svolto un focus group in tre reparti di un grande ospedale del nord Italia. In un quarto reparto agli infermieri è stato chiesto di scrivere un'esperienza di distress morale. Sono stati coinvolti 40 infermieri e raccolte 50 esperienze. Dall'analisi delle esperienze sono emersi 5 ambiti fonte di distress morale: 1) decisione clinica; 2) competenze infermieristiche; 3) collaborazione infermiere-medico; 4) organizzazione dell'assistenza; 5) cure sicure. Per ogni ambito sono stati individuati i temi più frequentemente ricorrenti nelle narrazioni. Gli ambiti della collaborazione infermiere-medico, delle competenze infermieristiche e dell'organizzazione dell'assistenza impegnano i nurse leader nella identificazione e attuazione di strategie di intervento per la gestione del distress morale. Parole chiave: distress etico, distress morale, infermiere clinico ospedaliero, pratica infermieristica, etica
ABSTRACT
Moral distress in nursing practice is described as a suffering situation that arises when the nurse is unable to act her/his ethical choices, when institutional constraints interfere with acting in the way she/he believes to be right. The aim is to describe nursing practice situations causing moral distress resulting from the recognition of the ethical appropriate actions combined with the impossibility to pursue it; to describe how nurses manage moral distress situations and the strategies to cope with them. A focus group was conducted in three wards of a large teaching-hospital in the north of Italy. In another ward the nurses were asked to write a moral distress experience. A total of 40 nurses were involved and 50 experiences collected. The experiences' analysis has shown 5 source areas of moral distress: 1) clinical decision; 2) nursing competences; 3) nurse-physician collaboration; 4) organization of care; 5) safe care. For each area the most frequent themes were highlighted.Areas of clinical decision, nursing competences, nurse-physician collaboration involve nurse leaders in identification and implementation of strategies for managing moral distress.
Key words: Moral/ethical distress, hospital nursing staff, nursing practice, ethics
Dettagli dell'articolo
Riferimenti
- American Association of Critical Care Nurses (2008). Position Statement - Moral Distress. Data accesso 1 Febbraio, 2011. Da http://www.aacn.org/wd/
- practice/ content/publicpolicy/publicpolicy-positionstatement.pcms?menu=practice
- Canadian Nurses Association (2003). Ethical distress in health care environments. Data accesso 1 Febbraio, 2011. Da http://www.cna nurses.ca/CNA/practice
- /ethics/code/resources/default_e.aspx
- Codice Deontologico del Consiglio Internazionale degli Infermieri (2006). Data accesso 25 Febbraio, 2011. Da http://www.icn.ch/images/stories/documents/about/icncode_italian.pdf
- Corley, M.C. (1995). Moral distress of critical care nurses. American Journal of Critical Care, 4(4), 280-5.
- Corley, M.C., Elswick, R.K., Gorman, M., Clor, T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250-6.
- Corley, M.C. (2002). Nurse moral distress: a proposed theory and research agenda. Nursing Ethics, 9(6), 636-50.
- Corley, M.C., Minick, P., Elswick, R.K., Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381-90.
- Elpern, H.E., Covert, B., Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American of Journal Critical Care, 14(6), 523-30.
- European Association for Palliative Care (2001). Data accesso 14 Aprile, 2011. Da www.sicp.it/documenti_pubblici/...sicp/raccomandazioni_EAPC.pdf
- Gutierrez, K.M. (2005). Critical care nurses' perceptions of and responses to moral distress. Dimensions of Critical Care Nursing, 24(5), 229-41.
- Jameton, A. (1984). Nursing Practice: the Ethical Issues. Prentice Hall: Englewood Cliffs.
- Lí¼tzén, K., Cronqvist, A., Magnusson, A., Andersson, L. (2003). Moral stress: synthesis of a concept. Nursing Ethics, 10(3), 312-22.
- Mobley, M.J., Rady, M.Y., Verheijde, J.L., Patel, B., Larson, J.S. (2007). The relationship between moral distress and the perception of futile care in the critical care unit. Intensive Critical Care Nursing, 23, 256-63.
- Organizzazione Mondiale della Sanití (1986). Data accesso 14 Aprile, 2011. Da http://www.euro.who.int/en/what-we-do/health-topics/noncommunicable-diseases/cancer/policy/palliative-care
- Pauly, B., Varcoe, C., Storch, J., Newton, L. (2009). Registered nurses' perceptions of moral distress and ethical climate. Nursing Ethics, 16(5), 561-73.
- 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 acute tertiary care hospital. Journal Nursing Management, 16(3), 360-73.
- Rittenmeyer, L., Huffman, D. (2008). How professional nurses working in hospital environments experience moral distress: a systematic review. Data accesso 1 Febbraio, 2011. Da www.joannabriggs.edu.au/events/.../docs/
- .../1300-%20L%20Rittenmeyer.pdf
- Saiani, L., Brugnolli, A., Ghitti, M.G., Martin, S., Rinaldi, N., Zannini, L. (2010). L'assistenza infermieristica durante la notte: revisione narrativa della letteratura. Assistenza Infermieristica e Ricerca, 29(3), 132-9.
