PMID- 38165288
OWN - NLM
STAT- Publisher
LR  - 20240102
IS  - 2329-4523 (Electronic)
IS  - 2329-4515 (Linking)
DP  - 2024 Jan 2
TI  - Structural Equation Modeling Analysis on Associations of Moral Distress and 
      Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of 
      Healthcare Professionals.
PG  - 1-13
LID - 10.1080/23294515.2023.2297922 [doi]
AB  - OBJECTIVE: Moral distress is a complex phenomenon experienced by healthcare 
      professionals. This study examined the relationships between key dimensions of 
      Organizational Culture in Healthcare (OCHC)-perceived psychological safety, 
      ethical climate, patient safety-and healthcare professionals' perception of moral 
      distress. DESIGN: Cross-sectional survey. SETTING: Pediatric and adult critical 
      care medicine, and adult hospital medicine healthcare professionals in the United 
      States. PARTICIPANTS: Physicians (n = 260), nurses (n = 256), and advanced 
      practice providers (n = 110) participated in the study. MAIN OUTCOME MEASURES: 
      Three dimensions of OCHC were measured using validated questionnaires: Olson's 
      Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality's 
      Patient Safety Culture Survey, and Edmondson's Team Psychological Safety Survey. 
      The perception of moral distress was measured using the Moral Distress Amidst a 
      Pandemic Survey. The hypothesized relationships between various dimensions were 
      tested with structural equation modeling (SEM). RESULTS: Adequate model fit was 
      achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 
      0.069 to 0.075), standardized root mean square residual = 0.056, and comparative 
      fit index =0.926. Perceived psychological safety (beta= -0.357, p <.001) and patient 
      safety culture (beta = -0.428, p<.001) were negatively related to moral distress 
      experience. There was no significant association between ethical climate and 
      moral distress (beta = 0.106, p = 0.319). Ethical Climate, however, was highly 
      correlated with Patient Safety Culture (factor correlation= 0.82). CONCLUSIONS: 
      We used structural equation model to test a theoretical model of 
      multi-dimensional organizational culture and healthcare climate (OCHC) and moral 
      distress.Significant associations were found, supporting mitigating strategies to 
      optimize psychological safety and patient safety culture to address moral 
      distress among healthcare professionals. Future initiatives and studies should 
      account for key dimensions of OCHC with multi-pronged targets to preserve the 
      moral well-being of individuals, teams, and organizations.
FAU - Thomas, Tessy A
AU  - Thomas TA
AUID- ORCID: 0000-0003-4959-1676
AD  - Department of Pediatrics, Division of Pediatric Critical Care Medicine, Janet 
      Weis Children's Hospital, Geisinger Health System, Danville, PA, USA.
AD  - Center for Bioethics & Decision Sciences, Geisinger Health System, Danville, PA, 
      USA.
FAU - Kumar, Shelley
AU  - Kumar S
AD  - Center for Research, Innovation and Scholarship in Health Professions Education, 
      Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 
      Houston, TX, USA.
FAU - Davis, F Daniel
AU  - Davis FD
AD  - Center for Bioethics & Decision Sciences, Geisinger Health System, Danville, PA, 
      USA.
FAU - Boedeker, Peter
AU  - Boedeker P
AD  - Department of Education, Innovation and Technology, Baylor College of Medicine, 
      Houston, TX, USA.
FAU - Thammasitboon, Satid
AU  - Thammasitboon S
AD  - Center for Research, Innovation and Scholarship in Health Professions Education, 
      Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 
      Houston, TX, USA.
AD  - Department of Pediatrics, Section of Critical Care Medicine, Baylor College of 
      Medicine, Texas Children's Hospital, Houston, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20240102
PL  - United States
TA  - AJOB Empir Bioeth
JT  - AJOB empirical bioethics
JID - 101631047
SB  - IM
OTO - NOTNLM
OT  - Moral distress
OT  - healthcare professionals
OT  - organizational culture
OT  - psychological safety
EDAT- 2024/01/02 11:41
MHDA- 2024/01/02 11:41
CRDT- 2024/01/02 10:23
PHST- 2024/01/02 11:41 [medline]
PHST- 2024/01/02 11:41 [pubmed]
PHST- 2024/01/02 10:23 [entrez]
AID - 10.1080/23294515.2023.2297922 [doi]
PST - aheadofprint
SO  - AJOB Empir Bioeth. 2024 Jan 2:1-13. doi: 10.1080/23294515.2023.2297922.