BACKGROUND: Nursing interns often faced moral distress in clinical practice, similar to registered nurses, which can lead to compassion fatigue. The roles of moral resilience and professional identity in influencing the psychological well-being of nursing interns are recognized, but the interrelationships among moral distress, moral resilience, professional identity, and compassion fatigue in this group remain unclear.
OBJECTIVE: This study aimed to investigate the impact of moral distress on compassion fatigue among nursing interns and to explore the mediating role of moral resilience and professional identity.
METHODS: A quantitative cross-sectional study was conducted with 467 nursing interns. Data were collected using Compassion Fatigue Short Scale, Moral Distress Scale-revised, Rushton Moral Resilience Scale, and Professional Identity Scale. Data analyses were performed using SPSS 22.0 and Amos 21.0, adhering to the STROBE statement.
RESULTS: The mean scores for compassion fatigue, moral distress, moral resilience, and professional identity were 35.876, 44.887, 2.578, and 37.610, respectively. Moral distress was positively correlated with compassion fatigue. Structural equation modeling showed that moral resilience and professional identity partially mediated the relationship between moral distress and compassion fatigue (β = 0.448, P < 0.001).
CONCLUSIONS: The findings suggest that moral distress directly influences compassion fatigue among nursing interns and also exerts an indirect effect through moral resilience and professional identity. Interventions aimed at enhancing moral resilience and fostering a strong professional identity may help mitigate the adverse effects of moral distress on compassion fatigue among nursing interns.

BACKGROUND: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice.
OBJECTIVE: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare.
METHODS: Conceptual and ethical analyses.
RESULTS: After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed.
CONCLUSIONS: Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants.
UNASSIGNED: HINTERGRUND: Im Rahmen klinischer Ethikberatung unterstützen Ethikberater*innen im Gesundheitswesen Professionelle in der Psychiatrie dabei, moralische Probleme zu identifizieren und zu analysieren.
UNASSIGNED: Darstellung von zentralen ethischen Grundbegriffen und Begründungsansätzen, die für die klinische Ethikberatung in der Psychiatrie von Relevanz sind.
METHODS: Konzeptionelle und ethische Analyse.
UNASSIGNED: Nach einer Unterscheidung von Moral, Ethik und Recht werden moralische von anderen Problemen abgegrenzt. Im Anschluss werden ethische Grundbegriffe geklärt und das Konzept des moralischen Stresses vorgestellt. Im Hinblick auf ethische Begründungsansätze werden philosophische ethische Theorien von medizinethischen Theorien, wie der Prinzipienethik und der Care-Ethik, abgegrenzt. Abschließend werden Rechtfertigungstests auf Grundlage des Schadensprinzips und des schwachen Paternalismus zur ethischen Entscheidungsfindung in Situationen von Eigen- oder Fremdgefährdung erläutert.
CONCLUSIONS: Die Kenntnis ethischer Grundbegriffe und Begründungsansätze ist wichtig für die Identifikation und Analyse moralischer Probleme in der Psychiatrie und sollte in der Ausbildung von Ethikberater*innen im Gesundheitswesen stärker vermittelt werden.

Understanding healthcare professionals\' (HCPs) experiences with patients undergoing hematopoietic allogeneic stem cell transplantation (allo-HSCT) is crucial, given its dual nature of offering a hope for cure which on the other hand is accompanied by a high risk for morbidity and mortality. Yet, how HCPs experience their patients\' existential threats remains unexplored. Qualitative thematic content analysis was employed to comprehend these experiences. This involved conducting three focus groups and 11 individual in-depth interviews with nurses and hematologists. We found that HCPs struggled to balance curative goals and the therapy\'s risks, while attempting to maintain their patients\' hopes. The unpredictability of patient trajectories and their suffering burdened HCPs. Despite occasional disagreements within the team, (inter-)professional exchanges remained a crucial ressource, especially in addressing the patients\' potential life threat. Team meetings and palliative care specialist supervisions were emphasized as vital for managing these challenges. HCPs sought support in communicating with patients about death-related issues and managing the transition from a curative to a palliative goal of care. Our research underscores the need for targeted support for HCPs and lays a groundwork for addressing their challenges. Trial registration number DRKS00027290 (German Clinical Trials Register). Date of trial registration January 10th, 2022.

Clinician distress is common in serious illness care. Palliative specialists are often consulted for cases involving significant distress among primary teams. Consults involving clinician distress can be challenging to navigate when it feels like 1) palliative specialists do not have the right skills to be helpful or 2) palliative specialists are being asked to \'fix\' difficult situations that would require changing other people\'s attitudes, beliefs, or behaviors, or healthcare systems writ large. This article uses three composite cases to illustrate types of clinician distress and examine the benefits and risks of palliative specialist involvement. We conclude with a discussion of potential impacts of palliative care consults for clinician distress on the field of palliative care and consider next steps in critically important efforts to support and sustain the entire workforce-both palliative specialists and nonspecialists alike-when caring for patients with serious illness and their family caregivers.

