Gender and the Experience of Moral Distress in Critical Care Nurses
Jessy Thomas
Grand Canyon University: NRS-433V
May 24, 2015

Gender and the experience of moral distress in critical care nurses Patricia Banner, an American nurse theorist defined the ethical compartment as “the embodied skilled know-how of relating to others” in ways that are respectful and support their concerns (Corley MC, Nurses Ethics 2002). Moral distress is fairly new topic of discussion in the print and media. The term begins when Jameton recognized the negative feelings when one person realize the morally correct course to be taken but can’t practice due to the restriction imposed by the place they work. Moral distress can happen in variety of setting and roles. Many researchers studied this topic among various health care workers among nurse educators, students, critical care and medical-surgical nurses and administrators. The moral distress among nurses may vary depending upon many factors such as gender, ethnic back ground or the context in which they practice. A meta-analysis of 19 studies on moral sensitivity and moral judgment found that females are higher in the case of moral sensitivity scores. (Christopher B, Gender and moral distress)
Problem Statement The problem of this study aimed to address was: “Critical care settings are highly technical, dynamic patient care environments”. Often nurses need to make sudden judgments and decisions of complex nature that can take care of patients needs while keeping their autonomy and human dignity. The judgments they makes may in conflict with doctors, families and other professionals in the healthcare field. The research question: Do significant gender differences exist in the moral distress scores of critical care nurses? The hypothesis was no significant gender differences would exist in the mean moral distress. (Christopher B)

Participants and Research context

There are 31 participants (n=31) all work as nurses in critical care from American Internet community. All nurses completed the Moral Distress Scale-Revised online over a 5-day period in July 2013.As far as ethical considerations of this study , the institutional review board approved this study, and accessing and completing the survey implied informed consent.
Data Collection and Quality of the Study This study was a quantitative and utilized a descriptive methodology to find out the moral distress levels by collecting a sample of critical care nurses and determine the gender differences makes any influence in their mean scores of moral distress. There are constraints exist in the form intrinsic and extrinsic. Jemaeton and De Veer et al, described this as regulatory practice restrictions, polices of the institution, physician centered power distribution. These constraints can not only effect nurses and organizations but also harmful to patients when they did not get proper care. (Christopher B)
Data Analysis and Data Management The sample was collected from critical care nurses who are in the United States was selected from Internet community. No incentives were offered for the participation. The data collected were analyzed by IBM SPSS version 21. All participants need to complete the Moral Distress Scale-Revised (MDS-R), consists of 21 questions covering the dimensions of frequency (f) and intensity (i) on a 5-point scale. Scores range from 0 to 4 , 0 being rare or minimal distress and 4 being most distressed. The total of each item is calculated by the product of frequency and intensity (f x i). The survey was administered after giving a minimal instructions and survey will take an estimated time of 10 minutes. The data validated and coded before the analysis and only completed data was included except the optional item, which was a free text. The total moral distress score for females and males at 95% confidence interval for mean in lower bond and upper bond is determined. The median, variance, standard deviation, min and max ranges were calculated. The skewness of the study and kurtosis is also calculated.(Christopher B.)
Findings, Interpretation, and Implications of the Study The survey was accessed 93 times and 62 were excluded by the criteria determined before the study or it was not completed. There are 31 left, who completed the MDS-R. The response rate was 33 % and out of that 24 females and the rest was males. Shapiro-Wilk test is used to assess the total moral distress (p=0.36 and p=20). 93% of participants are White and 3.23 % each was African Americans and Hispanics. The education level in the group participated were 45% baccalaureate, 6% hold graduate level and the rest 32% were with associate levels. The median moral distress scores were high in the associate degree levels in both gender (119.5 in females and 81.5 in males). Females reported greater mean moral distress scores (95 % confidence interval (CI) =112.75+/-54.31) than males (95% CI=60.43+/-18.83). The effect size (d=0.5) was moderate. The most distressing was the item #3 , which was continue life support even if not the best interest of the patient because of the family’s wishes. Item # 4 also was a moral issue regarding initiative extensive life-saving actions which only prolong death. The least distressing was item # 14, which is increasing the dose of sedatives for an unconscious patient, can hasten the patient’s death. A two-tailed significance level is shown statistically between the genders with a mean scores (p<0.05).(Christopher B.) Study Conclusion This study results shows a higher mean moral distress score among females which is statistically significant. The effect size was moderate (0.5). Crescendo effect which means repeated exposure and resolution is a possible factor hat influence the moral distress. The moral distress scores are low relatively in both groups, more researcher’s is warranted, which should include to prevent and reduce this phenomenon. Also more diverse populations from the profession which are related to nursing so that it can reflect the larger area of society. The study shows a clear picture of gender evidence.
Limitations of the study are that it utilized a convenience sampling method with a data collection for a five day continuous period. The second limitation was the sampling was very homogenous. There was also a lack of supporting evidence for the results. Further research of moral distress is recommended. Moral distress can have serious implication in all areas of nursing and cannot be eliminated fully. Only the causes and effects can be reduced and it is very important since the nursing field become increasingly culturally diverse.(Christopher B)

References
Christopher, B., (2013). Gender and the experience of moral distress in critical care nurses. Retrieved from edu library on May 19, 2015.
Burns, N., & Grove, S. (2011). Understanding nursing research. Building an evidence-based practice (5th ed.). Maryland Heights, MO: Elsevier Corely MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics 2002;9(6):63-650.
Jameton A. Nursing practice: the ethical issues. Upper Saddle River, NJ: Prentice Hall, 1984, p.16