The Relationship Between Moral Distress and Professional Autonomy Among Critical Care Nurses: A Systematic Review
Abstract
Title: The Relationship Between Moral Distress and Professional Autonomy Among
Critical and Acute Care Nurses: A Systematic Review
Background: Moral distress is an ethical issue faced by critical and acute care nurses who work in a complex environment. Moral distress has serious consequences, such as poor-quality patient care, job burnout and resignation. Among all the contributing factors highlighted in the literature, one can significantly contribute to moral distress: which is professional autonomy. It is thus important to explore the relationship between these variables in critical and acute care nursing.
Aim: This systematic review aims to identify the relationship between moral distress and professional autonomy among critical and acute care nurses.
Methodology: Six electronic databases (CINAHL, Medline, PsycINFO, Cochrane Library, Web of Science, and EMBASE) were searched systematically. A systematic search strategy was formulated with the assistance of an expert librarian. The appraisal tool for cross-sectional studies (AXIS) tool is used to assess the quality of each study.
Results: A total of ten studies are included. All the studies were cross-sectional, descriptive, and correlational, and they looked at the relationship between moral distress and professional autonomy either directly or indirectly through factors related to professional autonomy. Five studies found a negative relationship, three studies found a positive relationship, and two studies found no relationship between the variables. The discussion made based on the studies relates to organisational policy, leadership support, psychological characteristics, and education.
Conclusions: Moral distress has negative impacts on individuals, the quality of the delivered care, and organisations. This systematic review found that those factors which enhance professional autonomy can contribute to the reduction of moral distress. Therefore, this review highlights a need to decrease moral distress experiences through increases nurses autonomy.
Description
This systematic review focused on critical and acute care nurses who had experienced moral distress, as well as the relationship between their experiences and their level of professional autonomy. Moral distress is an ethical problem. It has attracted researchers' attention because it has negative consequences for nurses and works against the organisations' goals for proper patient care. Studies have focused on hidden reasons behind these experiences, most related situations, associated factors, and how to cope, resolve, and prevent these experiences. However, few studies have specifically assessed professional autonomy as a determinant of moral distress.
This systematic review's findings presented the factors associated with moral distress experience among critical and acute care nurses in relation to their professional autonomy including organisational policies and rules, leadership support, nurses' psychological characteristics, and nurses' education and qualification. These elements are highly connected with formally and informally promoting professional autonomy, and they have been analysed and explored in this systematic review.
Keywords
Professional Autonomy, Moral distress, Nursing Autonomy, Critical care nursing