- Schluter, J., Winch, S., Holzhauser, K., Henderson, A. (2008). Nurses' moral sensitivity and hospital ethical climate: a literature review. Nursing Ethics, 15(3), 304-21.
- Webster, G.C., Baylis, F.E. (2000). Moral residue. In: Rubin, S.B., Zoloth, L. Margin of error. The ethics of mistakes in the practice of medicine. Hagerstown: MD University Publishing Group, 217-32.
- Wilkinson, J.M. (1987). Moral distress in nursing: experience and effect. Nursing Forum, 23(1), 16-29.
- Zuzelo, P.R. (2007). Exploring the moral distress of registered nurses. Nursing Ethics, 14(3), 344-359.
Riferimenti
American Association of Critical Care Nurses (2008). Position Statement - Moral Distress. Data accesso 1 Febbraio, 2011. Da http://www.aacn.org/wd/
practice/ content/publicpolicy/publicpolicy-positionstatement.pcms?menu=practice
Canadian Nurses Association (2003). Ethical distress in health care environments. Data accesso 1 Febbraio, 2011. Da http://www.cna nurses.ca/CNA/practice
/ethics/code/resources/default_e.aspx
Codice Deontologico del Consiglio Internazionale degli Infermieri (2006). Data accesso 25 Febbraio, 2011. Da http://www.icn.ch/images/stories/documents/about/icncode_italian.pdf
Corley, M.C. (1995). Moral distress of critical care nurses. American Journal of Critical Care, 4(4), 280-5.
Corley, M.C., Elswick, R.K., Gorman, M., Clor, T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250-6.
Corley, M.C. (2002). Nurse moral distress: a proposed theory and research agenda. Nursing Ethics, 9(6), 636-50.
Corley, M.C., Minick, P., Elswick, R.K., Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381-90.
Elpern, H.E., Covert, B., Kleinpell, R. (2005). Moral distress of staff nurses in a medical intensive care unit. American of Journal Critical Care, 14(6), 523-30.
European Association for Palliative Care (2001). Data accesso 14 Aprile, 2011. Da www.sicp.it/documenti_pubblici/...sicp/raccomandazioni_EAPC.pdf
Gutierrez, K.M. (2005). Critical care nurses' perceptions of and responses to moral distress. Dimensions of Critical Care Nursing, 24(5), 229-41.
Jameton, A. (1984). Nursing Practice: the Ethical Issues. Prentice Hall: Englewood Cliffs.
Lí¼tzén, K., Cronqvist, A., Magnusson, A., Andersson, L. (2003). Moral stress: synthesis of a concept. Nursing Ethics, 10(3), 312-22.
Mobley, M.J., Rady, M.Y., Verheijde, J.L., Patel, B., Larson, J.S. (2007). The relationship between moral distress and the perception of futile care in the critical care unit. Intensive Critical Care Nursing, 23, 256-63.
Organizzazione Mondiale della Sanití (1986). Data accesso 14 Aprile, 2011. Da http://www.euro.who.int/en/what-we-do/health-topics/noncommunicable-diseases/cancer/policy/palliative-care
Pauly, B., Varcoe, C., Storch, J., Newton, L. (2009). Registered nurses' perceptions of moral distress and ethical climate. Nursing Ethics, 16(5), 561-73.
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 acute tertiary care hospital. Journal Nursing Management, 16(3), 360-73.
Rittenmeyer, L., Huffman, D. (2008). How professional nurses working in hospital environments experience moral distress: a systematic review. Data accesso 1 Febbraio, 2011. Da www.joannabriggs.edu.au/events/.../docs/
.../1300-%20L%20Rittenmeyer.pdf
Saiani, L., Brugnolli, A., Ghitti, M.G., Martin, S., Rinaldi, N., Zannini, L. (2010). L'assistenza infermieristica durante la notte: revisione narrativa della letteratura. Assistenza Infermieristica e Ricerca, 29(3), 132-9.
Schluter, J., Winch, S., Holzhauser, K., Henderson, A. (2008). Nurses' moral sensitivity and hospital ethical climate: a literature review. Nursing Ethics, 15(3), 304-21.
Webster, G.C., Baylis, F.E. (2000). Moral residue. In: Rubin, S.B., Zoloth, L. Margin of error. The ethics of mistakes in the practice of medicine. Hagerstown: MD University Publishing Group, 217-32.
Wilkinson, J.M. (1987). Moral distress in nursing: experience and effect. Nursing Forum, 23(1), 16-29.
Zuzelo, P.R. (2007). Exploring the moral distress of registered nurses. Nursing Ethics, 14(3), 344-359.