Moral Sensitivity and Delivering Bad News Skills: A Study on Critical Care Unit Nurses

Mohammadi, S. and Borhani, F. and Roshanzadeh, M. (2016) Moral Sensitivity and Delivering Bad News Skills: A Study on Critical Care Unit Nurses. Medical Ethics Journal, 10 (37).

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Abstract

Background and Aim: Delivering bad news to the patient and his/her family can pose a moral challenge to the nurses. Meanwhile, nurses’ knowledge and moral sensitivity towards such moral situations as delivering the bad news to the patient and his/her family can play a significant role in mitigating its effects and preventing the consequences which may affect many patients, health systems and the nurses as moral agents. This study, therefore, aimed to determine the relationship between moral sensitivity of the nurses working in critical care units and their skills of delivering bad news. Materials and Methods: This cross-sectional study was conducted in South Khorasan province, Iran, in January 2016. The study population consisted of 222 nurses working in critical care units (ICU, CCU, NICU and Dialysis) of the hospitals affiliated to the Medical University of South Khorasan province. The participants were selected by convenience sampling. Inclusion criteria were having at least a bachelor's degree, working full-time, having at least one year of clinical experience, and being currently engaged in the clinical work. Data were collected through a questionnaire which consisted of three parts: the first part included demographic information such as age, sex, education, number of years of service, type of employment, and type of workplace; the second part consisted of Spikes’ 20-question questionnaire for the skills of delivering bad news with Content Validity Index (CVI) of 0.81 and Cronbach's alpha of 0.82; the third part had a 25-question questionnaire regarding moral sensitivity with Cronbach's alpha of 0.79. The options of delivering the bad news questionnaire were determined according to a Likert scale of five points from never (1) to always (5). The options of the moral sensitivity questionnaire were also determined according to a Likert scale of five points from completely disagree (0) to completely agree (4). Having obtained all the necessary permits, the questionnaires were handed to the participants. Of the total 236 questionnaires distributed, 225 questionnaires were completed. Three questionnaires were excluded from the study due to some flaws in responding to the questions, and 222 questionnaires entered the process of statistical analysis. Data collection lasted for a month. The collected data were entered into SPSS statistical software and analyzed by descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics tests (t-test, ANOVA, Pearson correlation coefficient, and Chi-squared). Ethical Considerations: Having obtained the approval of the Ethics Committee of Shahid Beheshti University of Medical Sciences, the participants were provided with the full information about the objectives of the study and how to answer the questionnaires. It was also pointed out that participation in this study was voluntary, and that the participants had freedom to participate or withdraw from the study at any point. Verbal informed consent was obtained from all of the participants in the study. In addition, all of the participants were assured of the anonymity of the questionnaires and the confidentiality of their information. Results: There was a significant positive correlation between moral sensibility and the skill of delivering bad news (P=0.04, r=0.5). The mean total of nurses’ skills of delivering bad news was 3.5 ± 0.8 out of 5. The mean for psychological dimension was (3.6 ± 0.8) and for environmental dimension was (3.41 ± 0.77). The mean total of nurses’ moral sensibility was 3 ± 0.6 out of 4. Investigating the mean moral sensitivity based on separation of its components indicated the highest mean for the moral behavior (3.3 ± 0.41) and the lowest mean for respect for patients (2.5 ± 0.65). The relationship between moral sensitivity and the number of years of service and the age of the nurses was also significant (P <0.05). Moreover, there was a significant relationship between the skill of delivering bad news and sex, the number of years of service, and the workplace (P <0.05). Conclusion: The findings of the present study indicated that nurses who were more sensitive had more skills when faced with such moral situations as delivering bad news to the patient and his/her family. In other words, it can be said that nurses’ sensitivity towards moral issues will ensure the accuracy and precision of their skills in delivering bad news to the patient and his/her family. In this regard, it is recommended that hospital administrators, considering the nurses’ level of moral sensitivity, take some measures regarding teaching communication skills in such special circumstances as delivering bad news. Also, given that the skills of nurses working in the ICU were higher than those of the other units, perhaps a significant role can be considered for the experience and the number of years of service in delivering bad news to the patient and his/her family. However, it is also suggested that some lessons be learned from the strengths of experience of successful people in delivering bad news in similar circumstances.

Item Type: Article
Uncontrolled Keywords: Moral Challenge; Moral Sensitivity; Breaking Bad News; Critical Care Units; Nursing
Subjects: WM Psychiatry
WY Nursing
Divisions: Faculty of Nursing and Midwifery
Depositing User: zahra bagheri .
Date Deposited: 25 Sep 2017 05:32
Last Modified: 25 Sep 2017 05:32
URI: http://eprints.skums.ac.ir/id/eprint/5670

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