Professional nurses’ lived experiences of moral distress at a district hospital

Voget, Ursula (2017-03)

Thesis (MCur)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Background: Nurses have the most contact with patients and are therefore confronted by situations of moral conflict. Since nurses are trained to provide care sustaining life, situations that impede their ability to provide quality care, pose a risk of causing moral distress. Ethical practices are guided by various nursing regulations as well as national and international guidelines. The South African context adds unique stressors to the healthcare system. There is a demand for quality healthcare to be delivered with a budget shortfall of R600 million, coupled with challenges such as the burden of disease, excessive workloads, increased patient deaths, daily exposure to multidrug-resistant tuberculosis (MDR-TB) and a severe shortage of staff along all health professions. The public health sector work environment is stressful and unsupportive with severely disproportionate nurse–patient ratios. Such conditions could sway ethical decision making and compromise the provision of quality nursing care and enhance moral distress. Due to the adversities, many nurses believe they are no longer providing proper health care and seek other job opportunities or leave the profession. Methods: A descriptive phenomenological design was applied. One-on-one interviews were conducted with professional nurses permanently employed at a district hospital in the Cape Town Metro District Health Services, using a semi-structured interview guide. Thematic analysis of the data was performed. Results: Seven interviews were conducted and results indicate that moral distress is experienced irrespective of age and work experience. Newly qualified and newly appointed professional nurses seem more at risk for experiences of moral distress due to challenges in their work environment. The major distressing factors relate to staffing (shortage as well as disrespect from colleagues), management, complaints, resources and doctors. Consequences as a result of moral distress include emotional, personality and behavioural aspects as well as the intent to leave their position. Different coping mechanisms were employed in an effort to cope with the daily challenges the professional nurses experienced. Conclusion: Moral distress is experienced by professional nurses in medical and surgical wards. It can be elicited from different situations encountered in their daily work, which necessitates them to compromise their professional, moral and ethical standards.

AFRIKAANSE OPSOMMING : Agtergrond: Verpleegsters het die meeste kontak met pasiente en word dus deur situasies van morele spanning gekonfronteer. Siende verpleegsters opgelei word om lewe te onderhou, het situasies wat hulle beperk om kwaliteitsorg te lewer, die potensiaal om morele spanning te veroorsaak. Etiese praktyke word deur verskeie verpleeg-regulasies asook nasionale en internasionale riglyne gelei. Die Suid-Afrikaanse konteks dra tot unieke uitdagings in die gesondheidsorg-stelsel by. Daar is ‘n aanvraag na kwaliteit gesondheidsorg wat gelewer moet word te midde ‘n begrotingstekort van R600 miljoen, tesame met uitdagings soos siektelas, hoe werksladings, ‘n toename in pasientsterftes, daaglikse blootstelling aan multi-middelweerstandinge tuberkulose (MDR-TB) en ernstige personeeltekorte onder gesondheidswerkers. Die werksomstandighede in die openbare gesondheidsektor is stresvol en nie ondersteunend nie, met buitensporige verpleeg-pasient ratio’s. Morele spanning vererger wanneer sulke omstandighede etiese besluitneming beinvloed en die lewering van kwaliteit gesondheidsorg belemmer. As gevolg van die uitdagings glo baie verpleegsters dat hulle nie meer gehalte gesondheidsorg lewer nie, met die gevolg dat hulle van werk wil verander of die beroep wil verlaat. Metode: ‘n Beskrywende fenomenologiese ontwerp met ‘n kwalitatiewe benadering was toegepas. ‘n Semi-gestruktureerde onderhoudgids was gebruik om een-tot-een onderhoude met permanent aangestelde professionele verpleegkundiges by ‘n distrikshospitaal in die Kaapstad Metro Distriksgesondheidsdienste te voer. Tema-analise was gebruik om die data te analiseer. Resultate: Sewe onderhoude was gevoer en die resultate het daarop gedui dat morele spanning ongeag ouderdom of werksondervinding ervaar word. As gevolg van uitdagings in die werksomgewing het dit geblyk dat nuut gekwalifiseerde en nuut aangestelde professionele verpleegkundiges ‘n hoe risiko loop om morele spanning te ervaar. Die oorhoofse faktore wat tot morele krisisse aanleiding gee, is aan personeel (tekort, sowel as disrespek van kollegas), verpleegbestuur, klagtes, hulpbronne en dokters verwant. Morele spanning het emosionele, persoonlikheids- en gedragsveranderinge tot gevolg gehad asook die voorneme van deelnemers om hul werk te verlaat. Professionele verpleegkundiges gebruik verskillende hanteringsmeganismes om die daaglike uitdagings wat hulle ervaar, te hanteer. Slotsom: Professionele verpleegkundiges in mediese en chirurgiese sale ervaar morele spanning. Dit kan ontlok word deur verskeie situasies waarmee hulle in hul daaglikse werk te doen het, en hulle noodsaak om hul professionele, morele en etiese standaarde te skik.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/101297
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