1
|
Bokek-Cohen Y, Marey-Sarwan I, Tarabeih M. Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10300-4. [PMID: 37930560 DOI: 10.1007/s11673-023-10300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/31/2023] [Indexed: 11/07/2023]
Abstract
Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians' feelings of guilt and pangs of conscience.
Collapse
Affiliation(s)
- Y Bokek-Cohen
- School of Psychology, Tel Aviv University, 30 Haim Levanon Street, Postal code 699780, Tel Aviv, Israel.
| | - I Marey-Sarwan
- School of Education, Sakhnin College Academic for Teacher Education, Sakhnin, Israel
| | - M Tarabeih
- School of Nursing, Tel Aviv Jaffa Academic College, 2 Rabenu Yerucham St., Postal code 6161001, Tel Aviv, Israel
| |
Collapse
|
2
|
Brulin E, Ekberg K, Landstad BJ, Lidwall U, Sjöström M, Wilczek A. Money talks: performance-based reimbursement systems impact on perceived work, health and patient care for physicians in Sweden. Front Psychol 2023; 14:1216229. [PMID: 37484100 PMCID: PMC10361769 DOI: 10.3389/fpsyg.2023.1216229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The study aimed to investigate in which way performance-based reimbursement (PBR) systems in Swedish healthcare services (1) subjectively impacted physicians' work and patient care and (2) were associated with the occurrence of stress-induced exhaustion disorders among physicians. Method The study applied a mixed-method design. Data were collected from a representative sample of Swedish physicians. In the questionnaire, respondents were asked to answer an open-ended question regarding their reflections on PBR. The answers to the open-ended question were analysed using thematic analysis. Respondents were also asked to rate the impact of PBR on their work. The association between PBR and self-rated stress-induced exhaustion disease was analysed with logistic regressions. Stress-induced exhaustion disorder was measured using the Burnout Assessment Scale. Results Thematic analysis resulted in four themes: (1) Money talks, (2) Patients are affected, (3) Medical morals are challenged, and (4) PBR increase the quantity of illegitimate tasks. Logistic regressions showed that physicians who experienced PBR had an impact on their work and had a two-fold higher risk of stress-induced exhaustion disorder. Discussion Our findings suggest that current reimbursement systems in Sweden play an essential role in Swedish healthcare and negatively influence physicians' work and health. Also, current PBR impact patients negatively. No previous study has explored the potentially harmful impact of PBR on how physicians perceive work, health and patient care. Results indicate that policymakers should be encouraged to deeply review PBR systems and focus on ways that they can limit the negative impact on physicians' work and health while meeting future challenges.
Collapse
Affiliation(s)
- Emma Brulin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Ekberg
- Department of Health, Medicine, and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Bodil J. Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Ulrik Lidwall
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Official Statistics Unit, Department for Analysis, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Alexander Wilczek
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Moral Orientation, Moral Decision-Making, and Moral Distress Among Critical Care Physicians: A Qualitative Study. Crit Care Explor 2023; 5:e0879. [PMID: 36895887 PMCID: PMC9990831 DOI: 10.1097/cce.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Moral distress is common among critical care physicians and can impact negatively healthcare individuals and institutions. Better understanding inter-individual variability in moral distress is needed to inform future wellness interventions. OBJECTIVES To explore when and how critical care physicians experience moral distress in the workplace and its consequences, how physicians' professional interactions with colleagues affected their perceived level of moral distress, and in which circumstances professional rewards were experienced and mitigated moral distress. DESIGN Interview-based qualitative study using inductive thematic analysis. SETTING AND PARTICIPANTS Twenty critical care physicians practicing in Canadian ICUs who expressed interest in participating in a semi-structured interview after completion of a national, cross-sectional survey of moral distress in ICU physicians. RESULTS Study participants described different ways to perceive and resolve morally challenging clinical situations, which were grouped into four clinical moral orientations: virtuous, resigned, deferring, and empathic. Moral orientations resulted from unique combinations of strength of personal moral beliefs and perceived power over moral clinical decision-making, which led to different rationales for moral decision-making. Study findings illustrate how sociocultural, legal, and clinical contexts influenced individual physicians' moral orientation and how moral orientation altered perceived moral distress and moral satisfaction. The degree of dissonance between individual moral orientations within care team determined, in part, the quantity of "negative judgments" and/or "social support" that physicians obtained from their colleagues. The levels of moral distress, moral satisfaction, social judgment, and social support ultimately affected the type and severity of the negative consequences experienced by ICU physicians. CONCLUSIONS AND RELEVANCE An expanded understanding of moral orientations provides an additional tool to address the problem of moral distress in the critical care setting. Diversity in moral orientations may explain, in part, the variability in moral distress levels among clinicians and likely contributes to interpersonal conflicts in the ICU setting. Additional investigations on different moral orientations in various clinical environments are much needed to inform the design of effective systemic and institutional interventions that address healthcare professionals' moral distress and mitigate its negative consequences.
