Commentary: Exploring the moderating role of health-promoting behaviours and self-compassion on the relationship between clinical decision-making and nurses’ well-being

Since the COVID-19 pandemic, nurse well-being has become a priority throughout the health and social care sector. There is increasing evidence that a nurse’s well-being has an impact on patient care and outcomes (Kinman et al., 2020). Moral injury and moral distress, when nurses are unable to deliver the care they wish to, can cause distress, a negative impact on well-being and often an individual leaving the profession. Therefore, I was delighted when asked to review the paper ‘Exploring the moderating role of health-promoting behaviours and self-compassion on the relationship between clinical decision-making and nurses’ well-being’ that well-being was being considered.

This study considers nurses’ perceptions of their own clinical decision-making abilities and how this relates to moral distress. It also explores the impact of physical activity, eating behaviours and self-compassion and how these may support improved clinical decision-making abilities and reduce moral distress. Several validated questionnaires were utilised in a cross-sectional study design. Findings indicate that increased perceived clinical decision-making abilities is related to decreased levels of moral distress. The most significant moderations between these are eating behaviours, which has a negative impact and self-compassion levels, which has a positive impact.

In terms of eating, as grazing (or snacking) behaviours increased, the negative relationship between perceived clinical decision-making and moral distress was strengthened. Research has shown that particularly for nurses who work shifts they are more likely to graze than have adequate meals (Assiry et al., 2023; Lin et al., 2022). Awareness of the potential influence of this on clinical decision-making is important as this study suggests that grazing has an impact on the nurse’s ability to make clinical decisions, ultimately then impacting on care. Both individual responsibilities and systematic support are included within the recommendations. For the individuals in particular the importance of eating healthily and avoiding grazing behaviour is supported by a recommendation for organisations to ensure adequate facilities and time for breaks are available to ensure that individuals are able to eat well whilst at work, even when shift working.

Increased levels of self-compassion have a positive impact on moral distress and perceived clinical decision-making ability, specifically tolerating uncomfortable feelings. Importantly, the recommendation includes both an individual responsibility to increase compassion as well as learning opportunities for nurses. Individual’s ability to show themselves compassion is complex, with many fearing compassion as it feels like a weakness (Gilbert and Simos, 2022). Andrews et al. (2020) found that nurses require permission from others and from themselves to be self-compassionate and can find this challenging. This highlights the importance of self-compassion activities being within education, guidance and including formal permission and active support from their employer. Given the challenges individuals may experience in attempting to increase self-compassion levels, any learning sessions should focus on developing a community that has the ability to support one another, share a critical dialogue and enables reflective discussion (Stacey and Cook, 2019).

Finally, as indicated in the limitations of the paper, the current study does not show cause and effect. Whilst reviewing I was reflecting on what may come first, does low confidence in your own decision-making ability result in moral distress? Does moral distress impact on your ability to make decisions? Or is this multifaceted? Future qualitative studies that explore the ‘why’ would be useful to further make recommendations to organisations and individuals that would support their clinical decision-making abilities.

In conclusion, this is a well-written paper with some clear and key systematic and individual recommendations to support clinical decision-making ability in nursing.

Biography

Grace Cook is a mental health nurse and currently a person-centred practice facilitator at the Foundation of Nursing Studies leading on resilience-based clinical supervision.