Volume 29, Issue 1 (Winter 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(1): 61-71 | Back to browse issues page


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Zarei Nodee Y, Sheikhi M R, HosseinKhani Z, Soleimani M A. The Predictive Factors of Job Performance in Nurses' Moral Distress. Avicenna J Nurs Midwifery Care 2021; 29 (1) :61-71
URL: http://nmj.umsha.ac.ir/article-1-2211-en.html
1- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
2- Associate Professor of Nursing, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
3- Assistant Professor, Department of Epidemiology. School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
4- Associate Professor, Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran. , ma.soleimany@qums.ac.ir
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✅ Based on the results of the present study, educational dimension of job performance is a predictive factor for moral distress. Therefore, steps can be taken to reduce moral distress in clinical settings, such as the use of nurses with specialized training in Intensive Care Units, paying special attention to teaching ethical issues in nursing centers and holding retraining courses for nurses.


Extended Abstract:   (745 Views)
Introduction

Moral distress is one of the most complex ethical problems for nurses working in Intensive Care Units. Desired job performance of the nurse guarantees the quality of health care provided to patients and is an important factor in accelerating the process of treatment and recovery of patients. This study was conducted to investigate the predictive factors of job performance in nurses' moral distress.


 

Materials and Methods


This is a descriptive cross-sectional study, in which 256 nurses working in ICU wards of private and public hospitals of Qazvin province (from January to March 2019) were selected through convenience sampling method. Demographic characteristics questionnaire, Six Dimension Scale of Nursing Performance and Modified Moral Distress Scale-Revised were used for data collection. Statistical analysis was performed using linear regression model test in SPSS 22.

 

Results

The results showed that the mean score of nurses' moral distress was 171.37±55.63. In multivariate linear regression model, only educational dimension of job performance in both frequency (β=-26.37, P=0.001) and quality (β =-76.15, P=0.025) correlated significantly with moral distress.

Table 1. Demographic characteristics of the nurses participating in the study
Variable N %
Gender Man 51 23.3
Female 167 76.3
Marital status
 
Single 72 32.9
Married 146 66.7
Divorced 1 0.5
Widow 0 0
Level of Education Bachelor 201 91.8
MA 18 8.2
Type of employment
 
Duty 36 16.4
Official 98 44.7
Temporary 18 8.2
Contractual 43 19.6
Company 23 10.5
Average income per month (in Tomans)
 
1 to 2 million 29 13.2
2 to 3 million 162 74
Above 3 million 28 12.8
Shift type Fixed morning 4 1.8
Fixed era 0 0
Fixed night 2 0.9
Shifts in circulation 213 97.3
Variable M (SD) Min-Max
Age 31.96 (6.06) 50-22
Work experience in the nursing profession 8.34 (5.46) 25-1
Work experience in the special department 5.10 (4.02) 21-1
Average overtime rate 78.60 (40.53) 250-0
Job satisfaction 5.00 (2.01) 10-0
The level of interest in the job and field 6.56 (2.52) 10-0
The tendency to leave work 4.52 (2.79) 10-0
 
 
 
 
 
Table 2. Linear regression analysis in the predictive role of job performance on nurses' moral distress
Variable  
Moral distress (univariate analysis)
 
Moral distress (multivariate analysis)
Age Regression coefficient 0.062 _
Confidence interval (-1.86 – 0.61)
The significance level 0.321
Gender Regression coefficient -10.32 -
Confidence interval (-7.15-27.79)
The significance level 0.246
Marital status Regression coefficient 0.30- _
Confidence interval (-15.24-15.84)
The significance level 0.969
education Regression coefficient -1.38 _
Confidence interval (-25.65-28.41)
The significance level 0.920
Work experience in the nursing profession Regression coefficient 0.07 _
Confidence interval (-1.42-1.28)
The significance level 0.915
Work experience in the special department Regression coefficient -0.71 _
Confidence interval (-1.15-2.58)
The significance level 0.451
Type of employment Regression coefficient 5.11 4.97
Confidence interval (-10.98-0.75) (-10.90-0.91)
The significance level 0.088 0.099
Average monthly income Regression coefficient 0.74  
Confidence interval (-15.30-13.81) _
The significance level 0.920  
Average monthly overtime hours Regression coefficient 0.13 0.140
Confidence interval (0.32-0.05-9) (0.32-0.04-)
The significance level 0.164 0.145
Type of work shift Regression coefficient -23.76 -10.87
Confidence interval (-6.00- -41.52) (-13.44-35.19)
The significance level 0.009 0.379
Dimensions of job performance training Regression coefficient -26.37 -26.37
Confidence interval (-11.83- -40.84) (-11.09- -41.65)
The significance level >0.001 0.001
Dimensions of educational quality of job performance Regression coefficient -16.14 -15.76
Confidence interval (-2.84-29.45) (-1.97-29.54)
The significance level 0.018 0.025
Dimensions of job performance planning Regression coefficient -13.15 -8.51
Confidence interval (-0.43-26.74) (-6.16-23.20)
The significance level 0.058 0.254
Dimensions of job performance planning quality
 
