Clinical Question The clinical question driving the inquiry for a quantitative research article is: For nurses who experience moral distress, how does adequate staffing of nurses compared to an inadequate number of scheduled nurses affect patient care and ethical professionalism? Furthermore, a specific clinical question is created to address the aforementioned issue with a qualitative research article: How does the health care organization regulations positively or negatively effects nursing moral compass and professionalism with limited staffing for nurses.
Problem The problem that this paper will address is how moral distress caused by an inadequate supply of nurses may increase medical errors and affect patient care. This rising concern influence in an immense role in evoking moral distress that affects the nurse’s daily interactions with patient care and fellow peers. As the growing concern becomes more prevalent, evidence of statistics provided by a report from the Bureau of Labor Statistics'(BLS), Employment Projections 2012-2022 (BLS, 2013), “the registered nurse workforce will expand to 2. 71 million in 2012 to 3. 4 million in 2022, an increase of 526,800 or 19%” (American Association of Colleges of Nursing, 2014). In continuing, the BLS projects 525,000 replacements will be needed as a survey by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers in 2013, provide data that 55% of the RN workforce is age 50 or older. (American Association of Colleges of Nursing, 2014).
Furthermore, with the difference of projected growth and projected replacements, provides evidence of an inadequate growth rate to properly supplement n adequate workforce of nurses. As a consequence of this growing issue, substantially contributes to moral distress effecting the nursing care and healthcare as a whole. Moral distress has been defined as when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action (Varcoe, Pauly, Storch, Newton, & Makaroff, 2012). Astonishingly, there is little input or frame of reference to the nurses’ experience and understanding of moral distress events that affects patient care from a nurse’s point of view.
This paper will provide quantitative and qualitative evidence and the substantial effects that will support the group topic assigned to properly decipher if the research articles can provide sustenance towards of moral distress caused by an insufficient number of registered nurses. In addition, a matrix will provide this key concepts to qualify research articles for approval. Description of Findings: Summary Experts from the University of British Columbia, Canada and The University of Victoria, Canada conducted research through a survey disseminated to 1700 registered nurses working in British Columbia in an acute care setting.
The article written by the researchers, Nurses’ Perceptions of and Responses to Morally Distressing Situations, displayed the registered nurses opinions of 292 nurses that responded. The purpose of the researchers’ article is to find how does incompetence, moral agency, moral distress, nursing action, and organizational context affect healthcare provided by registered nurses. The article provides a quantitative and qualitative design. The article provides the dependent variable of registered nurses moral compass and the effect of the independent variable of moral distress.
Description of Findings: Description Concepts The dependent variable of the research article is the registered nurse moral compass and the independent variable is the incompetence, moral agency, moral distress, nursing action, and organizational context. The qualitative design is the survey provided to register nurses’ opinion and answers. In addition, the quantitative design is the data collected from the survey displaying common ethical issues.
The concept of the article is to provide evidence of moral distress and ethical issues from the view point of the registered nurse in an acute care setting. Methods The method used was data obtained by means of the Corley’s MDS13 and Olson’s Hospital Ethical Climate Survey. The article written by Varcoe et al. provides qualitative and quantitative designs to indicate the effect of inadequate population of registered nurses increasing or developing moral distress that affects team building and patient care.
The survey provided qualitative data, in which, open-ended questions were provided at the end of the survey. They are as follows: 1. Please describe a situation in which you have experienced moral distress in your practice. (Moral distress is defined as a painful feeling and/or psychological disequilibrium caused by a situation where you believe you know the ethically appropriate action to take and you believe you cannot carry out that action because of institutional obstacles, such as lack of time, supervisory disinterest, medical power, institution policy, or legal limits. 2. What action, if any, did you take in the situation you described? 3. What effect, if any, do you think moral distress had on patient care in this situation? In addition, the article provides a quantitative design from the number of participants’ similar answers and rationales of survey questions. As a result, a nominal percentage can be applied to the nursing population to provide evidence of moral distress induced by insufficient workfoce solutions.
Participants The participants involved in the article Nurses’ Perceptions of and Responses to Morally Distressing Situations were 5 authors, Colleen Varcoe of the University of British Columbia, Canada, Bernie Pauly, Jan Storch, Lorelei Newton, Kara Makaroff of University of Victoria, Canada. In addition, a panel of experts was established to eliminate bias and certify crediable material. Furthermore, a survey package was distributed amongst 1700 registered nurses from a database that worked in British Columbia, Canada.
The participants were randomly selected from a generated list, in which, they volunteered to participate and be contacted for research purposes and a requirement actively working in the acute care setting. Instrument The instrument that was used in the reference article was a panel of experts. The article refers to this panel as investigators and they independently examined the initial 10 responses of the participants. The investigators individually conducted in-depth analysis of selected sub-topic areas, in which, the panel looks for relationships and trends of each subtopic.
The panel met constantly and providing reflective notes that help refine analysis. By implementing this panel, it challenged theories, biases, and explanations to find the validity and enhance the credibility of the analysis. Purpose The research article answers the purpose of this paper’s qualitative question by providing the responses of the registered nurses in acute settings on the effects of hospital policies and regulations increase moral distress with decreased nursing workforce.
Furthermore, the article also provides solid statistical data from the survey by providing percentages and numbers participants and their corresponding responses. As a this will provide sufficient evidence to assist in answering the quantitative question by comparing medical errors, patient neglect, and ethical conflict between co-workers percentages from negative effects of moral distress cause by inadequate supply of registered nurse versus a sufficient number of RN workforce. With finding the contrast to half of the questions, the next step is to accumulate information that will provide vidence of a healthcare setting with adequate RN workforce and policies to display the gains of health care and camaraderie between peers. Next, is to implement the gain research into the group project. To properly implement and collaborate all information the group must submit and format questions to properly guide the paper. The first question is how will the group research be compiled while maintaining a cohesive topic of how lack of nursing moral compass and impact on ethical professional practice.
Second question, how will the group decide on what information to keep and exclude. Conclusion In conclusion, the research provided evidence of the registered nurses viewpoint of encountering moral distress and how it has an impact on the nursing profession. The effect may influence the nurses’ moral compass direct or indirect. This provides a valuable perspective of the emotional stress that effects team collaboration and patient care.
The moral distress associated with the nurses’ performance in patient care as a whole Furthermore, the evidence obtain by the research will provide plausible solutions to resolving this growing epidemic by reducing moral distress. Recommendations is required counseling, re-evaluations of health care facilities policies, and provide adequate staffing. These particular actions will relieve moral distress and enhances the nurses work performance. As a result, the over whelming result will be a high quality of health care provided to the patient.