Collapse
|
4
|
Viscarret JJ, Ballestero A, Úriz MJ, Idareta F. What Ethical Dilemmas Do Social Workers Face in the Healthcare Area in Spain? SOCIAL WORK IN PUBLIC HEALTH 2023; 38:135-146. [PMID: 35872638 DOI: 10.1080/19371918.2022.2104414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of the article is to identify the types of ethical dilemmas that Spanish social workers face in the healthcare arena (health centers, hospitals and mental health). A quantitative methodology was chosen using the questionnaire prepared by Eileen J. Ain. The questionnaire has been translated and adapted for Social Work in Spain. The statistical analysis shows the correlation between the different areas of intervention in Social Work and the most significant ethical dilemmas that such professionals have to solve (autonomy, confidentiality and informed consent). This article is an essential study on Social Work at the national level that emphasizes the importance of the ethics of Social Work in the Healthcare area.
Collapse
Affiliation(s)
| | - Alberto Ballestero
- Department of Social Work, Public University of Navarre, Pamplona, Spain
| | - María-Jesús Úriz
- Department of Social Work, Public University of Navarre, Pamplona, Spain
| | - Francisco Idareta
- Department of Social Work, Public University of Navarre, Pamplona, Spain
| |
Collapse
|
5
|
Quek CWN, Ong RRS, Wong RSM, Chan SWK, Chok AKL, Shen GS, Teo AYT, Panda A, Burla N, Wong YA, Chee RCH, Loh CYL, Lee KW, Tan GHN, Leong REJ, Koh NSY, Ong YT, Chin AMC, Chiam M, Lim C, Zhou XJ, Ong SYK, Ong EK, Krishna LKR. Systematic scoping review on moral distress among physicians. BMJ Open 2022; 12:e064029. [PMID: 36691160 PMCID: PMC9442489 DOI: 10.1136/bmjopen-2022-064029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians. METHODS A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows. RESULTS A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions. CONCLUSIONS Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.
Collapse
Affiliation(s)
- Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Rui Song Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Kun Woo Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Gabrielle Hui Ning Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Emmanuel Jian Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Song Yi Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore
| | - Xuelian Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
| |
Collapse
|
6
|
Skeff KM, Brown-Johnson CG, Asch SM, Zionts DL, Winget M, Kerem Y. Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record. J Healthc Manag 2022; 67:339-352. [PMID: 35984408 PMCID: PMC9447433 DOI: 10.1097/jhm-d-21-00070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
GOAL Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR. METHODS In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR "distressing events" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies. PRINCIPAL FINDINGS Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed. PRACTICAL APPLICATIONS Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.
Collapse
Affiliation(s)
- Kelley M. Skeff
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | |
Collapse
|
7
|
Mackel CE, Alterman RL, Buss MK, Reynolds RM, Fox WC, Spiotta AM, Davis RB, Stippler M. Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey. Neurosurgery 2022; 91:59-65. [PMID: 35319531 PMCID: PMC9514751 DOI: 10.1227/neu.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND "Moral distress" describes the psychological strain a provider faces when unable to uphold professional values because of external constraints. Recurrent or intense moral distress risks moral injury, burnout, and physician attrition but has not been systematically studied among neurosurgeons. OBJECTIVE To develop a unique instrument to test moral distress among neurosurgeons, evaluate the frequency and intensity of scenarios that may elicit moral distress and injury, and determine their impact on neurosurgical burnout and turnover. METHODS An online survey investigating moral distress, burnout, and practice patterns was emailed to attending neurosurgeon members of the Congress of Neurological Surgeons. Moral distress was evaluated through a novel survey designed for neurosurgical practice. RESULTS A total of 173 neurosurgeons completed the survey. Half of neurosurgeons (47.7%) reported significant moral distress within the past year. The most common cause was managing critical patients lacking a clear treatment plan; the most intense distress was pressure from patient families to perform futile surgery. Multivariable analysis identified burnout and performing ≥2 futile surgeries per year as predictors of distress (P < .001). Moral distress led 9.8% of neurosurgeons to leave a position and 26.6% to contemplate leaving. The novel moral distress survey demonstrated excellent internal consistency (Cronbach alpha = 0.89). CONCLUSION We developed a reliable survey assessing neurosurgical moral distress. Nearly, half of neurosurgeons suffered moral distress within the past year, most intensely from external pressure to perform futile surgery. Moral distress correlated with burnout risk caused 10% of neurosurgeons to leave a position and a quarter to consider leaving.
