Moral Distress and Intention to Leave Job with the Attitudes Towards Futile Treatments in Nurses: A Cross-Sectional Study

Year 2023, Issue: 3, 9 - 16, 31.10.2023

Dilara Sert Kasım , Fahriye Oflaz

https://doi.org/10.26650/CURARE.2023.1348106

Abstract

Objective: This study aimed to evaluate the relationship between attitudes toward futile treatments, moral distress, and intention to leave the job of nurses.
Materials And Methods: This study has a descriptive and correlational design and was carried out with 425 nurses in April-May 2021 in Istanbul. The data were collected using a Personal Information Form, The Nurses’ Attitudes Towards Futile Treatment Scale, the Moral Distress Scale, and the Intention to Leave Scale. Data analysis includes the Kruskal Wallis test, independent samples t-test, ANOVA, and regression analyses.
Results: More than half of nurses (51.4%) had never heard of the “futile treatment” concept. The Nurses’ Attitudes Towards Futile Treatment scores had a positive correlation with Moral Distress scores (r=0.295, p<0.001) and a negative correlation with Intention to Leave scores (r=-0.356, p<0.001). Also, Moral Distress Scores negatively correlated with Intention to Leave scores (r=-0.260, p<0.001).
Conclusion: The moral distress seemed related to practicing futile treatments. Considering these results, it’s thought that the protocols that hospitals will prepare for futile practices will be an essential step in preventing ethical dilemmas and moral distress experienced by nurses.

