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Evaluating Moral Distress, Moral Distress Residue and Moral Courage in Oncology Nurses
Title
Evaluating Moral Distress, Moral Distress Residue and Moral Courage in Oncology Nurses.
Creator
Melhado, Lolita, Chase, Susan, Conner, Norma, Loerzel, Victoria, Uddin, Nizam, Haley, William, University of Central Florida
Abstract / Description
Purpose: To examine relationships between moral distress, moral distress residue, and moral courage and to determine which nurse characteristics are predictive of moral distress and moral courage.Methods: The study used a mixed methods cross-sectional correlation design and qualitative content analysis to investigate oncology nurses' characteristics and relationships between moral distress, moral distress residue, and moral courage. A convenience sample of 187 oncology nurses working in...
Show morePurpose: To examine relationships between moral distress, moral distress residue, and moral courage and to determine which nurse characteristics are predictive of moral distress and moral courage.Methods: The study used a mixed methods cross-sectional correlation design and qualitative content analysis to investigate oncology nurses' characteristics and relationships between moral distress, moral distress residue, and moral courage. A convenience sample of 187 oncology nurses working in inpatient and outpatient settings was recruited through the national Oncology Nursing Society in the Southeastern United States. Hamric's 21-item Moral Distress Scale-Revised (MDS-R) and Sekerka et al. 15-item Professional Moral Courage Scale (PMCS) supplemented with written examples of moral courage were used for data collection. Descriptive statistics, independent-samples t test, Pearson correlation, ANOVA, and multiple regressions analyses were used to evaluate data.Findings: MDS-R scores were not predictive of PMCS scores. No statistically significant differences were found between nurses' characteristics (age, education level, certification, ELNEC training) and MDS-R. Though nurses with BSN had higher Moral Distress scores compared with other levels of education, none were predictors of MDS-R. ANOVA results indicate a marginal but not significant difference of the MDS-R score among the nurses with different basic ethics education (p = .067). Nurses working in adult inpatient settings had significantly higher MDS-R than those in outpatient settings. Nurses who had moral distress residue by virtue of leaving a previous job (26%) and those who considered leaving (28%) reported statistically significantly higher mean Moral Distress levels than those who had not considered leaving. Nurses (17%) currently considering leaving their jobs due to the way patient care was handled at their institutions had the highest Moral Distress mean scores and the lowest Professional Moral Courage scores. Work setting and having left a previous job were weak predictors of MDS-R, accounting for 11.6% of the moral distress score variance (p = .013) compared with 4.4% when work setting was a single predictor (p = .014). Total years' oncology experience was a weak predictor of PMCS, accounting for 2.5% or an inconsequential amount of the variance (p = .043). Moral courage was displayed in major areas of supporting the patient, risk taking, advocacy, enlarging the circle for decision-making, putting aside personal beliefs, respecting patient autonomy, empowering the patient, fighting for the patient in face of consequences in a complex system, sharing information, getting to the meaning, handling tricky situations, protecting the patient and truth-telling.Discussion/Implication: Despite experiencing levels of moral distress, oncology nurses demonstrate support and respect for patients' decision-making and autonomy. Ethics education derived from clinical practice can provide an opportunity for open discussion for nurses to create and maintain morally acceptable work environments that enable them to be morally courageous. This research underscores the presence of moral distress and moral distress residue among oncology nurses and the importance of finding ways to lessen moral distress and strengthen moral courage in nurses.
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Date Issued
2016
Identifier
CFE0006142, ucf:51175
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006142
EVALUATING INTERVENTIONS TO MITIGATE COMPASSION FATIGUE AMONG AT-RISK NURSING POPULATIONS
Title
EVALUATING INTERVENTIONS TO MITIGATE COMPASSION FATIGUE AMONG AT-RISK NURSING POPULATIONS.
Creator
Derayunan, Emily R, Andrews, Diane, University of Central Florida
Abstract / Description
This thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of...
Show moreThis thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of managerial support and organizational commitment contribute to the experience of compassion fatigue. An organization's involvement in maximizing compassion satisfaction through meaningful recognition of nurses' contributions to care and implementation of organizational prevention programs minimizes the risk of developing compassion fatigue. Once self-recognition by nurses and organizations participation level in mitigating compassion fatigue is addressed, interventions can be implemented to attenuate the experience of compassion fatigue. Resiliency programs and mindfulness-based interventions were efficacious in mitigating compassion fatigue.
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Date Issued
2019
Identifier
CFH2000469, ucf:45723
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH2000469
NURSING KNOWLEDGE AND PERCEIVED COMFORT LEVEL IN ACUTE INFUSION REACTIONS FROM ANTINEOPLASTIC AGENTS
Title
NURSING KNOWLEDGE AND PERCEIVED COMFORT LEVEL IN ACUTE INFUSION REACTIONS FROM ANTINEOPLASTIC AGENTS.
Creator
Maiorini, Andrea L, Loerzel, Victoria, University of Central Florida
Abstract / Description
INTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused...
