The relationship between professional autonomy and moral distress in ICU nurses of Guilan University of Medical Sciences in 2017
Background & Aim: Professional autonomy is a key component of decision-making and empowerment of the nurses. However, ICU nurses sometimes experience a degree of moral distress in their decision-making but the relationship of this distress with their autonomous performance in intensive care units is unclear. The aim of this study is determining the relationship between professional autonomy and moral distress of ICU nurses.
Methods & Materials : In this correlational cross-sectional study, 180 ICU nurses were selected by census method from educational hospitals of Guilan University of Medical Sciences in 2017. Research tools were Varjuss professional autonomy and Corely et al. moral distress questionnaires. Data were analyzed using SPSS software version 16.
Results: Most of the subjects were female (93.89%), full-time nurses (61.67%), with age mean and standard deviation of 35±5.97. Mean and standard deviation of professional autonomy and moral distress were 77.04±4 and 140.85±5.45, respectively. Moral distress of most nurses (55.6%) was moderate. There was a positive and significant correlation between professional autonomy and moral distress scores (p<0.001, r=0.33).
Conclusion: This study showed that by increasing the professional autonomy, the moral distress of ICU nurses increases as well. These results, by informing nursing mangers, remind the necessity of using some approaches for reducing the moral distress of nurses along with improving their professional autonomy.
2. Iliopoulou KK, While AE. Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece. Journal of advanced nursing. 2010 Nov;66(11):2520-31.
3. Deci EL, Ryan R M. Self-Determination Theory: A Macrotheory of Human Motivation, Development, and Health. Canadian Psychology 2008;49(3):182-5.
4. Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. Journal of advanced nursing. 2001 Jan 26;33(2):250-6.
5. Papathanassoglou ED, Karanikola MN, Kalafati M, Giannakopoulou M, Lemonidou C, Albarran JW. Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses. American Journal of Critical Care. 2012 Mar 1;21(2):e41-52.
6. Vafadar Z, Vanaki Z, Ebadi A. Barriers to implementation of team care and interprofessional education: The viewpoints of educational managers of iranian health system. Iranian Journal of Medical Education. 2015 Feb 15;14(11):943-56.
7. Karanikola MN, Albarran JW, Drigo E, Giannakopoulou M, Kalafati M, Mpouzika M, Tsiaousis GZ, Papathanassoglou ED. Moral distress, autonomy and nurse–physician collaboration among intensive care unit nurses in Italy. Journal of nursing management. 2014 May;22(4):472-84.
8. Yeganeh MR, Gholami S, Tabari R, Atrkar Roshan Z, Rimaz S. The effect of controlled sedation based on the Richmond scale on the duration of mechanical ventilation and the changes of blood pressure in patients following coronary artery bypass graft surgery: A randomized clinical trial. Journal of hayat. 2018 Jan 15;23(4):372-86.
9. Shoorideh FA, Ashktorab T, Yaghmaei F, Alavi Majd H. Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nursing ethics. 2015 Feb;22(1):64-76.
10. Dodek PM, Wong H, Norena M, Ayas N, Reynolds SC, Keenan SP, Hamric A, Rodney P, Stewart M, Alden L. Moral distress in intensive care unit professionals is associated with profession, age, and years of experience. Journal of critical care. 2016 Feb 1;31(1):178-82.
11. Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory and Critical Care Medicine. 2007 Apr 1;175(7):693-7.
12. Iranmanesh S, Rezaei HH, Rafiei H, Eslami H. Critical care nurses' moral distress in South-East of Iran. Asian Journal of Nursing Education and Research. 2013 Jul 1;3(3):1.
13. Heck C. A. Study of Moral Distress in Novice and Experienced Nurses. United States: Villanova University; 2016[thesis].
14. Maylone MM, Ranieri L, Griffin MT, McNulty R, Fitzpatrick JJ. Collaboration and autonomy: Perceptions among nurse practitioners. Journal of the American Academy of Nurse Practitioners. 2011 Jan;23(1):51-7.
15. Varjus SL, Leino‐Kilpi H, Suominen T. Professional autonomy of nurses in hospital settings–a review of the literature. Scandinavian Journal of Caring Sciences. 2011 Mar;25(1):201-7.
16. Papathanassoglou ED, Tseroni M, Karydaki A, Vazaiou G, Kassikou J, Lavdaniti M. Practice and clinical decision‐making autonomy among Hellenic critical care nurses. Journal of nursing management. 2005 Mar 1;13(2):154-64.
