Author ORCID Identifier

https://orcid.org/0000-0002-5252-2199

Year of Publication

2021

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Social Work

Department/School/Program

Social Work

First Advisor

Dr. Melanie Otis

Abstract

The COVID-19 pandemic caused a wave of critically ill patients, overwhelming hospitals, and creating unprecedented conditions for hospital employees, particularly bedside nurses. Concerns about the emotional and mental well-being of nurses have already been raised prior to the pandemic and depression, anxiety, and PTSD symptoms among nurses during the pandemic have been observed. Given the increased infection and safety risks, staffing shortages, inadequate personal protective equipment and resources, and hospital restrictions causing many nurses to be patients’ only support, there is also a growing concern about how these institutional and personal restrictions to providing best care and practicing ethically have impacted nurses.

Moral distress is the psychological disequilibrium that occurs when a professional knows what they need to do but is/feels unable to take that action due to perceived or actual internal and/or external constraints. Much has been researched about causes of moral distress in the last 20 years, but to date, there is limited evidence around the impact of organizational support, emotional intelligence (EI), and coping strategies.

This pilot study aimed to describe and explore the relationships among EI, coping, organizational support, and moral distress, and to provide pilot data and methodological information to inform a national study. Participants were Kentucky registered nurses currently working or who have worked at an inpatient hospital facility within the last six months. Participants were recruited using non-randomized purposive and snowball sampling techniques to complete an anonymous online survey using Qualtrics. Using SPSS, descriptive statistics and regression analyses examined the relationships between the independent study variables, using the Wong and Law Emotional Intelligence Scale, COVID-19 Organizational Support, Survey of Perceived Organizational Support, and the Ways of Coping Checklist Revised, and the dependent variable, moral distress, as measured by the Measurement of Moral Distress for Healthcare Professionals. Regression analysis adjusted for hospital ethical climate, intensive care setting, and age.

After data cleaning and screening, there were 544 nurse participants who completed most of the demographic questionnaire items with 271 participants completing all instruments included in the regression analysis. The sample included mostly white females with Bachelor of Science in nursing working with adult populations in non-ICU settings in central Kentucky. In support of predicted relationships, organizational support was associated with a reduction in moral distress and emotion-focused coping was positively related. However, in contrast of predicted relationships, problem-focused coping was also positively related to moral distress; and while EI had a negative relationship in correlational testing, EI resulted in a non-significant positive relationship in regression analysis. Additional regression analysis showed EI maintained a negative relationship only when entered with problem-focused coping adjusted for control variables.

Future research should strive for larger, more diverse samples that would allow for mediation testing to further explore the relationship between EI, coping, and moral distress. Metadata from Qualtrics will be used to inform potential changes in the structure, length and presentation of the survey for a national study.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2021.113

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