Predictors and consequences of moral distress in home-care nursing: A cross-sectional survey

Abstract

Background: Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress.

Objective: This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany.

Research design: A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic regressions, and Rasch analyses were performed.

Participants and research context: The invitation to participate was sent to every German home-care service (n = 16,608).

Ethical considerations: The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health.

Results: A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence.

Conclusions: To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector.

Keywords: Moral distress; ethics; home-care nurses; home-care nursing; moral stress; working conditions.