Moral Distress and Ethical Climate Among Japanese Intensive Care Unit Nurses

Area of Science:

• Nursing Ethics
• Healthcare Management
• Medical Sociology

Background:

• Moral distress is a significant global issue impacting intensive care unit (ICU) nurses' well-being and care quality.
• Japanese healthcare's hierarchical and consensus-driven culture may uniquely influence nurses' ethical experiences, an area requiring further investigation.

Purpose of the Study:

• To explore the prevalence and nature of moral distress among Japanese ICU nurses.
• To examine Japanese ICU nurses' perceptions of the hospital ethical climate.
• To investigate the relationship between moral distress and the ethical climate in Japanese ICUs.

Main Methods:

• A mixed-methods explanatory sequential design was employed.
• Phase one: Web-based survey of 168 ICU nurses using the revised Japanese Moral Distress Scale and Hospital Ethical Climate Survey.
• Phase two: Semi-structured interviews with 11 nurses, followed by content analysis.

Main Results:

• Moderate levels of moral distress were reported, with 'lack of respect for patient dignity' scoring highest.
• Low ratings for 'organizational support through clear hospital philosophy' correlated negatively with distress from collaboration difficulties.
• Qualitative data revealed themes of powerlessness regarding futile treatments, communication barriers, and dissatisfaction with physician-centered decision-making.

Conclusions:

• Japanese ICU nurses experience moderate moral distress, especially concerning end-of-life care, linked to a poor ethical climate and inadequate organizational support.
• Enhancing organizational structures, clarifying ethical principles, and promoting interprofessional communication are vital.
• Future research should explore longitudinal designs and interventions like ethical decision-making support systems to mitigate moral distress and improve the ethical climate.