***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Moral distress is the knowledge of the ethically appropriate action to take but the inability to act upon it . This phenomenon is one experienced in the critical care setting . To help staff members cope with moral distress , a team conducted workshops at one facility to help the staff identify and cope with this distress . The workshop consisted of discussion s of distressing situations in the intensive care unit , didactic information on  moral distress , formulation of an individual plan to reduce stress , and strategies to deal with moral distress  in the intensive care unit . This article discusses the workshop and its effect on participants ' coping with moral distress Moral distress is described as the painful feelings and psychological disequilibrium when a person believes she knows the morally right action to take and is unable to carry it out because of external or internal constraints . It has been studied in intensive care unit ( ICU ) nurses , but to the best of our knowledge not in burn ICU nurses . A pilot study was performed to gather initial data on moral distress among nurses treating burn victims . Findings from an intervention aim ed at decreasing the level of moral distress in these nurses are reported . Nurses ( n = 13 ) were recruited from one U.S. burn ICU and were r and omized into two groups . A separate sample pretest post-test design was used . Group A completed the  Moral Distress Scale-Revised ( MDS-R ) and Self-efficacy ( SE ) Scale before a 4-week educational intervention involving weekly 60-minute sessions , and Group B completed both scales afterward . Participants also completed written evaluations after each session . The MDS-R and SE Scale were readministered to both groups 6 weeks after the intervention was completed . Given the size and distribution of the sample , nonparametric data analyses were used . The MDS-R median score for Group B ( 92.0 ) was significantly different statistically from Group A ( 40.5 ) with P = .032 directly after the intervention was completed . No significant difference was found in the median SE scores between Group A ( 34.5 ) and Group B ( 34.0 ; P = .616 ) . The median for Group B was 69 and Group A was 60.5 ( P = .775 ) . At the 6-week follow up , the difference between the two groups was no longer observed . Defining and discussing moral distress may have contributed to increased awareness and higher levels of moral distress in Group B directly postintervention . The changes in moral distress levels postintervention and at the 6-week follow up highlight the need to examine the intervention in a larger sample Objective In this study , we tested an exp and ed model of Kanter ’s structural empowerment , which specified the relationships among structural and psychological empowerment , job strain , and work satisfaction . Background Strategies proposed in Kanter ’s empowerment theory have the potential to reduce job strain and improve employee work satisfaction and performance in current restructured healthcare setting s. The addition to the model of psychological empowerment as an outcome of structural empowerment provides an underst and ing of the intervening mechanisms between structural work conditions and important organizational outcomes . Methods A predictive , nonexperimental design was used to test the model in a r and om sample of 404 Canadian staff nurses . The Conditions of Work Effectiveness Question naire , the  Psychological Empowerment Question naire , the  Job Content Question naire , and the Global Satisfaction Scale were used to measure the major study variables . Results Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices ( χ2 = 1140 , df = 545 , χ2/df ratio = 2.09 , CFI = 0.986 , RMSEA = 0.050 ) . The amount of variance accounted for in the model was 58 % . Staff nurses felt that structural empowerment in their workplace result ed in higher levels of psychological empowerment . These heightened feelings of psychological empowerment in turn strongly influenced job strain and work satisfaction . However , job strain did not have a direct effect on work satisfaction . Conclusions These results provide initial support for an exp and ed model of organizational empowerment and offer a broader underst and ing of the empowerment process We prospect ively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit ( MICU ) using nurses ' and residents ' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care . Either readmission to the MICU or death was considered a negative patient outcome . Nurses ' reports of collaboration were significantly ( p = 0.02 ) and positively associated with patient outcome , controlling for severity of illness . Patient predicted risk of negative outcome decreased from 16 % , when the nurse reported no collaboration in decision making , to 5 % when the process was fully collaborative . There was an interaction of collaboration with availability of alternative choices in the transfer decision-making situation . When alternatives were available , collaboration was more strongly associated with patient outcome . There was no significant relationship between  residents ' reports of collaboration and patient outcomes . The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low ( r = 0.10 ) Study purpose was to describe critical care nurses ' levels of moral distress  and the effects of that distress on their professional practice environment . A descriptive , correlational , prospect i ve , survey design was used . The intensity of moral distress was inversely related to physician/nurse collegial relationships and the frequency of moral distress was inversely related to all aspects of the professional practice environment except foundations for quality of care . It is important to monitor the frequency of moral distress . Strategies to improve the nurse 's sense of control over practice , teamwork , communication , and autonomy need to be developed and tested in future research Moral distress is a phenomenon of increasing concern in nursing practice , education and research . Previous research has suggested that moral distress is associated with perceptions of ethical climate , which has implication s for nursing practice and patient outcomes . In this study , a r and omly selected sample of registered nurses was surveyed using Corley ’s Moral Distress Scale and Olson ’s Hospital Ethical Climate Survey ( HECS ) . The registered nurses reported moderate levels of moral distress intensity . Moral distress intensity and frequency were found to be inversely correlated with perceptions of ethical climate . Each of the HECS factors ( peers , patients , managers , hospitals and physicians ) was found to be significantly correlated with moral distress . Based on these findings , we highlight insights for practice and future research that are needed to enhance the development of strategies aim ed at improving the ethical climate of nurses ’ workplaces for the benefit of both nurses and patients The purpose of this study was to describe Finnish ICU nurses ' ( n=172 ) experiences of autonomy in their work . The research was carried out as part of a project concerned with empowerment in intensive care nursing . Viewed from a psychological perspective , empowerment is understood as referring to the ability to make goal -directed decisions and to take action towards meeting the goals set out . Autonomy , then , is seen as part of empowerment . The data were collected with a structured question naire specially design ed for this study . The r and om sample was drawn from 31 Finnish adult intensive care units . The respondents were registered nurses working in eight adult intensive care units . The data were analysed using statistical methods . Autonomy was defined as being composed of three bases : knowledge base ( independence , right and responsibility in decision-making ) , action base ( independence , right and responsibility in actions ) and value base ( independence , right and responsibility in values ) . The majority of the respondents felt they had more autonomy in decision-making and actions concerning patient care than in decision-making and actions concerning the intensive care unit as a whole . Autonomy usually increased with work experience . Work will be continued to study the autonomy of nurses  in different health care organisations in Finl and 
    Output:
    
Findings revealed that moral distress negatively affects  clinicians ' wellbeing and job retention .