بررسي تأثير برنامه توانمندسازي بر درماندگي اخلاقي پرستاران در بخش‌هاي مراقبت ويژه

Effectiveness of Empowerment Program on Nurses’ Moral Distress in Intensive Care Units

ﯾﮑﯽ از ﻣﺸﮑﻼت رواﻧﯽ و اﺟﺘﻤﺎﻋﯽ ﺷﺎﯾﻊ در ﺑﯿﻦ ﭘﺮﺳﺘﺎران ﺷﺎﻏﻞ در واﺣﺪ ﻣﺮاﻗﺒﺖ وﯾﮋه درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ اﺳﺖ. درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ را ﻣﯽ ﺗﻮان وﺿﻌﯿﺘﯽ از ﻋﺪم ﺗﻌﺎدل رواﻧﯽ داﻧﺴﺖ ﮐﻪ زﻣﺎﻧﯽ ﺗﺠﺮﺑﻪ ﻣﯽ ﺷﻮد ﮐﻪ اﻧﺴﺎن از اﻧﺠـﺎم ﻋﻤﻠـﯽ ﮐـﻪ ﻣـﯽ داﻧـﺪ درﺳﺖ اﺳﺖ ﺑﺎزداﺷـﺘﻪ و ﯾـﺎ ﻣﺠﺒـﻮر ﺑـﻪ اﻧﺠـﺎم ﮐﺎري ﺷﻮد ﮐﻪ ﻣﯽ داﻧﺪ ﻧﺎدرﺳـﺖ اﺳـﺖ. ﻟﺬا، ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺄﺛﯿﺮ ﺑﺮﻧﺎﻣﻪ ﺗﻮاﻧﻤﻨﺪﺳﺎزي ﺑﺮ درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ ﭘﺮﺳﺘﺎران واﺣﺪ ﻣﺮاﻗﺒﺖ وﯾﮋه اﻧﺠﺎم ﺷﺪ. روش ﮐﺎر: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﯿﻤﻪ ﺗﺠﺮﺑﯽ ﺑﺮ روي 60 ﭘﺮﺳﺘﺎر ﺷﺎﻏﻞ در ﺑﺨﺶ ﻫﺎي ﻣﺮاﻗﺒﺖ وﯾﮋه ﺑﯿﻤﺎرﺳﺘﺎن ﺷﻬﯿﺪ ﺑﻬﺸﺘﯽ ﮐﺎﺷﺎن در ﺳﺎل 1398اﻧﺠﺎم ﺷﺪ. روش ﻧﻤﻮﻧﻪ ﮔﯿﺮي از ﻧﻮع ﺑﻠﻮك ﺑﻨﺪي ﺗﺼﺎدﻓﯽ ﺑﻮد. ﺑﺮﻧﺎﻣﻪ ﺗﻮاﻧﻤﻨﺪﺳﺎزي اﺧﻼﻗﯽ ﻃﯽ ﯾﮏ ﮐﺎرﮔﺎه 2 روزه ﺑﺮاي ﮔﺮوه ﻣﺪاﺧﻠﻪ ﺑﺮﮔﺰار ﺷﺪ. در ﺷﺮوع، ﺑﻼﻓﺎﺻﻠﻪ و 1 ﻣﺎه ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ، ﭘﺮﺳﺸﻨﺎﻣﻪ اﻃﻼﻋﺎت ﻓﺮدي و درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ ﺑﺮاي ﻫﺮ دو ﮔﺮوه ﺗﮑﻤﯿﻞ ﺷﺪ. ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ داده ﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮن ﻫﺎي آﻣﺎر ﺗﻮﺻﯿﻔﯽ و ﺗﺤﻠﯿﻠﯽ ﻧﻈﯿﺮ ﺗﯽ ﻣﺴﺘﻘﻞ، ﮐﺎي اﺳﮑﻮﺋﺮ و آزﻣﻮن دﻗﯿﻖ ﻓﯿﺸﺮ در ﻧﺮم اﻓﺰار آﻣﺎري 16. SPSSV اﻧﺠﺎم ﮔﺮﻓﺖ. ﯾﺎﻓﺘﻪﻫﺎ: ﻗﺒﻞ از ﻣﺪاﺧﻠﻪ، ﻣﯿﺎﻧﮕﯿﻦ ﻓﺮاواﻧﯽ و ﺷﺪت درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ ﮔﺮوه ﻣﺪاﺧﻠﻪ و ﮐﻨﺘﺮل ﺑﺘﺮﺗﯿﺐ 5/05 ± 40/20 و 9/33 ± 40/53 )0/05 ≥P ( و 5/48 ± 40/63 و 9/55 ± 41/27 )0/05 ≥P ( ﺑﻮد. ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ، ﻣﯿﺎﻧﮕﯿﻦ ﻓﺮاواﻧﯽ درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ ﮔﺮوه ﻣﺪاﺧﻠﻪ و ﮐﻨﺘﺮل ﺑﺘﺮﺗﯿﺐ 4/99 ± 37 و 8/88 ± 39/10 )0/263 = P ( و ﻣﯿﺎﻧﮕﯿﻦ ﺷﺪت درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ ﺑﺘﺮﺗﯿﺐ 5/33 ± 37/17 و 23/90 ± 39/9 )0/318 = P( ﺑﻮد اﻣﺎ ﯾﮏ ﻣﺎه ﺑﻌﺪ از آن، از ﻧﻈﺮ ﻣﯿﺎﻧﮕﯿﻦ ﻓﺮاواﻧﯽ درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ )0/012 = P( و ﻣﯿﺎﻧﮕﯿﻦ ﺷﺪت درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ )0/009 = P( ﺗﻔﺎوت ﻣﻌﻨﺎداري وﺟﻮد داﺷﺖ. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﯿﻮع ﺑﺎﻻي درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ ﭘﺮﺳﺘﺎران، ﺑﻪ ﻧﻈﺮ ﻣﯽ رﺳﺪ ﺑﺎ ﺑﺮﻧﺎﻣﻪ رﯾﺰي و اﺟﺮاي ﺑﺮﻧﺎﻣﻪ ﻫﺎي ﺗﻮاﻧﻤﻨﺪﺳﺎزي ﺷﺎﯾﺪ ﺷﺪت و ﻓﺮاواﻧﯽ درﻣﺎﻧﺪﮔﯽ اﺧﻼﻗﯽ در ﺑﯿﻦ ﭘﺮﺳﺘﺎران را ﺑﻪ ﺣﺪاﻗﻞ رﺳﺎﻧﯿﺪ.

