道德困扰已成为重症监护护士的重要关注点,特别是由于重症监护病房为危重病人提供了复杂而苛刻的护理。持续的COVID-19大流行给临床实践带来了新的道德挑战和变化,进一步加剧了这些护士的道德困扰。本系统评价比较了COVID-19大流行之前和期间影响重症监护护士道德困扰的因素,以全面了解大流行对道德困扰的影响。对于这项系统审查,PubMed,Scopus,ProQuest,WebofScience,medRxiv,bioRxiv,Embase,和谷歌学者都在搜索中被利用。该搜索涵盖了2012年至2022年12月发表的文章,涵盖了10年的时间框架,以捕获有关重症监护护士道德困扰的相关研究。总的来说,本系统综述共52篇。调查结果表明,个人,关怀相关的,和组织因素会影响护士的道德困扰。在大流行之前,包括徒劳和临终关怀在内的因素,与医生的冲突,护士的表现和权威,糟糕的团队合作,关于治疗过程和患者护理的决策,有限的人力资源和设备,医疗错误,病人约束,护士的年龄和工作经验会影响重症监护护士的道德困扰。同样,在COVID-19大流行期间,导致道德困扰的因素包括徒劳和临终关怀,对感染和传播COVID-19的恐惧,对治疗过程的决策,糟糕的团队合作,是女性。这项研究表明,在两个时期,导致道德困扰的因素大致相同。徒劳的护理和临终问题是危重护理护士道德困扰的主要原因。实施预防策略并减少这些潜在因素可以减少这一主要问题并提高护理质量。
Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic
review compares the factors influencing
moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic
review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic
review. The findings indicate that personal, caring-related, and organizational factors can influence nurses\' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses\' age and work experience affect critical care nurses\' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses\' primary causes of
moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care.