Moral sensitivity, missed nursing care and moral distress among healthcare professionals have received considerable attention in recent years. These factors represent important healthcare challenges for new nurses (graduation to 2 years of work experience). However, studies on the relationships among these variables in the context of new nurses in China remain lacking.
OBJECTIVE: To explore the relationships among moral sensitivity, missed nursing care and moral distress in the context of new nurses in China.
METHODS: A cross-sectional descriptive survey was conducted.
METHODS: A total of 228 new nurses were recruited from three tertiary hospitals in Qingdao, Shandong Province, China. Participants provided their sociodemographic and professional information and completed the Chinese Moral Sensitivity Questionnaire-Revised Version, the Chinese Missed Nursing Care Survey Version and the Chinese Moral Distress Scale-Revised Version. The data were analysed using Spearman\'s correlation analysis and multiple linear regression analysis.
RESULTS: The means and standard errors of moral sensitivity, missed nursing care and moral distress were 40.71 (0.39), 9.82 (0.78) and 34.87 (2.41), respectively. The variable of missed nursing care exhibited a significant negative relationship with moral sensitivity and a significant positive relationship with moral distress. Regression analysis revealed that the main factors influencing new nurses\' moral distress were educational background, nature of job, current unit, frequency of night shifts and the dimensions of moral strength and responsibility. These factors can explain 14.9% of the total variation.
CONCLUSIONS: The findings revealed that higher rates of missed nursing care were associated with lower moral sensitivity and greater moral distress among new nurses. Therefore, developing interventions to reduce missed nursing care may be a promising strategy for improving moral sensitivity and preventing moral distress among new nurses.
UNASSIGNED: In hospitals, moral distress can be improved by focusing on modifiable factors such as staffing resources, leading to better promoting new nurses\' health and improving the quality of care. This study can highlight practices accounting for moral sensitivity and missed nursing care in nursing research and training programmes.
UNASSIGNED: Strengthening the reporting of observational studies in epidemiology (STROBE) statement.
UNASSIGNED: No patient or public contribution.

BACKGROUND: The War on Terrorism, which included Operation Enduring Freedom (OEF) in Afghanistan from 2001 to 2014 and the concurrent Operation Iraqi Freedom (OIF) from 2003 to 2011, exposed military nurses to situations and challenges for which many reported feeling unprepared. Clinically, nurses faced multi-trauma injuries and devastating wounds suffered by military troops and civilians alike. Cultural issues and harsh living conditions added further complications to the care environment. The purpose of this study was to address the research question: How do military nurses identify, assess, manage, and personally resolve ethical issues occurring in nursing practice during wartime deployments?
METHODS: Qualitative grounded theory provided the design for this study.
METHODS: Using the constant comparative method, data collection, and data analysis occurred simultaneously to build a theory of ethical issues management during wartime. Using a focused interview guide responsive to emerging themes and developing theory, interviews were conducted until theoretical saturation was achieved. Participants represented primarily Army (55%) active duty (83%) female nurses (71%) who had deployed to Iraq (52%), Afghanistan (32%), or both (16%). A sampling grid was used to recruit nurses representative of the demographics deployed in support of OIF and OEF. Data analysis used grounded theory methods to identify a core construct to detail proposed relationships and concepts. Rigor was maintained in study methods and analysis using established tenets to support trustworthiness.
RESULTS: The nurses shared stories regarding their experiences during deployment. Many struggled to find internal resolutions regarding the care of detainees, cultural differences, end-of-life decision-making, pain management, and care of civilian casualties.
CONCLUSIONS: The study described the ethical issues military nurses encountered during wartime and the strategies used to mitigate moral conflict. By better understanding how nurses define, assess, and manage ethical situations, we can better prepare our deploying nurses for future conflicts.
CONCLUSIONS: Military nurses returning from wars with unresolved moral conflicts are at risk for moral distress. Moral distress has been associated with burnout, dissatisfaction with and leaving the nursing profession, compassion fatigue, and disinterest in the provision of quality patient care. In the interest of preserving the health of military nurses, steps need to be taken to provide resources for helping them prepare for, encounter, and cope with the ethical situations inherent in wartime nursing care.

