Yoğun bakım hemşirelerinin yaşadığı ahlaki sıkıntı durumunun iş doyumu ve işten ayrılma niyeti üzerine etkisi
Abstract
Bu araştırma yoğun bakımda çalışan hemşirelerin ahlaki sıkıntı düzeyi, iş doyumu ve işten ayrılma niyeti arasındaki ilişkinin incelenmesi ve ahlaki sıkıntıyı etkileyen faktörlerin belirlenmesi amacıyla yapılmıştır. Tanımlayıcı, ilişkisel ve kesitsel tipteki bu çalışmanın evrenini, Sağlık Bilimleri Üniversitesi Hamidiye Etfal Eğitim Araştırma Hastanesi'nde Mart ile Mayıs 2019 tarihleri arasında çalışmakta olan 191 yoğun bakım hemşiresi oluşturmuştur. Çalışmanın örneklemi, evren belli olduğu durumda örneklem hesaplama formülüne göre belirlenmiş, araştırma kriterlerini karşılayan ve verileri eksiksiz tamamlayan 135 hemşire ile gerçekleştirilmiştir. Verilerin toplanmasında yarı yapılandırılmış bilgi formu, Yoğun Bakım Ahlaki Sıkıntı Ölçeği, Hemşire İş Doyum Ölçeği ve İşten Ayrılma Niyeti Ölçeği kullanılmıştır. Veriler SPSS 15.0 paket programı kullanılarak, tanımlayıcı istatistikler, Mann Whitney U ve Kruskal Wallis testi, Spearman Korelasyon Analizi ile değerlendirilmiştir. Çalışmaya katılan yoğun bakım hemşirelerinin %80'i kadın olup, yaş ortalaması 27,6±4,5 (20 ila 47) yıldır. Çoğu (%80) lisans mezunu olup, meslekte çalışma süresi ortalaması 62,1±61,0 (6-343) ay ve şu anda çalıştıkları birimde ortalama 28,6±39,0 (2-324) ay çalışmakta oldukları bulunmuştur. Çoğu (%72,6) mesleğini de, çalıştıkları birimi de (%75,6) isteyerek seçtiklerini ve yaklaşık %86'sı çalıştıkları birimden memnun olduklarını bildirmiştir. Hemşirelerin Yoğun Bakım Ahlaki Sıkıntı Ölçeği puan ortalaması 83,3±48,4 (0-238), Hemşire İş Doyum Ölçeği puan ortalaması 3,64±0,52 (1,70-4,85), İşten Ayrılma Niyeti Ölçeği puan ortalaması 2,62±1,06 (1-5) olarak bulunmuştur. İncelenen yoğun bakım üniteleri arasında Nöroşirurji YBÜ'nde çalışan hemşirelerin ahlaki sıkıntı düzeyinin daha yüksek olduğu görülmüştür. Yoğun Bakım Ahlaki Sıkıntı Ölçeği ile Hemşire İş Doyum Ölçeği toplam puanı (r=-0,199; p=0,021) ve 'Üstlerden Uygun Destek alt ölçeği (r=-0,243; p=0,004) arasında negatif yönde, zayıf ve İşten Ayrılma Niyeti Ölçeği puanı (r=0,254; p=0,003) ile pozitif yönde, zayıf' istatistiksel olarak anlamlı ilişki saptanmıştır. Hemşirelerin ahlaki sıkıntı düzeyinin meslekte (r=0,219; p=0,01) ve şuan ki birimde (r=0,244; p=0,004) çalışma süresi ile pozitif yönde zayıf ilişkisinin olduğu belirlenmiştir. Mesleğini isteyerek seçmeyen (p=0,007), tedavi ekibiyle kurduğu ilişkinin destekleyici olduğunu düşünmeyen (p=0,008), ekipte yer alan üyeler ve yöneticilerle (p≤0,01) ilişki problemi yaşayan hemşirelerin ahlaki sıkıntı puanı ortalamasının istatistiksel olarak anlamlı düzeyde daha yüksek olduğu saptanmıştır. Diğer demografik ve mesleki özelliklere göre ahlaki sıkıntı düzeyinde fark olmadığı tespit edilmiştir. Ayrıca Hemşire İş Doyum Ölçeği toplam puanı ile İşten Ayrılma Niyeti Ölçeği puanı arasında (r=-0,651; p<0,001) negatif yönde güçlü istatistiksel olarak anlamlı ilişkili tespit edilmiştir. Yapılan çalışma doğrultusunda hemşirelerin ahlaki sıkıntı yaşama düzeyinin düşük, iş doyumu ve işten ayrılma niyetinin orta düzeyde olduğu ve birbirleri arasında ilişkili olduğu bulunmuştur. Hemşirelerin çalışma süresi artıkça ahlaki sıkıntı yaşama düzeyinin artığı, mesleğini isteyerek seçmeyen ve birlikte çalıştığı ekiple (hekim, hemşire, personel, yönetici) ilişki problemi yaşayan, desteklendiğini hissetmeyenlerin ahlaki sıkıntı yaşama açısından riskli grupta olduğu anlaşılmıştır.
