L’infermiere e la percezione del Moral Distress nella cura del fine vita nel paziente dializzato




Parole chiave:

Dialysis, Emotional integrity, End of life, Moral distress


The phenomenon of Moral Distress in nursing practice is described as a situation of suffering that arises when the nurse recognizes the ethically appropriate action to be taken and yet institutional impediments make it impossible for him to follow the right course of action. Dialysis patients often have a complex disease trajectory that sometimes involves professional and emotional challenges for staff, especially at the end of life. The objective of this review is to identify which strategies are useful for preserving emotional integrity and awareness in operational settings, for the benefit of both operators and patients.



I dati di download non sono ancora disponibili.

Riferimenti bibliografici

Austin W. Moral distress and the contemporary plight of health professionals. HEC Forum. 2012;24(1):27–38.6-8. https://doi.org/10.1007/s10730-012-9179-8 DOI: https://doi.org/10.1007/s10730-012-9179-8

Suleiman-Martos N, Gomez-Urquiza JL, Aguayo-Estremera R, Cañadas-De La Fuente GA, De La Fuente-Solana EI, Albendín-García L. The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. J Adv Nurs. 2020;76(5):1124-1140. https://doi.org/10.1111/jan.14318 PMID:32026484 DOI: https://doi.org/10.1111/jan.14318

Ling K, Xianxiu W, Xiaowei Z. Analysis of nurses’ job burnout and coping strategies in hemodialysis centers. Medicine (Baltimore). 2020;99(17):e19951. https://doi.org/10.1097/MD.0000000000019951 PMID:32332677 DOI: https://doi.org/10.1097/MD.0000000000019951

Lusignani M, Giannì ML, Re LG, Buffon ML. Moral distress among nurses in medical, surgical and intensive-care units. J Nurs Manag. 2017;25(6):477-485. https://doi.org/10.1111/jonm.12431PMID:27726233 DOI: https://doi.org/10.1111/jonm.12431

Jameton A. Nursing practice: the ethical issues. Englewood Cliffs, NJ: Prentice Hall; 1984.

McCarthy J, Deady R. Moral distress reconsidered. Nurs Ethics. 2008;15(2):254-262. https://doi.org/10.1177/0969733007086023 PMID:18272615 DOI: https://doi.org/10.1177/0969733007086023

Pauly BM, Varcoe C, Storch J. Framing the issues: moral distress in health care. HEC Forum. 2012;24(1):1-11. https://doi.org/10.1007/s10730-012-9176-y PMID:22446885 DOI: https://doi.org/10.1007/s10730-012-9176-y

Kleinknecht-Dolf M, Frei IA, Spichiger E, Müller M, Martin JS, Spirig R. Moral distress in nurses at an acute care hospital in Switzerland: results of a pilot study. Nurs Ethics. 2015;22(1):77-90. https://doi.org/10.1177/0969733014534875 PMID:24917266 DOI: https://doi.org/10.1177/0969733014534875

Villa G, Pennestrì F, Rosa D, et al. Moral distress in community and hospital settings for the care of elderly people. A grounded theory qualitative study. Healthcare (Basel). 2021;9(10):1307. https://doi.org/10.3390/healthcare9101307 PMID:34682986 DOI: https://doi.org/10.3390/healthcare9101307

Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Ethical problems and moral distress in primary care: A scoping review. Int J Environ Res Public Health. 2021;18(14):7565. https://doi.org/10.3390/ijerph18147565 PMID:34300016 DOI: https://doi.org/10.3390/ijerph18147565

De Brasi EL, Giannetta N, Ercolani S, et al. Nurses’ moral distress at the end of life care: a qualitative study. Nurs Ethics. 2021;28(5):614-627. https://doi.org/10.1177/0969733020964859 PMID:33267730 DOI: https://doi.org/10.1177/0969733020964859

Rainer J, Schneider JK, Lorenz RA. Ethical dilemmas in nursing: an integrative review. J Clin Nurs. 2018;27(19-20):3446-3461. https://doi.org/10.1111/jocn.14542 PMID:29791762 DOI: https://doi.org/10.1111/jocn.14542