Collapse
Affiliation(s)
- Charles E. Mackel
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
| | - Ron L. Alterman
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
| | - Mary K. Buss
- Section of Palliative Care, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;
| | - Renée M. Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA;
| | - W. Christopher Fox
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA;
| | - Alejandro M. Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA;
| | - Roger B. Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Martina Stippler
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
| |
Collapse
|
8
|
The Association Between Factors Promoting Nonbeneficial Surgery and Moral Distress: A National Survey of Surgeons. Ann Surg 2022; 276:94-100. [PMID: 33214444 PMCID: PMC9635854 DOI: 10.1097/sla.0000000000004554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence of moral distress among surgeons and test the association between factors promoting non-beneficial surgery and surgeons' moral distress. SUMMARY BACKGROUND DATA Moral distress experienced by clinicians can lead to low-quality care and burnout. Older adults increasingly receive invasive treatments at the end of life that may contribute to surgeons' moral distress, particularly when external factors, such as pressure from colleagues, institutional norms, or social demands, push them to offer surgery they consider non-beneficial. METHODS We mailed surveys to 5200 surgeons randomly selected from the American College of Surgeons membership, which included questions adapted from the revised Moral Distress Scale. We then analyzed the association between factors influencing the decision to offer surgery to seriously ill older adults and surgeons' moral distress. RESULTS The weighted adjusted response rate was 53% (n = 2161). Respondents whose decision to offer surgery was influenced by their belief that pursuing surgery gives the patient or family time to cope with the patient's condition were more likely to have high moral distress (34% vs 22%, P < 0.001), and this persisted on multivariate analysis (odds ratio 1.44, 95% confidence interval 1.02-2.03). Time required to discuss nonoperative treatments or the consulting intensivists' endorsement of operative intervention, were not associated with high surgeon moral distress. CONCLUSIONS Surgeons experience moral distress when they feel pressured to perform surgery they believe provides no clear patient benefit. Strategies that empower surgeons to recommend nonsurgical treatments when they believe this is in the patient's best interest may reduce nonbeneficial surgery and surgeon moral distress.
Collapse
|
9
|
Ong RSR, Wong RSM, Chee RCH, Quek CWN, Burla N, Loh CYL, Wong YA, Chok AKL, Teo AYT, Panda A, Chan SWK, Shen GS, Teoh N, Chin AMC, Krishna LKR. A systematic scoping review moral distress amongst medical students. BMC MEDICAL EDUCATION 2022; 22:466. [PMID: 35710490 PMCID: PMC9203147 DOI: 10.1186/s12909-022-03515-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Characterised by feelings of helplessness in the face of clinical, organization and societal demands, medical students are especially prone to moral distress (MD). Despite risks of disillusionment and burnout, efforts to support them have been limited by a dearth of data and understanding of MD in medical students. Yet, new data on how healthcare professionals confront difficult care situations suggest that MD could be better understood through the lens of the Ring Theory of Personhood (RToP). A systematic scoping review (SSR) guided by the RToP is proposed to evaluate the present understanding of MD amongst medical students. METHODS The Systematic Evidence-Based Approach (SEBA) is adopted to map prevailing accounts of MD in medical students. To enhance the transparency and reproducibility, the SEBA methodology employs a structured search approach, concurrent and independent thematic analysis and directed content analysis (Split Approach), the Jigsaw Perspective that combines complementary themes and categories, and the Funnelling Process that compares the results of the Jigsaw Perspective with tabulated summaries to ensure the accountability of these findings. The domains created guide the discussion. RESULTS Two thousand six hundred seventy-one abstracts were identified from eight databases, 316 articles were reviewed, and 20 articles were included. The four domains identified include definitions, sources, recognition and, interventions for MD. CONCLUSIONS MD in medical students may be explained as conflicts between the values, duties, and principles contained within the different aspects of their identity. These conflicts which are characterised as disharmony (within) and dyssynchrony (between) the rings of RToP underline the need for personalised and longitudinal evaluations and support of medical students throughout their training. This longitudinal oversight and support should be supported by the host organization that must also ensure access to trained faculty, a nurturing and safe environment for medical students to facilitate speak-up culture, anonymous reporting, feedback opportunities and supplementing positive role modelling and mentoring within the training program.