This study was conducted to investigate the relationship between the level of moral distress, job satisfaction and turnover intention of nurses working in intensive care unit and to determine the factors affecting moral distress. The population of this descriptive, relational and cross-sectional study is 191 Intensive Care Unit Nurses working in the Hamidiye Etfal Training and Research Hospital of Health Sciences University between March and May 2019. The sample of the study was determined according to the sample calculation form when the population is known. The study was conducted with 135 nurses who fulfilled the research criteria and completed entire data. The data were collected using a semi-structured information tool, Intensive Care Moral Distress Scale, Nurse Job Satisfaction Scale, and Turnover Intention Scale. The data were analyzed with descriptive statistics, Mann Whitney U and Kruskal Wallis test and Spearman Correlation Analysis by using SPSS 15.0 package program. 80% of the intensive care nurses participated in the study were female and the ages of the participants ranged from 20 to 47 and the mean age is 27.6 ± 4.5. Most of them (80%) were undergraduate and the average duration of working in the profession is 62.1 ± 61.0 (6-343) months and it was found that they work for 28.6 ± 39.0 (2-324) months at the unit they currently part of. Most reported that they choosed both their job (72.6%) and the unit they work (75.6 %) willingly and satisfied the unit they currently worked (approximately 86%). The total score of the Intensive Care Moral Distress Scale was 83.3 ± 48.4 (0-238), and the total score of Nurse Job Satisfaction Scale was 3.64 ± 0.52 (1.70-4.85), the total score of Turnover Intention Scale was found to be 2.62 ± 1.06 (1-5). It is observed that the level of moral distress is higher for Neurosurgery ICU Nurses than other examined intensive care unit's nurses. It was determined that, the total score of the Intensive Care Moral Distress Scale had significant negative correlation with the total score of the Nurse Job Satisfaction Scale (r = -0.199; p = 0.021) and the total score of the appropriate support subscale (r = -0.243; p = 0.004). Also determined a weak, positive correlation between the total score of the Intensive Care Moral Distress Scale and the total score Scale of Turnover Intention (r=0,254; p=0,003). It was determined that the level of moral distress of nurses was positive weakly correlated with work experience (r=0.219; p=0.011) and working time in the current unit (r=0.244; p=0.004). The mean score of moral distress of the nurses who do not choose their profession willingly (p=0.007), who do not think that the relationship with the treatment team was supportive (p=0.008), and who have relationship problems with the members of the team and managers (p≤0.01) had a statistically significant higher level. It was determined that there was no difference in the level of moral distress according to other demographic and occupational characteristics. Besides, it was determined a strong negative statistically significant correlation between score of the Nurse Job Satisfaction Scale and the score of the Turnover Intention Scale (r = -0.651; p <0.001). As a result of this study, it was found that the level of moral distress of nurses was low; level of the job satisfaction and turnover intention were moderate and correlated. It was understood that, as the experience of nurses increases, the level of moral distress increases. However, who do not willingly choose their profession and who have relationship problems with the team they work with (physicians, nurses, staff, managers) and who do not feel supported are in risky group in terms of experiencing moral distress.