Giannetta N, Villa G, Pennestrì F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int J Nurs Stud. 2020;111:103767. https://doi.org/10.1016/j.ijnurstu.2020.103767 PMID:32956930 DOI: https://doi.org/10.1016/j.ijnurstu.2020.103767

McAndrew NS, Leske J, Schroeter K. Moral distress in critical care nursing: the state of the science. Nurs Ethics. 2018;25(5):552-570. https://doi.org/10.1177/0969733016664975PMID:27660185 DOI: https://doi.org/10.1177/0969733016664975

Prentice TM, Gillam L, Davis PG, Janvier A. Always a burden? Healthcare providers’ perspectives on moral distress. Arch Dis Child Fetal Neonatal Ed. 2018;103(5):F441-F445. https://doi.org/10.1136/archdischild-2017-313539 PMID:28970316 DOI: https://doi.org/10.1136/archdischild-2017-313539

Hlubocky FJ, Back AL, Shanafelt TD, et al. Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force. JCO Oncol Pract. 2021;17(7):e427-e438. https://doi.org/10.1200/OP.21.00147 PMID:34152789 DOI: https://doi.org/10.1200/OP.21.00147

Axelsson L, Benzein E, Lindberg J, Persson C. Processes toward the end of life and dialysis withdrawal Physicians’ and nurses’ perspectives. Nurs Ethics. 2020;27(2):419-432. https://doi.org/10.1177/0969733019848050 PMID:31185802 DOI: https://doi.org/10.1177/0969733019848050

Brioni E, Delli Zotti G, Apuzzo L, et al. [Self-efficacy and self-management in patients in hemodialysis: a narrative review of multidisciplinary theories]. G Ital Nefrol. 2021;38(3):2021-vol3. PMID:34169692

Ducharlet K, Philip J, Gock H, et al. Moral Distress in Nephrology: Perceived Barriers to Ethical Clinical Care. Am J Kidney Dis. 2020;76(2):248-254. https://doi.org/10.1053/j.ajkd.2019.09.018 PMID:31866229 DOI: https://doi.org/10.1053/j.ajkd.2019.09.018

Cohen LM, Germain MJ, Poppel DM. Practical considerations in dialysis withdrawal: “to have that option is a blessing”. JAMA. 2003;289(16):2113-2119. https://doi.org/10.1001/jama.289.16.2113 PMID:12709469 DOI: https://doi.org/10.1001/jama.289.16.2113

Brown EA, Bargman J, van Biesen W et al. Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis - Position Paper for ISPD: 2017 Update. Perit Dial Int 2017;37(4):362–374. https://doi.org/10.3747/pdi.2017.00018 PMID: 28676507 DOI: https://doi.org/10.3747/pdi.2017.00018

Murtagh FE, Sheerin NS, Addington-Hall J, Higginson IJ. Trajectories of illness in stage 5 chronic kidney disease: a longitudinal study of patient symptoms and concerns in the last year of life. Clin J Am Soc Nephrol. 2011;6(7):1580-1590. https://doi.org/10.2215/CJN.09021010PMID:21685021 DOI: https://doi.org/10.2215/CJN.09021010

Davison SN. The ethics of end-of-life care for patients with ESRD. Clin J Am Soc Nephrol. 2012;7(12):2049-2057. https://doi.org/10.2215/CJN.03900412 PMID:22997341 DOI: https://doi.org/10.2215/CJN.03900412

Parliamentary Committee on Palliative and Compassionate Care. Not to Be Forgotten: Care of Vulnerable Canadians. 2011. Accessed September 2021. Online https://www.pallium.ca/wp-content/uploads/2019/07/Not-to-be-Forgotten-Care-of-Vulnerable-Canadians-2011.pdf

Almutary H, Bonner A, Douglas C. Symptom burden in chronic kidney disease: a review of recent literature. J Ren Care. 2013;39(3):140-150. https://doi.org/10.1111/j.1755-6686.2013.12022.x PMID:23826803 DOI: https://doi.org/10.1111/j.1755-6686.2013.12022.x