Collapse
Affiliation(s)
- Rui Song Ryan Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Ning Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore libraries, Singapore Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, 119228, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, 169610, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, Singapore 8 College Rd,, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
| |
Collapse
|
10
|
Heggestad AKT, Konow-Lund AS, Christiansen B, Nortvedt P. A vulnerable journey towards professional empathy and moral courage. Nurs Ethics 2022; 29:927-937. [PMID: 35225056 PMCID: PMC9289973 DOI: 10.1177/09697330221074013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Empathy and moral courage are important virtues in nursing and nursing ethics. Hence, it is of great importance that nursing students and nurses develop their ability to empathize and their willingness to demonstrate moral courage. Research aim: The aim of this article is to explore third-year undergraduate nursing students’ perceptions and experiences in developing empathy and moral courage. Research design: This study employed a longitudinal qualitative design based on individual interviews. Participants and research context: Seven undergraduate nursing students were interviewed during or immediately following their final clinical placement. Ethical considerations: The Norwegian Social Science Data Services (NSD) approved the study. Participants were informed that their participation was voluntary and were assured confidentiality. They were informed that they could withdraw from the study at any time, without providing reasons. Findings: Affective empathy seemed to be strong among third-year undergraduate nursing students. However, they tried to handle the situations in a ‘professional’ way, and to balance their emotions. At the same time, they expressed how difficult it can be to show moral courage when confronted with poor patient care. In addition, they spoke about a lack of role models during clinical practice and supervision. Conclusions: Undergraduate nursing students are in a vulnerable position throughout their journey to become professional and to develop empathy and moral courage. The professional socialisation and forming of professional empathy and moral courage among nursing students, may be seen as a complex interaction of formal and hidden curriculum, where role models play an important role. We argue that the main theme ‘Vulnerable students – a journey towards professional empathy and moral courage’ may cover the longitudinal project as a whole. This vulnerability is something both teachers and supervisors should be aware of when following up with students in their clinical placements.
Collapse
Affiliation(s)
- Anne Kari Tolo Heggestad
- Faculty of Health Studies, VID Specialized University, Oslo and Centre for Medical Ethics, University of Oslo, Norway
| | | | - Bjørg Christiansen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Per Nortvedt
- Centre for Medical Ethics, University of Oslo, Oslo
| |
Collapse
|
11
|
Hagqvist E, Ekberg K, Lidwall U, Nyberg A, Landstad BJ, Wilczek A, Bååthe F, Sjöström M. The Swedish HealthPhys Study: Study Description and Prevalence of Clinical Burnout and Major Depression among Physicians. CHRONIC STRESS 2022; 6:24705470221083866. [PMID: 35402760 PMCID: PMC8984863 DOI: 10.1177/24705470221083866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/11/2022] [Indexed: 11/15/2022]
Abstract
Objectives The study purpose was to describe the Swedish HealthPhys cohort. Using data from the HealthPhys study, we aimed to describe the prevalence of clinical burnout and major depression in a representative sample of Swedish physicians across gender, age, worksite, hierarchical position, and speciality in spring of 2021, during the third wave of the Covid-19 pandemic. Method The HealthPhys questionnaire was sent to a representative sample of practising physicians (n = 6699) in Sweden in February to May of 2021 with a 41.3% response rate. The questionnaire included validated instruments measuring psychosocial work environment and health including measurements for major depression and clinical burnout. Results Data from the HealthPhys study showed that among practising physicians in Sweden the prevalence of major depression was 4.8% and clinical burnout was 4.7%. However, the variations across sub-groups of physicians regarding major depression ranged from 0% to 10.1%. For clinical burnout estimates ranged from 1.3% to 14.5%. Emergency physicians had the highest levels of clinical burnout while they had 0% prevalence of major depression. Prevalence of exhaustion was high across all groups of physicians with physicians working in emergency departments, at the highest (28.6%) and anaesthesiologist at the lowest (5.6%). Junior physicians had high levels across all measurements. Conclusions In conclusion, the first data collection from the HealthPhys study showed that the prevalence of major depression and clinical burnout varies across genders, age, hierarchical position, worksite, and specialty. Moreover, many practising physicians in Sweden experienced exhaustion and were at high risk of burnout.
