Moral distress and coping strategies among nurses and midwives at Kawempe National Referral Hospital Kampala District

Abstract

Background: Moral distress is a major issue in nursing practice, especially for those in clinical care. The existence of such distress may affect nurses’ physical and mental health, as well as their quality of life and hinder the accomplishment of their routine activities. The study sought to determine moral distress and coping strategies among nurses and midwives at Kawempe National Referral Hospital, Kampala District. Specific objectives included determining the prevalence of moral distress among the nurses and midwives, factors contributing to moral distress among nurses and midwives, the coping strategies among nurses and midwives and exploring institutional mechanisms to support nurses and midwives with moral distress. Methods: This was a cross-sectional mixed-methods study conducted at Kawempe National Referral Hospital. A survey was conducted among 126 nurses and midwives and Key informant interviews (KII) were conducted among 07 ward managers and in charges. Survey data was analyzed using STATA version 14.0 and presented using descriptive statistics and displayed in tables and figures. On the other hand, Qualitative data was analyzed using thematic analysis. Results: The prevalence of moral distress among nurses and midwives was very high (96%) and those in the 21-29 age group (62.9%) were the most affected. The factors contributing to moral distress included position “Assistant nursing officer” had more respondents with Low (52.8%) and Moderate (56.8%) moral distress. Low moral distress was common among nurses and midwives who have stayed at the hospital for more than 2 years (49.4%) while those that had stayed for 1 to 2 years had more moderate moral distress (40.5%). Internal factors contributing to moral distress included inadequate equipment and supplies in the hospital, power dynamics between nurses and doctors, a disproportionately heavy workload and having to deal with financially constrained patients. Among the external factors was the Impact of nurses/midwives duties on their private lives and marriages, and the meagre salaries that forced nurses/midwives to have multiple jobs. Participants were confident about their decision-making capabilities however they were not in position to exercise this fully because they must abide by the decisions of their superiors; and this also contributed to their moral distress. Participants reported several coping strategies such as taking action to make the situation better, getting help and advice, looking for something good in what is happening, finding comfort in religion or spiritual beliefs. Conclusion: Institutions should develop mechanisms to support nurses with moral distress, such as hospital management efforts to motivate and empower staff towards achieving its goals, conflicts resolution, and guidance and mentorship in addressing ethical issues. There is need for provision of counselling and psychotherapy services for hospital staff with psychosocial problems.