评估西班牙重症监护医疗保健专业人员(HCP)的道德困扰(MD)。
横截面,前瞻性研究。
西班牙的ICU。
目前在西班牙ICU工作的HCP。
以电子方式分发了55项问卷。
问卷包括工作相关和社会人口统计学特征,西班牙语版的医疗专业人员道德困扰的措施(MMD-HP-SPA),医院伦理气候调查(HECS)。
总共,1065名重症监护提供者填写了问卷。四个有效性假设中有三个得到了支持。医生的MD(80,IQR40-135)明显高于护士(61,IQR35-133,p=0.026)。对于那些考虑离开他们的位置的临床医生,MD明显更高(78,IQR46-163与61,IQR32-117;p<0.001)。MMD-HP-SPA与HECS呈负相关(r=-0.277,p<0.001)。探索性因素分析揭示了四因素结构,证明病人,团队,和MD的系统级别。
在研究样本中,西班牙重症医师报告MD高于护士。改善ICU伦理氛围和纠正其他相关因素的策略,以减轻患者的MD,团队,制度层面要落实。两组HCP都表现出由于MD而离开其职位的相关意图。需要进一步的研究来确定MD影响他们离职愿望的程度。
To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs).
Cross-sectional, prospective study.
ICUs in Spain.
HCPs currently working in Spanish ICUs.
A 55-item questionnaire was electronically distributed.
The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS).
In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD.
In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.