Keywords

Attitude, ethics, nurse, futile treatment, moral distress, intention to leave

References

• Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: Responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med. 2015;191(11):1318-30. https://doi.org/10.1164/rccm.201505-0924ST. google scholar
• Lambden JP, Chamberlin P, Kozlov E, Lief L, Berlin DA, Pelissier LA, et al. Association of perceived futile or potentially inappropriate care with burnout and thoughts of quitting among health-care providers. Am J Hosp Palliat Care 2019;36(3):200-6. https://doi.org/10.1177/1049909118792517. google scholar
• Vieira JV, Deodato S, Mendes F. Perceptions of intensive care unit nurses of therapeutic futility: A scoping review. Clinical Ethics 2021;16(1):17-24. https://doi. org/10.1177/1477750920930376. google scholar
• Yıldırım G, Karagözoğlu S, Özden D, Çınar Z, Özveren H. A scale-development study: Exploration of intensive-care nurses’ attitudes towards futile treatments. Death Stud. 2019;43(6):397-405. https://doi.org/10.1080/07481187.2018.1479470. google scholar
• Kim SC, Quiban C, Sloan C, Montejano A. Predictors of poor mental health among nurses during COVID-19 pandemic. Nurs Open 2021;8(2):900-907. https://doi.org/10.1002/nop2.697. google scholar
• Kim Y, Oh Y, Lee E, Kim SJ. Impact of nurse-physician collaboration, moral distress, and professional autonomy on job satisfaction among nurses acting as physician assistants. Int J Environ Res Public Health 2022;19(2):661. https://doi. org/10.3390/ijerph19020661. google scholar
• Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J Ethics 2017;19(6):617-28. https://doi.org/10.1001/journalofethics.2017. google scholar
• Sannino P, Giannı ML, Re LG, Lusignani M. Moral distress in the neonatal intensive care unit: An Italian study. J Perinatol. 2015;35(3):214-7. https://doi.org/10.1038/jp.2014.182. google scholar
• Lewis SL. Emotional intelligence in neonatal intensive care unit nurses: Decreasing moral distress in end-of-life care and laying a foundation for improved outcomes: An integrative review. J Hosp Palliat Nurs. 2019;21(4):250-6. https://doi.org/10.1097/ NJH.0000000000000561. google scholar
• Maluwa VM, Andre J, Ndebele P, Chilemba E. Moral distress in nursing practice in Malawi. Nurs Ethics 2012;19(2):196-207. https://doi.org/10.1177/0969733011414968. google scholar
• Nikbakht Nasrabadi A, Wibisono AH, Allen KA, Yaghoobzadeh A, Bit-Lian Y. Exploring the experiences of nurses’ moral distress in long-term care of older adults: A phenomenological study. BMC Nurs. 2021;20(1):156. https://doi.org/10.1186/s12912-021-00675-3. google scholar
• Romero-Garda M, Delgado-Hito P, Galvez-Herrer M, Angel-Sesmero JA, Velasco-Sanz TR, Benito-Aracil L, Heras-La Calle G. Moral distress, emotional impact and coping in intensive care unit staff during the outbreak of COVID-19. Intensive Crit Care Nurs. 2022;70:103206. https://doi.org/10.1016/j. iccn.2022.103206. google scholar
• Wiegand DL, Funk M. Consequences of clinical situations that cause critical care nurses to experience moral distress. Nurs Ethics 2012;19(4):479-87. https://doi.org/ 10.1177/0969733011429342. google scholar
• Henrich NJ, Dodek PM, Gladstone E, Alden L, Keenan SP, Reynolds S, Rodney P. Consequences of moral distress in the intensive care unit: A qualitative study. Am J Crit Care 2017;26(4):e48-e57. https://doi.org/10.4037/ajcc2017786. google scholar
• Cavaliere TA, Daly B, Dowling D, Montgomery K. Moral distress in neonatal intensive care unit RNs. Adv Neonatal Care 2010;10(3):145-56. https://doi.org/10.1097/ANC.0b013e3181dd6c48. google scholar
• Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res. 2012;3(2):1-9. https://doi.org/10. 1080/21507716.2011.652337. google scholar
• Laurs L, Blazeviciene A, Capezuti E, Milonas D. Moral Distress and Intention to Leave the Profession: Lithuanian Nurses in Municipal Hospitals. J Nurs Scholarsh 2020;52(2):201-9. doi: https://doi.org/10.1111/jnu.12536. google scholar
• Karagözoğlu Ş, Yıldırım G, Özden D, Çınar Z. Moral distress in Turkish intensive care nurses. Nurs Ethics 2017;24(2):209-24. https://doi.org/10.1177/0969733015593408. google scholar
• Wayne SJ, Shore LM, Liden RC. Perceived organizational support and leader-member exchange: A social exchange perspective. Academy of Management Journal 1997;40(1):82-111. https:// doi.org/10.2307/257021. google scholar
• Avcı N, Küçükusta D. The analysis of the relationship among organizational learning, organizational commitment and tends to leave in hotels [Konaklama işletmelerinde örgütsel öğrenme, örgütsel bağlılık ve işten ayrılma eğilimi arasındaki ilişki]. Anatolia: Journal of Tourism Research 2009;20(1), 33-44. https://dergipark.org.tr/tr/pub/atad/issue/16797/174482 google scholar
• Özden D, Karagözoğlu Ş, Yıldırım G. Intensive care nurses’ perception of futility: Job satisfaction and burnout dimensions. Nurs Ethics 2013;20(4):436-47. https://doi. org/10.1177/0969733012466002. google scholar
• Altınayak SÖ, Özorhan EY, Apay SE. Futile care in newborn [Yenidoğanda yararsiz bakım]. Journal of Anatolia Nursing and Health Sciences 2016;19(4): 292-7. Available from: https:// dergipark.org.tr/tr/pub/ataunihem/issue/27668/291666 google scholar
• Orkun N, Eşer İ, Çetin P. Intensive care nurses’ opinions of futile treatment and its administration [Yoğun Bakım Birimlerinde Çalışan Hemşirelerin Yararsız Tedavi ve Uygulamalara İlişkin Görüşleri]. Journal of Ege University Nursing Faculty 2018;34(1), 79-90. Available from: https://dergipark.org.tr/tr/pub/ egehemsire/issue/36787/391979 google scholar
• Neuberg GW. The cost of end-of-life care. Circulation: Cardiovascular quality and outcomes 2009;2(2):127-33. https:// doi.org/10.1161/CIRCOUTCOMES.108.829960. google scholar
• Özden D, Karagözoğlu Ş, Tel Aydin H, Tabak E. Opinions of nurses working at critical care units on futility in therapy and practice [Yoğun bakım ünitesinde çalışan hemşirelerin yararsız tedavi ve uygulamaya ilişkin görüşleri]. Journal of Research and Development in Nursing 2012;14(1), 1-10. Available from: https://dergipark.org.tr/tr/pub/hemarge/issue/52723/695421 google scholar
• Müller R, Kaiser S. Perceptions of medical futility in clinical practice - A qualitative systematic review. J Crit Care 2018;48:78-84. https://doi.org/10.1016/j.jcrc.2018.08.008. google scholar
• Piers RD, Van den Eynde M, Steeman E, Vlerick P, Benoit DD, Van Den Noortgate NJ. End-of-life care of the geriatric patient and nurses’ moral distress. J Am Med Dir Assoc. 2012;13(1):80 e7-13. https://doi.org/10.1016/j.jamda.2010.12.014. google scholar
• Stewart C. Futility determination as a process: Problems with medical sovereignty, legal issues and the strengths and weakness of the procedural approach. J Bioethical Inq. 2011;8(2):155-63. https://doi.org/10.1007/s11673-011-9297-z. google scholar
• Colville GA, Dawson D, Rabinthiran S, Chaudry-Daley Z, Perkins-Porras L. A survey of moral distress in staff working in intensive care in the UK. J Intensive Care Soc. 2019;20(3):196-203. https:// doi.org/10.1177/1751143718787753. google scholar
• Şeko Ö. The effect of moral distress experienced by intensive care unit nurses on job satisfaction and turnover intent. [Yoğun bakım hemşirelerinin yaşadığı ahlaki sıkıntı durumunun iş doyumu ve işten ayrılma niyeti üzerine etkisi dissertation on the internet]. 2019: Okan University, Istanbul. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=nj0fXlFg UHcFUb2gW7QDXA&no=OPaFNKU7m3CvI83JlX0uTw google scholar
• Dyo M, Kalowes P, Devries J. Moral distress and intention to leave: A comparison of adult and pediatric nurses by hospital setting. Intensive Crit Care Nurs. 2016;36:42-8. https://doi. org/10.1016/j.iccn.2016.04.003. google scholar
• Rostami S, Esmaeali R, Jafari H, Cherati JY. Perception of futile care and caring behaviors of nurses in intensive care units. Nurs Ethics 2019;26(1):248-55. https://doi. org/10.1177/0969733017703694. google scholar Banner P. From Novice to Expert. 9th ed. New Jersey: Pearson; 2000. google scholar
• Chapman R, Styles I, Perry L, Combs S. Nurses’ experience of adjusting to workplace violence: A theory of adaptation. Int J Ment Health Nurs. 2010;19(3):186-94. https://doi.org/10.1111/ j.1447-0349.2009.00663.x. google scholar
• Asayesh H, Mosavi M, Abdi M, Masoud MP, Jodaki K. The relationship between futile care perception and moral distress among intensive care unit nurses. J Med Ethics Hist Med. 2018;7:11-2. google scholar
• Hsu MY, Su SF, Chiang LY, Shih SJ, Chen YC. The medical futility experience of nurses in caring for critically ill patients. J Nurs Res. 2018;26(2):80-7. https://doi.org/10.1097/ google scholar