Regression coefficient -10.91 -7.74
Confidence interval (-1.52-23.36) (-5.15-20.65)
The significance level 0.085 0.238
Dimensions of leadership career performance
 
Regression coefficient -17.56 -12.33
Confidence interval (-3.91- -31.21) (-1.93-26.59)
The significance level 0.012 0.090
Quality of leadership dimension of job performance
 
Regression coefficient -12.20 -7.31
Confidence interval (-0.08-24.48) (-5.44-20.07)
The significance level 0.052 0.260
Dimensions of job performance care
 
Regression coefficient -17.91 -10.59
Confidence interval (-2.55- -33.27) (-5.55-26.74)
The significance level 0.022 0.197
Dimensions of the quality of job performance care
 
Regression coefficient -12.35 -6.50
Confidence interval (-1.47-26.18) (-8.03-21.03)
The significance level 0.080 0.379
Dimensions of job performance communication
 
Regression coefficient -9.01 _
Confidence interval (-7.56-25.59)
The significance level 0.285
Dimensions of job performance communication quality
 
Regression coefficient -9.50 -7.88
Confidence interval (-4.42-23.43) (-6.51-22.28)
The significance level 0.180 0.281
The dimension of individual development of job performance Regression coefficient -8.51 -3.14
Confidence interval (-3.26-20.29) (-9.11-15.40)
The significance level 0.156 0.613
 
 
 
 

 
Discussion


The results of this study indicated that there is less than average moral distress among the participants; while the degree of moral distress in the special sections has been reported in the study of Beikmoradi et al. and the study of Bennett are moderate [25, 13] and high in the study of Cummings [26]. Linear regression analysis in the predictive role of job performance on moral distress in both frequency and quality, indicated a significant relationship between the educational dimension of job performance and moral distress in the field of quality; that is, increasing the quality and frequency of job performance in the educational dimension will reduce the amount of moral distress among nurses and vice versa.
The results of the raw regression model of this study showed that the employment status of nurses is one of the predictors of moral distress in them. In the study of the type of employment variable in this study, the highest frequency of staff (nearly half of it) was related to the formal employment group and the lowest was related to nurses in the contractual employment group. In Iran, the most focus is on formal and contractual employees. Also, the number of project nurses varies according to the output of universities and their demand for work in clinical settings [28]; therefore, it seems that having job security can be one of the effective and predictive factors of moral distress. However, in the studies of Beikmoradi et al. And Abbas Zadeh et al., no significant relationship was found between these two variables. In fact, according to them, moral distress can occur for all nurses regardless of their place of work [28, 13].
 The average monthly overtime hours and the type of nurses' shift work based on the results of the raw regression model of this study are predictive factors of moral distress; while the results of Elpern, Covert, and Kleinpell study showed that the personal characteristics of intensive care unit nurses are not related to the severity of their moral distress [29].
Another result of the raw regression model of this study is the predictive role of all dimensions of job performance (except for the frequency of job performance relationships) for moral distress. Consistent with the results of the present study, which includes almost all aspects of job performance in creating moral distress, in the study of Waziri et al., professional and functional incompetence have been identified as one of the most distressing factors in creating moral distress [13].