One of the most common psychological and social problems among nurses working in the intensive care unit is moral distress. Moral distress can be characterized as a state of mental imbalance experienced when a person is aware of the practical implication that it is right to be deterred or forced to do something that he knows is wrong. Therefore, the present study aimed to determine the effect of empowerment program on nurses' moral distress in the intensive care unit. Methods: This quasi-experimental study was performed on 60 nurses working in intensive care units of Kashan Shahid Beheshti Hospital. The sampling method was randomized blocking. The intervention program was conducted during two consecutive weeks during a 2-day workshop. At baseline, immediately and one month after the intervention, demographic and moral distress questionnaires were completed for both groups. Data were analyzed using descriptive and inferential statistics Such as independent t-test, chi-square, and Fisher's exact test in SPSSV.16 software. Results: Before the intervention, the mean frequency and severity of moral distress in intervention and control group were 40.20 ± 5.05 and 40.53 ± 9.33 (P ≥ 0.05) and 40.63 ± 5.48 and 41.27 ±9.55 (P ≥ 0.05), respectively. After the intervention, the mean frequency of moral distress in the intervention and control groups were 37 ±4.99 and 39.10 ± 8.88, respectively (P = 0.226) and the mean severity of moral distress was 37.17 ± 5.33 and 39.23 ± 0.90(P = 0.318), respectively. There was a significant difference between the mean frequency of moral distress (P = 0.012) and the mean severity of moral distress (P = 0.009) one month later the intervention. Conclusions: Given the high prevalence of nurses' moral helplessness, it seems planning and implementing empowerment programs maybe minimize the severity and frequency of moral distress among nurses.