17. Ohnishi K, Ohgushi Y, Nakano M, Fujii H, Tanaka H, Kitaoka K, Nakahara J, Narita Y. Moral distress experienced by psychiatric nurses in Japan. Nursing Ethics. 2010 Nov;17(6):726-40.
18. Sarkoohijabalbarezi Z, Ghodousi A, Davaridolatabadi E. The relationship between professional autonomy and moral distress among nurses working in children's units and pediatric intensive care wards. International Journal of Nursing Sciences. 2017 Apr 10;4(2):117-21.
19. Varjus SL, Suominen T, Leino-Kilpi H. Autonomy among intensive care nurses in Finland. Intensive and Critical Care Nursing. 2003 Feb 1;19(1):31-40.
20. Motamed-Jahromi M, Jalali T, Eshghi F, Zaher H, Dehghani SL. Evaluation of professional autonomy and the association with individual factors among nurses in the Southeast of Iran. Journal of Nursing and Midwifery Sciences. 2015 Oct 1;2(4):37-42.
21. Gaudine A, LeFort SM, Lamb M, Thorne L. Ethical conflicts with hospitals: The perspective of nurses and physicians. Nursing Ethics. 2011 Nov;18(6):756-66.
22. Motamed-Jahromi M, Jalali T, Eshghi F, Zaher H, Dehghani SL. Evaluation of professional autonomy and the association with individual factors among nurses in the Southeast of Iran. Journal of Nursing and Midwifery Sciences. 2015 Oct 1;2(4):37-42.
23. Joolaee S, Jalili H, Rafiee F, Haggani H. The relationship between nurses’ perception of moral distress and ethical environment in Tehran University of Medical Sciences. Iranian Journal of Medical Ethics and History of Medicine. 2011 Jul 15;4(4):56-66.
24. Lawrence LA. Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses. InNursing forum 2011 Oct (Vol. 46, No. 4, pp. 256-268). Malden, USA: Blackwell Publishing Inc.
25. Rabiee S, Khatiban M, Cheraghi MA. Nurses distress in intensive care unit: a survey in teaching hospitals. Iranian Journal of Medical Ethics and History of Medicine. 2012 Apr 15;5(2):58-69.
26. Abbaszadeh A, Nakhaei N, Borhani F, Roshanzadeh M. Moral distress in clinical function of nurses: A descriptive-periodic Study. J Morl Hist Med. 2012;6(21):113-30.
27. Gonzalez J. Exploring the Presence of Moral Distress in Critical Care Nurses.[Master's Theses]. [Island ]:School of Nursing Rhode Island College:2016.184p.
28. Rathert C, May DR, Chung HS. Nurse moral distress: A survey identifying predictors and potential interventions. International journal of nursing studies. 2016 Jan 1;53:39-49.
29. Azarm A, Hasanlo M, Hojt Ansari M, Mohammadi F, Ebrahimi H, Asghari Jafarabadi M. Moral distress and the nursing care quality: A correlational study in teaching hospitals. Health, Spirituality and Medical Ethics. 2017 Aug 15;4(3):38-47.
30. Burston AS, Tuckett AG. Moral distress in nursing: contributing factors, outcomes and interventions. Nursing ethics. 2013 May;20(3):312-24.
31. Abdolmaleki M, Lakdizaji S, Ghahramanian A, AllahBakhshian A, Behshid M. Relationship between autonomy and moral distress in emergency nurses. Indian journal of Medical Ethics. 2018 Oct 6:1-5.
32. AllahBakhshian M, Alimohammadi N, Taleghani F, Nik AY, Abbasi S, Gholizadeh L. Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study. Nursing Outlook. 2017 Jul 1;65(4):392-9.
33. Labrague LJ, McEnroe‐Petitte DM, Tsaras K. Predictors and outcomes of nurse professional autonomy: A cross‐sectional study. International journal of nursing practice. 2019 Feb;25(1):e12711.
34. Amini K, Negarandeh R, Ramezani‐Badr F, Moosaeifard M, Fallah R. Nurses’ autonomy level in teaching hospitals and its relationship with the underlying factors. International journal of nursing practice. 2015 Feb;21(1):52-9.
35. Mirkamali SM, Javanak Liavali M, Yeganeh MR. Correlation between Organizational Culture with Clinical Governance in Public Hospitals in Rasht. Hayat, Journal of School of Nursing and Midwifery, Tehran University of Medical Sciences. 2014 Mar 1;20(1).
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.