Collapse
Affiliation(s)
- Emma Hagqvist
- Unit of Occupational Medicine, Institute of environmental medicine, Karolinska Institutet, Stockholm Sweden
| | - Kerstin Ekberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Ulrik Lidwall
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Official statistics Unit, Department for Analysis, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Anna Nyberg
- Unit of Occupational Medicine, Institute of environmental medicine, Karolinska Institutet, Stockholm Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala Sweden
| | - Bodil J. Landstad
- Department of Health Sciences, Mid Sweden University, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Alexander Wilczek
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm Sweden
| | - Fredrik Bååthe
- Institute for Studies of the Medical Profession LEFO - Legeforskningsinstituttet, Oslo, Norway
- Institute of Stress Medicine at Region VGR, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
12
|
Fischer-Grönlund C, Brännström M. The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). BMC Med Ethics 2021; 22:151. [PMID: 34772400 PMCID: PMC8588668 DOI: 10.1186/s12910-021-00722-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one's convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context. METHODS The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0-4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts. RESULTS The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items' had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible. CONCLUSION The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context.
Collapse
|
13
|
Day P, Lawson J, Mantri S, Jain A, Rabago D, Lennon R. Physician moral injury in the context of moral, ethical and legal codes. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107225. [PMID: 34290114 DOI: 10.1136/medethics-2021-107225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to 'burnout', there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how-if at all-this changes anything.The current research seeks to develop the construct of moral injury outside military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics.
Collapse
Affiliation(s)
- Philip Day
- Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer Lawson
- Department of Pediatrics and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University of School Medicine, Durham, North Carolina, USA
| | - Sneha Mantri
- Department of Neurology and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Abhi Jain
- St Mark's School of Texas, Dallas, Texas, USA
| | - David Rabago
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robert Lennon
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
14
|
Delgado J, Siow S, de Groot J, McLane B, Hedlin M. Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106764. [PMID: 33762300 PMCID: PMC7992383 DOI: 10.1136/medethics-2020-106764] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 05/25/2023]
Abstract
This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.
Collapse
Affiliation(s)
- Janet Delgado
- NICU, University Hospital of the Canary Islands, La Laguna, La Laguna, Spain
- University Institute of Women's Studies, University of La Laguna, La Laguna, Spain
| | - Serena Siow
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Janet de Groot
- Department of Psychiatry, Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brienne McLane
- Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Margot Hedlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
15
|
Hildesheim H, Rogge A, Borzikowsky C, Witt VD, Schäffer E, Berg D. Moral distress among residents in neurology: a pilot study. Neurol Res Pract 2021; 3:6. [PMID: 33517916 PMCID: PMC7849144 DOI: 10.1186/s42466-021-00104-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Medical progress, economization of healthcare systems, and scarcity of resources raise fundamental ethical issues. Physicians are exposed to increasing moral conflict situations, which may cause Moral Distress (MD). MD occurs when someone thinks he or she might know the morally correct action but cannot act upon this knowledge because of in- or external constraints. Correlations of MD among residents to job changes and burn-out have been shown previously. There are, however, hardly any quantitative studies about MD among physicians in Germany. The aim of this study was to investigate the frequency of occurrence, the level of disturbance, and reasons for MD among neurological residents in German hospitals. Methods 1st qualitative phase: Open interviews on workload and ethical conflicts in everyday clinical practice were conducted with five neurological residents. Ethical principles of medical action and potential constraints that could cause MD were identified and a questionnaire designed. 2nd quantitative phase: A preliminary questionnaire was tested and evaluated by five further neurological residents. The final questionnaire consisted of 12 items and was conducted online and anonymously via e-mail or on-site as part of an unrelated resident training event at 56 sites. Results One hundred seven neurological residents from 56 university/acute care and rehabilitation hospitals throughout Germany were examined (response rate of those requesting the questionnaire: 75.1%). 96.3% of the participants had experienced MD weekly (3.86, SD 1.02), because they were unable to invest the necessary time in a patient or relative consultation. Errors in medical care, which could not be communicated adequately with patients or relatives, were rated as most distressing. The most common reasons for MD were the growing numbers of patients, expectations of patient relatives, fears of legal consequences, incentives of the DRG-system, and the increasing bureaucratization requirement. 43.0% of participants mentioned they considered leaving the field of inpatient-care. 65.4% stated they would like more support in conflict situations. Conclusion MD plays an important role for neurological residents in German hospitals and has an impact on participants’ consideration of changing the workplace. Important aspects are rationing (time/beds) and incentives for overdiagnosis as well as lack of internal communication culture and mentoring. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00104-5.
