The barometer of moral distress in midwifery : A pilot study

Journal article


Foster, Wendy, McKellar, Lois, Fleet, Julie-Anne, Creedy, Debra and Sweet, Linda. (2024). The barometer of moral distress in midwifery : A pilot study. Women and Birth. 37(3), p. Article 101592. https://doi.org/10.1016/j.wombi.2024.101592
AuthorsFoster, Wendy, McKellar, Lois, Fleet, Julie-Anne, Creedy, Debra and Sweet, Linda
Abstract

Background
Moral distress is a phenomena that occurs following a compromise to moral beliefs. Moral distress has been reported across health professions, including midwifery. Although there are validated tools to assess for moral distress, none have been identified that suit the Australian healthcare system or midwifery.

Aim
The aim of this study was to pilot the Barometer of Moral Distress in Midwifery.
Methods
This study was the fourth stage of a mixed method project. Using a cross-sectional approach, a survey tool including demographic questions, the Barometer of Moral Distress in Midwifery, and the Copenhagen Burnout Inventory assessed tool stability, reliability, and validity.

Findings
A total of 103 surveys were completed. A test-retest demonstrated tool reliability and stability (
=.97). Factor analysis confirmed internal consistency; Factor 1 - Professional Identity (
=.91), Factor 2 - Inadequate Resources (
=.85), and Factor 3 - Unethical Cultures (
=.88). Concurrent validity was demonstrated through positive correlations between self-reported types of moral distress with mean scores for each Factor. Strong correlations were identified between work-related burnout and mean scores, while only weak correlations were noted between client-related burnout and mean scores. Only Factor 1 demonstrated a correlation between leaving the profession and mean scores.

Discussion/conclusion
This was the first moral distress tool that assessed both frequency of exposure and psychological outcomes to score moral distress. Findings indicate that moral distress in midwifery is not associated with caring work but with occupational environments. Further research is required to assess self-sacrifice in moral distress.

Keywordsmoral distress; midwifery; ethics; moral injury; moral frustration
Year2024
JournalWomen and Birth
Journal citation37 (3), p. Article 101592
PublisherElsevier Australia
Elsevier Ltd
ISSN1871-5192
Digital Object Identifier (DOI)https://doi.org/10.1016/j.wombi.2024.101592
PubMed ID38418320
Scopus EID2-s2.0-85186317698
Open accessPublished as ‘gold’ (paid) open access
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online12 Apr 2024
Publication process dates
Accepted14 Feb 2024
Deposited16 Feb 2025
Additional information

© 2024 The Authors. Published by Elsevier Ltd on behalf of Australian College of Midwives. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Permalink -

https://acuresearchbank.acu.edu.au/item/91558/the-barometer-of-moral-distress-in-midwifery-a-pilot-study

Download files


Publisher's version
OA_Foster_2024_The_barometer_of_moral_distress_in.pdf
License: CC BY-NC-ND 4.0
File access level: Open

