Assessment of Moral Distress in Respiratory Therapists Öffentlichkeit
Timmer, Marjorie (2014)
Published
Abstract
Moral distress (Md) is the psychological disequilibrium experienced when one perceives the right moral action to take but is constrained from taking that action. Only one study has focused specifically on Md among respiratory therapists (RTs). Research demonstrates a correlation between Md and perception of workplace ethical climate (PEC). It is important to study this problem in all health care workers (HCWs) because, left unaddressed, Md may result in adverse emotional and physical symptoms, increased risk of burnout, and loss of HCWs from the workforce. Existing surveys may underestimate Md in non-nursing HCWs.
Five RT-specific survey items were designed for and administered to RTs along with a validated Md instrument (MDS-R) that has been utilized in nursing research. Survey reliability was assessed with calculation of Cronbach's alpha. Statistical analyses were performed on 1) moral distress index (MdI) measured with and without RT-specific survey items; 2) MdI in RTs who had left or considered leaving a clinical position because of Md versus RTs who had not done so; and 3) the relationship between Md and the PEC.
Cronbach's alpha was 0.898. Two of the five RT-specific Md survey items demonstrated construct validity with two recent studies in RTs. The MdI measured using the revised survey was significantly higher than that from the MDS-R alone (r = .982, p < 0.001). The MdI was significantly higher in RTs who had ever left or considered leaving a position because of their Md than in those who had never done so (p < .021); and among those currently planning versus not planning leave a position (p < 0.001). There was a negative correlation (-0.423) between Md and PEC.
The data supported the hypothesis that augmenting a generic survey with a limited number of discipline-specific items optimized Md assessment in RTs. Correlations reported elsewhere of job attrition and PEC with Md are replicated in this study.
Validation of new survey items should continue. Other HC disciplines are encouraged to develop discipline-specific Md survey items for their constituencies. End-of-life education for RTs and their colleagues is recommended.
Table of Contents
Table of Contents
Chapter One - Study description 1
Introduction 1
Respiratory therapists 1
Moral distress 3
Moral uncertainty, moral dilemma vs. moral distress 4
Root causes of moral distress 4
The "medical hierarchy" 5
End of life care 9
Inappropriate use of resources 10
Conclusion 10
Research questions 11
Chapter Two - Literature review 12
Introduction 12
Defining moral distress 12
Root causes of moral distress 15
Clinical situations 16
External constraints 16
Internal constraints 17
Perception and powerlessness 18
Initial and reactive moral distress 19
Measurement of moral distress 21
M L Raines 21
M C Corley 21
A B Hamric 22
Wocial and Weaver 23
Workplace ethical climate 24
Relationship between moral distress and workplace ethical climate 25
Moral distress in RTs 27
Caplan et al 28
Schwenzer and Wang 30
Allen et al 31
Houston et al 32
Respiratory therapy, moral distress and the Sentimentalist moral theory 33
Professional boundaries 35
RTs and end-of-life care 37
Conclusion 40
Chapter Three - Study Methods 45
Introduction 45
Study methods summary 46
Supplement vs. replace MDS-R 47
Survey development 49
Pilot studies 50
Rationale for survey items 54
Preparations for initiating the survey 58
Data collection 58
Statistical analysis 60
Cronbach's alpha 60
Covariance and correlations 61
Chapter Four - Results 63
Introduction 63
Description of data and statistical tests 63
Cronbach's alpha 64
Descriptive data 64
Comparisons of moral distress index 67
Moral distress vs. intent to leave a position 67
Correlation with workplace ethical climate 69
Answers to research questions 70
Research question #1 70
Research question #2 70
Research question #3 72
Summary of results 75
Chapter Five - Conclusions and Next Steps 87
Introduction 87
Research question #1 87
Research question #2 90
Research question #3 91
Other data 92
Moral Distress and Perception of Workplace Ethical Climate 92
Moral Distress and the Intent to Leave a Clinical Position 92
Conclusion 93
Recommendations for future research 93
Bibliography 96
Non-print citations 102
Illustrations
Tables
Table 2.1. Corley's moral distress factors 22
Table 2.2. Root causes of Moral Distress 42
Table 2.3. Most common sources of moral distress - Schwenzer and Wang 43
Table 2.4. Most common causes of moral distress - Allen et al (2013) 44
Table 3.1. Situations causing moral distress to RTs 50
Table 3.2. Characteristics of pilot participants 51
Table 3.3. Survey distribution 60
Table 4.1. Reliability statistics 76
Table 4.2. Demographic data 64
Table 4.3. Respondents' education 66
Table 4.4. Professional credentials 66
Table 4.5. Hospital type and size 66
Table 4.6. Moral distress score rankings 79
Table 4.7. Moral Distress Index 67
Table 4.8. Moral distress and intent to leave a clinical position 68
Table 4.9. RN, MD, and RT moral distress index comparisons 85
Table 4.10. RT attitudes about terminal extubation 86
Table 5.1. Moral distress sources - comparison to RN studies 95
Table 5.2. Comparisons of moral distress index: Hamric & Corley vs. study data 89
Figures
Figure 2.1. Moral distress index and number of respondents (Allen et al 2013) 43
Figure 4.1. RT age vs. moral distress 65
Figure 4.2. Scatterplot of moral distress vs. PEC scores 69
Figure 4.3. Moral distress, ethical climate and intent or actual decision to resign 77
Figure 4.4. Moral distress, PEC vs. intention to leave 78
Appendices
Moral distress survey: MDS-R, HECS, RT-specific items, Appendix A
and demographic items
Institutional Review Board Letter, July 26, 2013 Appendix B
Institutional Review Board Letter, May 15, 2013 Appendix C
Permission letter via email from Ann Hamric, PhD, RN, FAAN Appendix D
Confirmation of permission via email from A. Hamric Appendix E
Permission letter via email from Linda Olson, PhD, MBA, RN, NEA-BC Appendix F
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