Show moreINTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused by antineoplastic agents. METHODOLOGY: An original survey was created to test nursing knowledge and assess comfort level. Nursing knowledge was broken down into six subscales: general knowledge of acute infusion reactions, signs and symptoms of hypersensitivity, anaphylaxis, and cytokine release infusion reaction, and drugs most likely to cause hypersensitivity and anaphylactic reactions and cytokine release infusion reactions. Comfort questions were asked on a 6-point Likert scale from extremely uncomfortable to extremely comfortable. There was an additional section in the survey related to nurses' distress and support in situations with acute infusion reactions. The questions were presented using a 6-point Likert scale ranging from strongly disagree to strongly agree. There were two open-ended questions that were designed to allow the nurses to share any additional information about their experiences with acute infusion reactions. Oncology nurses working with adults and pediatric populations were invited to participate. Descriptive statistics were used to analyze the survey results. T tests were used to compare groups and Pearson R statistics were used to examine relationships between total knowledge, knowledge subscale score, and comfort level. RESULTS: 20 nurses completed the survey. 12 were from the adult nurse population and 8 were from the pediatric nurse population. The typical participant was forty-four years of age, had sixteen years experience as a Registered Nurse, and thirteen years experience in the oncology setting. The average total knowledge score was a 56% based on 84 possible points. The basic knowledge section and the anaphylactic signs and symptoms were the highest scoring subscales, both scoring a 62%. Cytokine release infusion reaction signs and symptoms was the lowest scoring subscale with a 45%. There were no significant differences in knowledge between groups. The nurses chose an overwhelming agree/strongly agree when asked to choose the signs and symptoms related to each type of infusion reaction. The total comfort level score indicated that nurses were very comfortable managing acute reactions. There was no significant difference between the adult and pediatric setting comfort level scores. There was no statistically significant relationship between total knowledge score and total comfort level score. DISCUSSION: The knowledge score showed knowledge deficits while the comfort score indicated confidence in management of acute infusion reactions. The high frequency of agree/strongly agree for all three subscales of signs and symptoms indicates that the nurses at least know what to look for even if they cannot assign the specific sign and symptom to the type of infusion reaction. Knowledge about signs of specific types of drug reactions may not be necessary as long as a basic understanding of what to look for and how to manage a reaction is present.
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Date Issued
2016
Identifier
CFH2000077, ucf:45564
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH2000077
EDUCATION FOR PEDIATRIC ONCOLOGY NURSES ON FERTILITY PRESERVATION OF PEDIATRIC ONCOLOGY PATIENTS
Title
EDUCATION FOR PEDIATRIC ONCOLOGY NURSES ON FERTILITY PRESERVATION OF PEDIATRIC ONCOLOGY PATIENTS.
Creator
Breit, Elyse, Loerzel, Victoria, University of Central Florida
Abstract / Description
Although the survival rate of childhood cancer is high, nearly two thirds of these survivors experience negative long-term secondary side effects from cancer treatments. Infertility is one such side effect that can have a prominent impact on quality of life as the patient ages. It is important for nurses working with pediatric oncology patients to provide the patient and family with education about risk for infertility and fertility preservation (FP) in order to allow families to make...
Show moreAlthough the survival rate of childhood cancer is high, nearly two thirds of these survivors experience negative long-term secondary side effects from cancer treatments. Infertility is one such side effect that can have a prominent impact on quality of life as the patient ages. It is important for nurses working with pediatric oncology patients to provide the patient and family with education about risk for infertility and fertility preservation (FP) in order to allow families to make decisions about FP before cancer treatment starts. However, pediatric oncology nurses report being uneducated about FP guidelines and are hesitant to broach this subject with families. The purpose of this HIM thesis is to review nurse perceived barriers related to educating patients and their families about the risk for infertility following cancer treatments and FP and to make recommendations for improving communication between nurses and families about FP. A search was performed using CINAHL, PreCINAHL, PsychINFO, PsychARTICLES, and Medline databases and examined peer-reviewed quantitative and qualitative research studies. Key terms used in the database searches were ped* OR child*, onco* OR cancer*, fert*, and nurs*. Findings indicated that there were many barriers for pediatric oncology nurses, which inhibited the discussion of FP with patients and families such as lack of knowledge and resources, provider attitudes toward FP, and patient factors. Based on the findings, the researcher identified several interventions to aid pediatric oncology nurses in overcoming these barriers to FP discussion.
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Date Issued
2014
Identifier
CFH0004620, ucf:45295
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004620
NURSING INTERVENTIONS THAT FACILITATE END-OF-LIFE DECISION-MAKING IN PEDIATRIC ONCOLOGY
Title
NURSING INTERVENTIONS THAT FACILITATE END-OF-LIFE DECISION-MAKING IN PEDIATRIC ONCOLOGY.
Creator
Baeringer, Lauren, Wink, Diane, University of Central Florida
Abstract / Description
Nearly one-third of all pediatric oncology patients die from their disease, so nurses need to have an evidence-based standard of practice to guide their role in end-of-life decision-making. The purpose of this integrative review is to analyze current research on end-of-life decision-making within pediatric oncology to create a practice guideline for nurses working with this patient population. Eleven studies were examined to identify nursing interventions regarding the role of the nurse in...
Show moreNearly one-third of all pediatric oncology patients die from their disease, so nurses need to have an evidence-based standard of practice to guide their role in end-of-life decision-making. The purpose of this integrative review is to analyze current research on end-of-life decision-making within pediatric oncology to create a practice guideline for nurses working with this patient population. Eleven studies were examined to identify nursing interventions regarding the role of the nurse in end-of-life care, the role of the nurse in end-of-life decision-making, parent involvement in end-of-life decision-making, and child involvement in end-of-life decision-making, including the child's ability to participate in end-of-life decision-making. Based on the findings, the researcher identified several interventions that can be used by nurses to facilitate end-of-life discussion and decision-making that includes both parent and, when appropriate, the child.
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Date Issued
2013
Identifier
CFH0004443, ucf:45081
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004443