  • 11
    total views
  • 3
    total downloads
  • 10
    views this month
  • 3
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Evaluation of a pilot online education program to develop midwives’ knowledge, skill and confidence in perinatal mental health in rural South Australia
McKellar, Lois, Martinez, Lee, De Sousa Machado, Tiffany, Eden, Amye, Stoodley, Cathy and Adelson, Pamela. (2024). Evaluation of a pilot online education program to develop midwives’ knowledge, skill and confidence in perinatal mental health in rural South Australia. Women and Birth. 37(2), pp. 355-361. https://doi.org/10.1016/j.wombi.2023.11.005
‘There is no other option’ : Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia
McKellar, Lois, Fleet, Julie-Anne and Adelson, Pamela. (2024). ‘There is no other option’ : Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia. Australian Journal of Rural Health. 32(1), pp. 67-79. https://doi.org/10.1111/ajr.13066
The role of midwives in supporting the development of the mother-infant relationship : a scoping review
Stoodley, Cathy, McKellar, Lois, Ziaian, Tahereh, Steen, Mary, Fereday, Jennifer and Gwilt, Ian. (2023). The role of midwives in supporting the development of the mother-infant relationship : a scoping review. BMC Psychology. 11(1), pp. 1-14. https://doi.org/10.1186/s40359-023-01092-8
Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia : Women's experiences and birth outcomes
Adelson, Pamela, Fleet, Julie-Anne and McKellar, Lois. (2023). Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia : Women's experiences and birth outcomes. Women and Birth. 36(1), pp. 80-88. https://doi.org/10.1016/j.wombi.2022.03.004
Examining the transformation of midwifery education in Australia to inform future directions : An integrative review
McKellar, Lois, Graham, Ms Kristen, Sheehan, Athena, Fleet, Julie-Anne, Sidebotham, Mary and Sweet, Linda. (2023). Examining the transformation of midwifery education in Australia to inform future directions : An integrative review. Women and Birth. 36(2), pp. 155-166. https://doi.org/10.1016/j.wombi.2022.11.010
Yourtime : The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach
McKellar, Lois, Steen, Mary, Charlick, Samantha J., Andrew, Jane, Altieri, Benjamin and Gwilt, Ian. (2023). Yourtime : The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach. Applied Nursing Research. 73, pp. 1-8. https://doi.org/10.1016/j.apnr.2023.151714
Examining the Influence of Self-compassion Education and Training Upon Parents and Families When Caring for their Children : A Systematic Review
Othman, Shwikar, Steen, Mary, Wepa, Dianne and McKellar, Lois. (2022). Examining the Influence of Self-compassion Education and Training Upon Parents and Families When Caring for their Children : A Systematic Review. Open Psychology Journal. 15(1), pp. 1-16. https://doi.org/10.2174/18743501-V15-E221020-2022-39
Moral distress in midwifery practice : A concept analysis
Foster, Wendy, McKellar, Lois, Fleet, Julie-Anne and Sweet, Linda. (2022). Moral distress in midwifery practice : A concept analysis. Nursing Ethics. 29(2), pp. 364-383. https://doi.org/10.1177/09697330211023983
Development and validation of an online survey to assess perception of diabetes risk and barriers and facilitators to weight loss following gestational diabetes
Gray, Kristy L., Grebenshchikova, Mayya, O’reilly, Sharleen L., McKellar, Lois, Clifton, Peter and Keogh, Jennifer. (2021). Development and validation of an online survey to assess perception of diabetes risk and barriers and facilitators to weight loss following gestational diabetes. International Journal of Environmental Research and Public Health. 18(2), pp. 1-16. https://doi.org/10.3390/ijerph18020480
Moving beyond first year : An exploration of staff and student experience
Birbeck, David, McKellar, Lois and Kenyon, Kat. (2021). Moving beyond first year : An exploration of staff and student experience. Student Success. 12(1), pp. 82-92. https://doi.org/10.5204/ssj.1802
Identifying the priorities for midwifery education across Australia and New Zealand : A Delphi study
Sidebotham, Mary, McKellar, Lois, Walters, Caroline, Gilkison, Andrea, Davis, Deborah and Gamble, Jenny. (2021). Identifying the priorities for midwifery education across Australia and New Zealand : A Delphi study. Women and Birth. 34(2), pp. 136-144. https://doi.org/10.1016/j.wombi.2020.05.011
Midwifery-led care in South Australia : Looking back to move forward
McKellar, Lois, Newnham, Elizabeth, Fleet, Julie-Anne and Adelson, Pamela. (2021). Midwifery-led care in South Australia : Looking back to move forward. Women and Birth. 34(5), pp. 537-545. https://doi.org/10.1016/j.wombi.2020.10.011
Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016
Adelson, Pamela, Fleet, Julie-Anne, McKellar, Lois and Eckert, Marion. (2021). Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016. Women and Birth. 34(1), pp. 84-91. https://doi.org/10.1016/j.wombi.2020.05.005
Simulation in midwifery education : A descriptive explorative study exploring students’ knowledge, confidence and skills in the care of the preterm neonate
Stoodley, Cathy, McKellar, Lois, Steen, Mary and Fleet, Julie-Anne. (2020). Simulation in midwifery education : A descriptive explorative study exploring students’ knowledge, confidence and skills in the care of the preterm neonate. Nurse Education in Practice. 42, pp. 1-7. https://doi.org/10.1016/j.nepr.2019.102635
Shared decision aids in pregnancy care : A scoping review
Kennedy, K., Adelson, Pamela, Fleet, Julie-Anne, Steen, Mary, McKellar, Lois, Eckert, Marion and Peters, Micah D J. (2020). Shared decision aids in pregnancy care : A scoping review. Midwifery. 81, pp. 1-13. https://doi.org/10.1016/j.midw.2019.102589
Women’s barriers to weight loss, perception of future diabetes risk and opinions of diet strategies following gestational diabetes: An online survey
Gray, Kristy L., McKellar, Lois, O’reilly, Sharleen L., Clifton, Peter and Keogh, Jennifer. (2020). Women’s barriers to weight loss, perception of future diabetes risk and opinions of diet strategies following gestational diabetes: An online survey. International Journal of Environmental Research and Public Health. 17(24), pp. 1-12. https://doi.org/10.3390/ijerph17249180
A public e-survey to explore community understanding of the role of the midwife in Australia
McKellar, Lois, Brown, Angela and Adelson, Pamela. (2019). A public e-survey to explore community understanding of the role of the midwife in Australia. European Journal of Midwifery. 3(November), pp. 1-9. https://doi.org/10.18332/ejm/114226
Validation of the Australian Midwifery Standards Assessment Tool (AMSAT) : A tool to assess midwifery competence
Sweet, Linda, Bazargan, Maryam, McKellar, Lois, Gray, Joanne and Henderson, Amanda. (2018). Validation of the Australian Midwifery Standards Assessment Tool (AMSAT) : A tool to assess midwifery competence. Women and Birth. 31(1), pp. 59-68. https://doi.org/10.1016/j.wombi.2017.06.017
It's more than just luck : A qualitative exploration of breastfeeding in rural Australia
McKellar, Lois, Fleet, Julie and Dove, Shona. (2018). It's more than just luck : A qualitative exploration of breastfeeding in rural Australia. Women and Birth. 31(3), pp. 177-183. https://doi.org/10.1016/j.wombi.2017.09.005
Exploring routine hospital antenatal care consultations : An ethnographic study
Wright, Diane, Pincombe, Jan and McKellar, Lois. (2018). Exploring routine hospital antenatal care consultations : An ethnographic study. Women and Birth. 31(3), pp. 162-169. https://doi.org/10.1016/j.wombi.2017.09.010