 

Conclusion


Based on the results of the present study, educational dimension of job performance is a predictive factor for moral distress. Therefore, steps can be taken to reduce moral distress in clinical settings, such as the use of nurses with specialized training in Intensive Care Units, paying special attention to teaching ethical issues in nursing centers and holding retraining courses for nurses.

 

Acknowledgments


This article is part of the first author's master's thesis on intensive care nursing. We would like to thank all the professors, participants in this study, as well as the Vice Chancellor for Education, School of Nursing and Midwifery, Qazvin University of Medical Sciences, for their sincere support and assistance in conducting this research.

 

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 

Type of Study: Original Research | Subject: Nursing
Received: 2020/04/12 | Accepted: 2020/07/18 | Published: 2020/10/11

References
1. Gallagher A. Moral distress and moral courage in everyday nursing practice. Online J Issues Nurs. 2011;16(2).
2. Burston AS, Tuckett AG. Moral distress in nursing: contributing factors, outcomes and interventions. Nurs Ethics. 2013;20(3):312-24. [DOI:10.1177/0969733012462049] [PMID]
3. Pauly BM, Varcoe C, Storch J. Framing the issues: moral distress in health care. InHec Forum 2012 Mar 1 (Vol. 24, No. 1, pp. 1-11). Springer Netherlands. [DOI:10.1007/s10730-012-9176-y] [PMID] [PMCID]
4. Vaziri MH, Merghati-Khoei E, Tabatabaei S. Moral distress among Iranian nurses. Iran Psychiatry. 2015;10(1):32. (In Persian)
5. Mason VM, Leslie G, Clark K, Lyons P, Walke E, Butler C, Griffin M. Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study. Dimens Crit Care Nurs. 2014;33(4):215-25. [DOI:10.1097/DCC.0000000000000056] [PMID]
6. Aminizadeh M, Arab M, Mehdipour R. The Relationship between Nurses' Moral Courage and Moral Stress in Intensive Care Units. Med Ethics History. 2017; 10 (1): 131-40. (In Persian)
7. Andolhe R, Barbosa RL, Oliveira EM, Costa AL, Padilha KG. Stress, coping and burnout among Intensive Care Unit nursing staff: associated factors. Revista da Escola de Enfermagem da USP. 2015;49(SPE):58-64. [DOI:10.1590/S0080-623420150000700009] [PMID]
8. Moghaddam MN, Amiresmaeili M, Ghorbaninia R, Sharifi T, Tabatabaie SS. Awareness of Patients' rights charter and respecting it from the perspective of patients and nurses: A study of limited surgical centers in Kerman city, 2013. Bioethics J. 2016;4(11):31-56.
9. Joolaee S, Nikbakht-Nasrabadi A, Parsa-Yekta Z, Tschudin V, Mansouri I. An Iranian perspective on patients' rights. Nurs Ethics. 2006;13(5):488-502. [DOI:10.1191/0969733006nej895oa] [PMID]
10. Mohammadi S, Borhani F, Roshanzadeh L, Roshanzadeh M. Moral distress and compassion fatigue in patient care: a correlational study on nurses. Ethics History Med. 2014; 7(2):69-79. (In Persian)
11. Georges JJ, Grypdonck M. Moral problems experienced by nurses when caring for terminally ill people: a literature review. Nurs Ethics. 2002;9(2):155-78. [DOI:10.1191/0969733002ne495oa] [PMID]
12. Meltzer LS, Huckabay LM. Critical care nurses' perceptions of futile care and its effect on burnout. Ame J Crit Care. 2004;13(3):202-8. [DOI:10.4037/ajcc2004.13.3.202]
13. Beikmoradi A, Rabiee S, Khatiban M, Cheraghi MA. Nurses distress in intensive care unit: a survey in teaching hospitals. Med Ethics History. 2012; 5 (2): 58-69.
14. Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and its relationship with professional stress in nurses. Iran J Med Ethics History Med. 2014;6(6):10-9. [DOI:10.21859/mej-103819]
15. Russell AC. Moral distress in neuroscience nursing: An evolutionary concept analysis. Journal of Neuroscience Nursing. 2012;44(1):15-24. [DOI:10.1097/JNN.0b013e31823ae4cb] [PMID]