Axelsson L, Benzein E, Lindberg J, Persson C. End-of-life and palliative care of patients on maintenance hemodialysis treatment: a focus group study. BMC Palliat Care. 2019;18(1):89. https://doi.org/10.1186/s12904-019-0481-y PMID:31666038 DOI: https://doi.org/10.1186/s12904-019-0481-y

Bristol AA, Chaudhry S, Assis D, et al. An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care. Am J Hosp Palliat Care. 2021;38(10):1242-1249. https://doi.org/10.1177/1049909120986121 PMID:33438435 DOI: https://doi.org/10.1177/1049909120986121

Seccareccia D, Downar J. “Should I go on dialysis, Doc?”: initiating dialysis in elderly patients with end-stage renal disease. Can Fam Physician. 2012;58(12):1353-1356, e704-e707. PMID:23242893

Gluyas H. Patient-centred care: improving healthcare outcomes. Nursing standard (Royal College of Nursing (Great Britain):1987). 2015;30(4):50–59. DOI: https://doi.org/10.7748/ns.30.4.50.e10186

Verberne WR, van den Wittenboer ID, Voorend CGN, et al. Health-related quality of life and symptoms of conservative care versus dialysis in patients with end-stage kidney disease: a systematic review. Nephrol Dial Transplant. 2021;36(8):1418-1433. https://doi.org/10.1093/ndt/gfaa078 PMID:32535622 DOI: https://doi.org/10.1093/ndt/gfaa078

Savitsky K, Keysar B, Epley N, Carter T, Swanson A. The closeness-communication bias: increased egocentrism among friends versus strangers. J Exp Soc Psychol. 2011;47(1):269-273. https://doi.org/10.1016/j.jesp.2010.09.005 DOI: https://doi.org/10.1016/j.jesp.2010.09.005

Bruce SD, Allen D. Moral Distress: One Unit’s Recognition and Mitigation of This Problem. Clin J Oncol Nurs. 2020;24(1):16-18. https://doi.org/10.1188/20.CJON.16-18 PMID:31961832 DOI: https://doi.org/10.1188/20.CJON.16-18

Manara DF, Villa G, Moranda D. In search of salience: phenomenological analysis of moral distress. Nurs Philos. 2014;15(3):171-182. https://doi.org/10.1111/nup.12048 PMID:24528533 DOI: https://doi.org/10.1111/nup.12048

Gerchow L, Burka LR, Miner S, Squires A. Language barriers between nurses and patients: A scoping review. Patient Educ Couns. 2021;104(3):534-553. https://doi.org/10.1016/j.pec.2020.09.017 PMID:32994104 DOI: https://doi.org/10.1016/j.pec.2020.09.017

Helmers A, Palmer KD, Greenberg RA. Moral distress: developing strategies from experience. Nurs Ethics. 2020;27(4):1147-1156. https://doi.org/10.1177/0969733020906593 PMID:32238031 DOI: https://doi.org/10.1177/0969733020906593

Aasen EM, Kvangarsnes M, Heggen K. Nurses’ perceptions of patient participation in hemodialysis treatment. Nurs Ethics. 2012;19(3):419-430. https://doi.org/10.1177/0969733011429015 PMID:22323398 DOI: https://doi.org/10.1177/0969733011429015

Kliger AS. Maintaining safety in the dialysis facility. Clin J Am Soc Nephrol. 2015;10(4):688-695. https://doi.org/10.2215/CJN.08960914 PMID:25376767 DOI: https://doi.org/10.2215/CJN.08960914



Come citare

Brioni, E., Pennacchio, N., Villa, G., Giannetta, N., Magnaghi, C., Vezzoli, G., & Manara, D. F. (2022). L’infermiere e la percezione del Moral Distress nella cura del fine vita nel paziente dializzato. Giornale Di Clinica Nefrologica E Dialisi, 34(1), 10–13. https://doi.org/10.33393/gcnd.2022.2357
Received 2021-11-17
Accepted 2021-12-09
Published 2022-01-08


Puoi leggere altri articoli dello stesso autore/i

1 2 > >>