Search

Aim To explore the level of moral distress and potential associations between moral distress indices and (1) nurse–physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Background Poor nurse–physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. Methods A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. Results The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0–84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0–84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0–336). The severity of moral distress was associated with (1) nurse–physician collaboration and dissatisfaction on care decisions (r = −0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = −0. 209, P < 0.0001). Conclusion Moral distress seems to be associated with the intention to resign, whereas poor nurse–physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Implications for nursing management Enhancement of nurse–physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.

Background and aims: A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries. Design and methods: A cross-sectional survey of ICU nurses attending the fourth European federation of Critical Care Nursing associations (EfCCNa) in Denmark, 2011. Data included use of protocols; sedation, pain and delirium assessment tools; collaborative decision-making; sedation and analgesic medications; and educational preparation related to sedation. Results: Response rate was 42% (n=291) from 22 countries where 53% (n=148) used sedation protocols. Nordic nurses reported greater use of sedation (91% versus 67%, p

Background Discretionary autonomy is a key factor in enhanced patient outcomes and nurses’ work satisfaction. Among nurses, insufficient autonomy can result in moral distress. Objectives To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses’ characteristics. Methods Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a self-administered questionnaire with validated scales for nurses’ autonomy, nurse-physician collaboration, and moral distress. Results The mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P