16. Nafchi S, Borhani F, RoshanZadeh M. Relationship between moral distress and environmental empowerment in nurses of educational hospitals of Kerman. J Med Ethics. 2014; 7 (26): 91-113.
17. Wiegand, D. L. and M. Funk. Consequences of clinical situations that cause critical care nurses to experience moral distress..Nursing Ethics (2012); 19(4): 479-487. [DOI:10.1177/0969733011429342] [PMID]
18. Rushton CH. Defining and addressing moral distress: tools for critical care nursing leaders. AACN Adv Crit Care. 2006;17(2):161-8. [DOI:10.1097/00044067-200604000-00011] [PMID]
19. Dyrbye LN, Shanafelt TD, Johnson PO, Johnson LA, Satele D, West CP. A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC nursing. 2019;18(1):57. [DOI:10.1186/s12912-019-0382-7] [PMID] [PMCID]
20. Asfaw AM, Argaw MD, Bayissa L. The impact of training and development on employee performance and effectiveness: A case study of District Five Administration Office, Bole Sub-City, Addis Ababa, Ethiopia. Journal of Human Resource and Sustainability Studies. 2015;3(04):188. [DOI:10.4236/jhrss.2015.34025]
21. Schwirian PM. Evaluating the performance of nurses: A multidimensional approach. Nurs Res. 1978;27(6):347-50. [DOI:10.1097/00006199-197811000-00004] [PMID]
22. Sharma J, Dhar RL. Factors influencing job performance of nursing staff: mediating role of affective commitment. Personnel Rev. 2016;45(1):161-82. [DOI:10.1108/PR-01-2014-0007]
23. Mrayyan MT, AL‐FAOURI IB. Predictors of career commitment and job performance of Jordanian nurses. J Nurs Manag. 2008;16(3):246-56. [DOI:10.1111/j.1365-2834.2007.00797.x] [PMID]
24. Soleimani MA, Sharif SP, Yaghoobzadeh A, Sheikhi MR, Panarello B, Win MT. Spiritual well-being and moral distress among Iranian nurses. Nurs Ethics. 2019;26(4):1101-13. [DOI:10.1177/0969733016650993] [PMID]
25. Bennett G. Re: Moral distress of staff nurses in a medical intensive care unit. American journal of critical care: an official publication, Am J Crit Care. 2006;15(2):127. [DOI:10.4037/ajcc2006.15.2.127] [PMID]
26. Cummings CL. The effect of moral distress on nursing retention in the acute care setting.
27. Kousar Perveen, Afzal M, Abid S, Majeed I, Hussain M. Impact of Moral Distress on Nurse's Performance. Saudi J Med Pharm Sci. 2017: 3 (9): 991-996.
28. AbbasZadeh A, Nakhaei N, Borhani F, Roshanzadeh M. Ethical distress in nurses' clinical practice: a descriptive cross-sectional study. J Med Ethics. 2013; 6 (21): 113-30.
29. Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. American J Critical Care. 2005;14(6):523-30. [DOI:10.4037/ajcc2005.14.6.523]
30. Sadeghi M, Ebrahimi H, Abbasi M. The relationship between moral distress and burnout in clinical nurses in the Shahroud city. Iran J Nurs Res. 2016;11(2):78-87.
31. Zakerian SA, Mosaferchi S, Sepidarkish M, Nasiri Z, Yaseri M. The Role of Individual Effective Factors on Nurses' Job Performance. A Case Study: Selected Hospitals in Tehran. Occup Med Q J. 2018;10(1):54-61.
32. Keighobadi F, Sadeghi H, Keighobadi F, Tabarae Y. The relationship between moral distress and emotional exhaustion in nurses. Med Ethics History. 2014;7(3):36-47.
33. Pauly BM, Varcoe C, Storch J, Newton L. Registered nurses' perceptions of moral distress and ethical climate. Nurs Ethics. 2009;16(5):561-73. [DOI:10.1177/0969733009106649] [PMID]
34. Rogers S, Babgi A, Gomez C. Educational Interventions in End-of-Life Care: Part IAn Educational Intervention Responding to the Moral Distress of NICU Nurses Provided by an Ethics Consultation Team. Adv Neonatal Care. 2008;8(1):56-65. [DOI:10.1097/01.ANC.0000311017.02005.20] [PMID]

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