Value congruence and depressive symptoms among critical care clinicians: The mediating role of moral distress

Published on Feb 1, 2018in Stress and Health2.35
· DOI :10.1002/SMI.2769
Giulia Lamiani13
Estimated H-index: 13
(Humanitas University),
Paola Dordoni6
Estimated H-index: 6
(UNIPV: University of Pavia),
Piergiorgio Argentero17
Estimated H-index: 17
(UNIPV: University of Pavia)
Sources
Abstract
Clinicians working in intensive care units are often exposed to several job stressors that can negatively affect their mental health. Literature has acknowledged the role of value congruence and job control in determining clinicians' psychological well-being and depressive symptoms. However, potential mediators of this association have been scarcely examined. This study aimed to test the mediating role of moral distress in the relationship between value congruence and job control, on the one hand, and depression, on the other hand. A cross-sectional study involving physicians, nurses, and residents working in 7 intensive care units in the north of Italy was conducted. Clinicians were administered in the Italian Moral Distress Scale—Revised, the value and control subscales of the Areas of Worklife Scale, and the Beck Depression Inventory II. Structural equation modeling was used to test the mediation model. Analysis on 170 questionnaires (response rate 72%) found no relations between job control and moral distress. A total indirect effect of value congruence on depression through moral distress (β = −.12; p = .02) was found. Moral distress contributes to the development of depressive symptoms among critical care clinicians who perceive a value incongruence with their organization and therefore should be addressed.
📖 Papers frequently viewed together
200 Citations
15 Citations
References55
Newest
#1Hsun-Kuei Ko (KMU: Kaohsiung Medical University)H-Index: 3
#2Chi-Chun Chin (KMU: Kaohsiung Medical University)H-Index: 2
Last. Min-Tao HsuH-Index: 1
view all 3 authors...
Background: The problems of nurse burnout and manpower shortage relate to moral distress. Thus, having a good understanding of moral distress is critical to developing strategies that effectively improve the clinical ethical climate and improve nursing retention in Taiwan. Purpose: The aim of this study was to reconstruct the model of moral distress using the grounded theory. Methods: Twenty-five staff nurses at work units who attend to the needs of adult, pediatric, acute, and critical disease ...
5 CitationsSource
#1Giulia Lamiani (University of Milan)H-Index: 13
#2Ilaria SettiH-Index: 10
Last. Piergiorgio ArgenteroH-Index: 17
view all 5 authors...
OBJECTIVES: Moral distress is a common experience among critical care professionals, leading to frustration, withdrawal from patient care, and job abandonment. Most of the studies on moral distress have used the Moral Distress Scale or its revised version (Moral Distress Scale-Revised). However, these scales have never been validated through factor analysis. This article aims to explore the factorial structure of the Moral Distress Scale-Revised and develop a valid and reliable scale through fac...
18 CitationsSource
#1Giulia Lamiani (UNIPV: University of Pavia)H-Index: 13
#2Lidia Borghi (University of Milan)H-Index: 8
Last. Piergiorgio Argentero (UNIPV: University of Pavia)H-Index: 17
view all 3 authors...
Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational enviro...
100 CitationsSource
#1Laura Pulkki-Råback (UH: University of Helsinki)H-Index: 34
#2Marko Elovainio (National Institute for Health and Welfare)H-Index: 88
Last. Liisa Keltikangas-Järvinen (UH: University of Helsinki)H-Index: 67
view all 12 authors...
There have been calls to know more about vulnerability factors that may predispose to adverse health outcomes at work. We examined if childhood adverse experiences would affect vulnerability to psychosocial stress factors at work. A nationally representative sample of 1546 Finnish men and women was followed up from childhood to adulthood. Childhood adverse experiences consisted of socioeconomic and emotional factors. Job demands and job control were measured 21 years later, and depressive sympto...
4 CitationsSource
#1Natalie Henrich (St. Paul's Hospital)H-Index: 19
#2Peter Dodek (UBC: University of British Columbia)H-Index: 59
Last. Patricia Rodney (UBC: University of British Columbia)H-Index: 20
view all 6 authors...
Abstract Purpose The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs. Materials and methods We used focus groups and coding of transcripts into themes and subthemes in 2 tertiary care ICUs and 1 community ICU. Results Based on input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus gr...
45 CitationsSource
#1John R. Graham (FAU: Florida Atlantic University)H-Index: 96
#1John R. Graham (FAU: Florida Atlantic University)H-Index: 3
Last. David Nicholas (U of C: University of Calgary)H-Index: 72
view all 3 authors...
Workplace expectations reflect an important consideration in employee experience. A higher prevalence of workplace congruence between worker and employer expectations has been associated with higher levels of productivity and overall workplace satisfaction across multiple occupational groups. Little research has investigated the relationship between workplace congruence and occupational health outcomes among social service workers. This study sought to better understand the extent to which occup...
7 CitationsSource
#1Jharna Mandal (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 17
#2KP Dinoop (PSG Institute of Medical Sciences and Research)H-Index: 1
Last. Subhash Chandra Parija (JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)H-Index: 25
view all 3 authors...
"Microethics" is an avant-garde in the field of ethics. When the term "ethics" is brought into discussion in medical education or clinical practice, it customarily points to the traditional ethics, that is, biomedical ethics that deals with the ethical issues faced during unaccustomed or rare clinical circumstances. In contrast, microethics is a continuous ethical science existing in the physician-patient interaction that happens each day in every physician's clinical liaison. These ethical issu...