UNASSIGNED: The coronavirus (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide, with intensive care unit (ICU) nurses at the forefront of patient care. To date, there is limited evidence into ICU nurses\'experiences of the pandemic in Kuwait.
UNASSIGNED: To elucidate the challenges faced by ICU nurses in Kuwait during the pandemic, by considering two research questions: \"What contributed to intensified pressure for the ICU nurses?\" and \"How were the nurses affected?\".
UNASSIGNED: This was a qualitative study which utilised semi-structured interviews. Interviews were conducted between January 2021 and June 2022 with ICU nurses who worked during the COVID-19 pandemic. The data were analysed using Charmaz\'s grounded theory methodology.
UNASSIGNED: 25 nurses from three ICUs in Kuwait.
UNASSIGNED: The study was approved by the University Ethics Committee and by the Ministry of Health in Kuwait.
UNASSIGNED: The analysis identified two themes (the factors contributing to intensified pressure in the ICU, and the impact on the nurses) and seven sub-themes. The pressure in the ICU intensified due to the rise in the number of patients, staff shortages, and the requirement to adhere to unrealistic new procedures for infection control. Restricted and cancelled leave, as well as impaired autonomy at work, impeded the nurses\' ability to recover from stress. The heightened stress also contributed to a worsening in interpersonal relationships between the nurses and their colleagues. The nurses\' care was compromised by these challenges, leading to moral distress and a range of mental health symptoms (e.g., stress, anxiety, emotional exhaustion).
UNASSIGNED: The study accords with other research conducted during the pandemic in revealing a significant mental health toll among healthcare workers during the pandemic. The stressors were similar to those which have been reported in other studies, although there were also context-specific effects relating to the environment of the ICU and the Kuwaiti context.

BACKGROUND: This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences.
METHODS: Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees.
RESULTS: Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities.
CONCLUSIONS: Targeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.

OBJECTIVE: This study aims to examine the mediating effect of moral distress on the relationship between moral resilience and the intention to leave.
BACKGROUND: Moral distress is a phenomenon that negatively impacts healthcare workers, healthcare institutions, and recipients. To eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience is important in protecting against the negative effects of moral distress, such as burnout and turnover intention. In this direction, it is necessary to increase the moral resilience of nurses to reduce negative situations such as turnover intention in nurses.
METHODS: It is a descriptive-predictive study. Sociodemographic Information Form, Measure of Moral Distress - Healthcare Professionals, and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 220 clinical nurses were recruited.
METHODS: Approval was obtained from the university\'s non-interventional ethics committee, and informed consent was obtained from the participants.
RESULTS: The study found a total moral distress score of 6.39 ± 0.3.12 and moral resilience score of 2.69 ± 0.48. A moderate and weak negative correlation was found between moral distress and moral resilience. Moral distress has a moderating effect on the intention to leave nursing (β = -0.158, p = .010) and the intention to leave the current position (β = -0.174, p = .000). Individual\'s moral resilience directly affects the intention to leave. The presence of moral distress eliminates the direct effect of moral resilience and affects the intention to leave together with moral resilience.
CONCLUSIONS: Moral resilience leads to decreased intention to leave, and moral distress mediates this situation. An increase in moral distress decreases moral resilience and increases intention to leave. It can be assumed that if moral distress is not controlled, increasing moral resilience will not affect the intention to leave the job.

OBJECTIVE: This study investigates the relationship between burnout levels of moral distress and missed nursing care in pediatric nurses.
METHODS: A cross-sectional study was conducted between November and December 2023. Pediatric nurses working in two hospitals and providing direct care to children (n = 140) completed the Moral Distress Scale-Revised Pediatric Nurses, MISSCARE Survey - Pediatric Version and Burnout Measure-Short Version questionnaire. Multivariate regression analysis modeling was applied to test the mediating effect on the relationship between burnout, moral distress, and missed nursing care.
RESULTS: There was a significant positive correlation between the Moral Distress Scale-Revised Pediatric Nurses and its sub-dimensions and the Burnout Measure-Short Version (p < 0.05). There was a significant positive correlation between the mean MISSCARE- Survey-Ped score of the nurses participating in the study and its sub-dimensions and Burnout Measure-Short Version (p < 0.05). Providing Benefit-Do No Harm, one of the Moral Distress Scale-Revised Pediatric Nurses sub-dimensions, and Labour Resources, one of the MISSCARE sub-dimensions, were found to be predictors of burnout. The ethical principle of Providing Benefit-Do No Harm was found to mediate between moral distress and burnout and reduce burnout associated with missed care.
CONCLUSIONS: Accordingly, as the nurses\' moral distress and inability to meet the necessary patient care increase, their burnout levels also increase. Providing Benefit-Do No Harm is an basic ethical principle that will positively affect the burnout level of pediatric nurses.
CONCLUSIONS: This study may provide insights into ethics training, communication improvement strategies, and individual support intervention programs aimed at reducing moral distress, and burnout and improving the coping mechanisms of nurses working in pediatric wards.