The Status And Influencing Factors Of Moral Distress Among Undergraduate Nursing Students In Clinical Practice

Objectives:Under the guidance of the moral distress model,a mixed research design was used to adapt the Moral Distress Scale for Clinical Practice Nursing Students,to investigate the level of moral distress and the influencing factors of undergraduate nursing students in clinical practice,to analyze the influence of their level of moral distress on their employment intentions,and to explore the moral distress experience of undergraduate nursing students in clinical practice through semi-structured interviews.Methods:(1)Quantitative study: from November 2021 to January 2022,the revised version of the moral distress scale was adapted to the actual situation of clinical intern nursing students,experts rated and analyzed the content validity index,and a convenience sample of 248 clinical intern nursing students was selected as the study subjects to analyze the reliability of the internal consistency assessment scale.from January to February2022,a convenience sample of 811 clinical intern nursing students was selected as the study The subjects were subjected to a cross-sectional survey.The General Information Questionnaire,the Ethical Distress Scale for Clinical Internship Nursing Students,the Hospital Ethical Climate Scale,the Appreciative Social Support Scale,the Ethical Sensitivity Scale,and the Psychological Resilience Scale were used for measurement,and SPSS 26.0 was used as the data analysis software for this study.Statistical methods included statistical description,correlation analysis,and multiple linear regression analysis.Statistical description: statistical description was performed using the mean ± standard deviation for measurement data,and statistical description was performed using the composition ratio for count data.One-way analysis: moral distress did not conform to a normal distribution and was analyzed using the nonparametric Mann-Whitney U test or the nonparametric Kruskal-Wallis H test.Correlation analysis:Pearson or Spearman correlation analysis was used for correlation analysis between hospital ethical climate,moral sensitivity,psychological resilience,social support and moral distress.Multiple linear regression: general information,hospital ethical climate,moral sensitivity,psychological resilience and social support were used as independent variables and moral distress was put into the equation as the dependent variable.(2)Qualitative study: In March 2022,a total of nine interviewees were included using a semi-structured interview method,and the data were analyzed using NVivo 11.0 software and the "traditional content analysis method".Results:(1)Quantitative study: The Cronbach’s alpha coefficient of the total scale of moral distress of clinical internship nursing students was 0.954,the Cronbach’s alpha coefficient of each dimension ranged from 0.807 to0.956,the content validity index of the scale entry level was 0.80-1.00,and the average content validity index of the scale level was 0.91.824 questionnaires were collected in the cross-sectional survey.After eliminating invalid questionnaires,811 valid questionnaires were finally obtained,and the questionnaire recovery efficiency was 98.4%;the average age was 21.57±0.96 years,the average duration of clinical practice was9.04±1.19 months,the score of moral distress was 30.46±30.21,the score of moral distress frequency was greater than the score of moral distress degree,the dimension with the highest score was value conflict,the lowest was individual responsibility,and the internship unit with the highest frequency and degree of moral distress was the intensive care unit.The hospital ethical climate score was 101.93±20.47,the comprehension social support score was 66.19±14.68,the moral sensitivity score was 40.56±8.26,and the psychological resilience score was 27.77±7.78.There were statistically significant differences in the level of moral distress among clinical internship nursing students with or without religious beliefs,ethnicity,whether or not they practiced in obstetrics and gynecology,and whether or not they practiced in pediatrics,and the clinical internship nursing students There were statistically significant differences in frequency of moral distress,total score and different employment intentions.Hospital ethical climate,comprehending social support,moral sensitivity,and psychological resilience scores were all correlated with moral distress.The results of multiple linear regression showed that there were linear regression relationships between religious beliefs,ethnicity,whether to practice in obstetrics and gynecology,whether to practice in pediatrics,hospital ethical climate,comprehending social support,moral sensitivity,and psychological resilience into the equation and the level of moral distress.(2)Qualitative study: The collected interview data were analyzed to distill three relevant themes regarding clinical intern nursing students’ experiences of moral distress: psychological experience of moral distress,the role of clinical teachers,and the impact on clinical learning.seven subthemes were included under the three themes: feelings of powerlessness,feelings of shock,empathy,lack of support,good role models,sources of moral distress,constraints on clinical learning,and motivation to learn.Conclusion:(1)The Moral Distress Scale for Clinical Practice Nursing Students has good reliability and validity and is suitable for use in our clinical practice nursing student population.(2)The frequency scores of moral distress among undergraduate nursing students in clinical practice were higher than their degree scores.The dimension with the highest moral distress score was value conflict,and the lowest was individual responsibility.The internship units with the highest frequency and degree of moral distress were both intensive care units.The level of moral distress was higher among undergraduate nursing students in clinical practice who had religious beliefs,were Han Chinese,practiced in pediatrics,and did not practice in obstetrics and gynecology.The higher the level of perceived hospital ethical climate,the higher the level of social support,the greater the moral competence,and the better the psychological resilience,the lower the level of moral distress among nursing students.(3)Insufficient clinical faculty support when undergraduate nursing students in clinical practice face moral distress may also be a source of moral distress,and nursing students want to be supported by faculty.The more frequently moral distress occurred and the higher the level the more likely nursing students were to leave the nursing field for employment.Moral distress is a motivating or hindering factor for nursing students’ learning experiences and has a negative psychological impact on them,while low levels of moral distress lead to more empathic skills.