3 CitationsSource
#1Courtenay R. Bruce (BCM: Baylor College of Medicine)H-Index: 14
#2Susan M. MillerH-Index: 2
Last. Janice L. ZimmermanH-Index: 24
view all 3 authors...
Objective:Our study objectives were to determine the key sources of moral distress in diverse critical care professionals and how they manage it in the context of team-based models.Design:Qualitative case study methodology using three recently resolved clinical cases.Setting:A medical and surgical a
62 CitationsSource
#1Younjae Oh (Catholic University of Leuven)H-Index: 1
#2Chris Gastmans (Catholic University of Leuven)H-Index: 36
Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impa...
137 CitationsSource
#1Robert D. TruogH-Index: 72
#2Stephen D. BrownH-Index: 15
Last. Elaine C. MeyerH-Index: 28
view all 7 authors...
Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case-based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from...
44 CitationsSource
Cited By11
Newest
#1Céline A. Baele (UGent: Ghent University)
#2Johnny Fontaine (UGent: Ghent University)H-Index: 11
AIMS Moral distress-arising when one is constrained from moral action-has been receiving increased attention in nursing research. The phenomenon is associated with negative outcomes and is shown to impact a broad range of healthcare professions. The context-specific nature of existing measures, however, makes it difficult, if not impossible, to compare the prevalence and impact of moral distress across nursing settings and healthcare professions. This study presents an appraisal approach to the ...
Source
#1Boris Cheval (University of Geneva)H-Index: 16
#2Denis Mongin (University of Geneva)H-Index: 13
Last. Delphine S. Courvoisier (University of Geneva)H-Index: 34
view all 7 authors...
Abstract Objectives To investigate 1) whether care-related regrets (regret intensity, number of recent regrets) are associated with sick leave, independently of personality traits, perceived safety climate, and physical activity; and 2) whether these associations were mediated or moderated by coping strategies. Methods Using a longitudinal international observational study (ICARUS), data were collected by the means of a weekly web survey. Descriptive and generalized estimation equations were per...
Source
#1Leonard L. Berry (A&M: Texas A&M University)H-Index: 74
#2Deanna J. Attai (UCLA: University of California, Los Angeles)H-Index: 12
Last. Rana Awdish (HFHS: Henry Ford Health System)H-Index: 9
view all 4 authors...
In health care, a high-emotion service, unintended consequences can be especially problematic. People’s physical, psychological, and financial well-being—even their lives—are at stake. As scientifi...
Source
#1Noemi Giannetta (University of Rome Tor Vergata)H-Index: 5
#2Giulia VillaH-Index: 6
Last. Duilio F. Manara (UniSR: Vita-Salute San Raffaele University)H-Index: 6
view all 6 authors...
Abstract Background An increasing number of professionals is challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distres...
1 CitationsSource
#1Giulia Lamiani (Humanitas University)H-Index: 13
#2Matteo Ciconali (University of Milan)H-Index: 1
Last. Elena Vegni (University of Milan)H-Index: 19
view all 4 authors...
This study explored the relationship between clinicians’ moral distress and family satisfaction with care in five intensive care units in Italy. A total of 122 clinicians (45 physicians and 77 nurses) and 59 family members completed the Italian Moral Distress Scale-Revised and the Family Satisfaction in the ICU questionnaire, respectively. Clinicians’ moral distress inversely correlated with family satisfaction related to the inclusion in the decision-making process. Specifically, physicians’ mo...
2 CitationsSource
#1Elizabeth G. Epstein (UVA: University of Virginia)H-Index: 13
#2Julie Haizlip (UVA: University of Virginia)H-Index: 6
Last. Mary Faith Marshall (UVA: University of Virginia)H-Index: 18
view all 6 authors...
Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities-groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the ...
2 CitationsSource
#1Lina Laurs (Lithuanian University of Health Sciences)H-Index: 1
#2Aurelija Blaževičienė (Lithuanian University of Health Sciences)H-Index: 5
Last. Daimantas Milonas (Lithuanian University of Health Sciences)H-Index: 8
view all 4 authors...
PURPOSE: The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the profession. METHODS: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types ...
8 CitationsSource
#1Lucia D. Wocial (IU: Indiana University)H-Index: 10
#2James E. SlavenH-Index: 18
Last. Alexia M. TorkeH-Index: 24
view all 11 authors...
When working with surrogate decision-makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a surrogate. Prospective survey. Physicians (n = 154) caring for patients aged 65 years and older and their surrogate decision-makers (n = 362 patient/surrogate dyads). Patients were admitted to medicine or medical ...
1 CitationsSource
#1Giulia Lamiani (University of Milan)H-Index: 13
#2Paola Dordoni (UNIPV: University of Pavia)H-Index: 6
Last. Isabella Barajon (Humanitas University)H-Index: 17
view all 4 authors...
Background. Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians’ empathy and patients’ adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, p...
1 CitationsSource
#1Jolita Vveinhardt (VMU: Vytautas Magnus University)H-Index: 12
#2Povilas Foktas (VMU: Vytautas Magnus University)
The aim of this research is, upon the comparison of values of different generations, to propose further hypotheses for the development of the concept of personal and organizational value congruence. Objectives of the research were set to analyze the meaning of value congruence for person and organization; to compare personal values of employees of different generations; and to present contact points of personal values of employees of different generations in order to achieve congruence of person...
Source