This study was conducted to investigate the relationship between the level of moral distress, job satisfaction and turnover intention of nurses working in intensive care unit and to determine the factors affecting moral distress. The population of this descriptive, relational and cross-sectional study is 191 Intensive Care Unit Nurses working in the Hamidiye Etfal Training and Research Hospital of Health Sciences University between March and May 2019. The sample of the study was determined according to the sample calculation form when the population is known. The study was conducted with 135 nurses who fulfilled the research criteria and completed entire data. The data were collected using a semi-structured information tool, Intensive Care Moral Distress Scale, Nurse Job Satisfaction Scale, and Turnover Intention Scale. The data were analyzed with descriptive statistics, Mann Whitney U and Kruskal Wallis test and Spearman Correlation Analysis by using SPSS 15.0 package program. 80% of the intensive care nurses participated in the study were female and the ages of the participants ranged from 20 to 47 and the mean age is 27.6 ± 4.5. Most of them (80%) were undergraduate and the average duration of working in the profession is 62.1 ± 61.0 (6-343) months and it was found that they work for 28.6 ± 39.0 (2-324) months at the unit they currently part of. Most reported that they choosed both their job (72.6%) and the unit they work (75.6 %) willingly and satisfied the unit they currently worked (approximately 86%). The total score of the Intensive Care Moral Distress Scale was 83.3 ± 48.4 (0-238), and the total score of Nurse Job Satisfaction Scale was 3.64 ± 0.52 (1.70-4.85), the total score of Turnover Intention Scale was found to be 2.62 ± 1.06 (1-5). It is observed that the level of moral distress is higher for Neurosurgery ICU Nurses than other examined intensive care unit's nurses. It was determined that, the total score of the Intensive Care Moral Distress Scale had significant negative correlation with the total score of the Nurse Job Satisfaction Scale (r = -0.199; p = 0.021) and the total score of the appropriate support subscale (r = -0.243; p = 0.004). Also determined a weak, positive correlation between the total score of the Intensive Care Moral Distress Scale and the total score Scale of Turnover Intention (r=0,254; p=0,003). It was determined that the level of moral distress of nurses was positive weakly correlated with work experience (r=0.219; p=0.011) and working time in the current unit (r=0.244; p=0.004). The mean score of moral distress of the nurses who do not choose their profession willingly (p=0.007), who do not think that the relationship with the treatment team was supportive (p=0.008), and who have relationship problems with the members of the team and managers (p≤0.01) had a statistically significant higher level. It was determined that there was no difference in the level of moral distress according to other demographic and occupational characteristics. Besides, it was determined a strong negative statistically significant correlation between score of the Nurse Job Satisfaction Scale and the score of the Turnover Intention Scale (r = -0.651; p <0.001). As a result of this study, it was found that the level of moral distress of nurses was low; level of the job satisfaction and turnover intention were moderate and correlated. It was understood that, as the experience of nurses increases, the level of moral distress increases. However, who do not willingly choose their profession and who have relationship problems with the team they work with (physicians, nurses, staff, managers) and who do not feel supported are in risky group in terms of experiencing moral distress.
Description
Keywords
Hemşirelik, Ahlak, Hemşireler, Hemşirelik, Nursing, Hemşirelik araştırmaları, Morality, Tıp etiği, Nurses, Nursing, Yoğun bakım, Nursing research, Medical ethics, Yoğun bakım üniteleri, Intensive care, İş doyumu, Intensive care units, Job satisfaction, İşten ayrılma niyeti, Turnover intention