Collapse
Affiliation(s)
- Hanna Hildesheim
- Department of Neurology, Kiel University, University-Hospital-Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Annette Rogge
- Institute for Experimental Medicine, Medical Ethics, Kiel University, University-Hospital-Schleswig-Holstein, Kiel, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University-Hospital-Schleswig-Holstein, Kiel, Germany
| | | | - Eva Schäffer
- Department of Neurology, Kiel University, University-Hospital-Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Kiel University, University-Hospital-Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| |
Collapse
|
16
|
Tarabeih M, Bokek-Cohen Y. Moral distress and moral residue experienced by transplant coordinators. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105593. [PMID: 32723760 DOI: 10.1136/medethics-2019-105593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/17/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for more than 20 years in this job were recruited by using a purposive sampling technique. The transplant coordinators spoke of negative feelings and moral distress with regard to futile care of family members of deceased donors as well as of living donors. Transplant coordinators experience moral distress on a daily basis; being compelled to compromise their integrity causes moral distress and moral residue, hence, training and support should be offered to them.
Collapse
Affiliation(s)
- Mahdi Tarabeih
- School of Nursing, The Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel
| | | |
Collapse
|
17
|
McGill N, Crowe K, Mcleod S. "Many wasted months": Stakeholders' perspectives about waiting for speech-language pathology services. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:313-326. [PMID: 32295426 DOI: 10.1080/17549507.2020.1747541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: High demand for speech-language pathology services is reflected in long waiting lists. Waiting can be active or passive and has implications for stakeholders, including consumers, professionals, and organisations. The present study explored experiences and perspectives regarding waiting for speech-language pathology services through analysis of stakeholders' written submissions to an Australian Government Senate Inquiry.Method: Written submissions (n = 337) were screened for terms related to waiting. Included submissions (n = 133) were written by organisations (36.8%), speech-language pathologists (29.3%), parents (27.8%), individuals with communication and/or swallowing difficulties (5.3%), and others.Result: Inductive thematic analysis identified three themes. (1) Duration. Consistently described as long. (2) Consequences. Consumers' consequences included: burden on physical health, finances, time, emotional wellbeing, and relationships, reduced continuity of care, and increased intervention needs. Professional consequences included: stress and burnout impacting job satisfaction, and reduced effectiveness. Societal consequences included: social and ethical burden, and a drain on health and legal systems. (3) Actions. Consumers advocated and sought alternatives (e.g. threats to harm their child, relocation to a capital city), professionals implemented service delivery and policy actions, and organisations lacked effective system-wide strategies.Conclusion: Existing services did not appear to meet stakeholders' needs. Action is needed to improve speech-language pathology waiting lists and access to services, and minimise possible consequences for stakeholders.
Collapse
Affiliation(s)
- Nicole McGill
- School of Teacher Education, Charles Sturt University, Bathurst, NSW, Australia
| | - Kathryn Crowe
- School of Teacher Education, Charles Sturt University, Bathurst, NSW, Australia
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Sharynne Mcleod
- School of Teacher Education, Charles Sturt University, Bathurst, NSW, Australia
| |
Collapse
|
18
|
Astbury JL, Gallagher CT. Moral distress among community pharmacists: causes and achievable remedies. Res Social Adm Pharm 2020; 16:321-328. [DOI: 10.1016/j.sapharm.2019.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 11/27/2022]
|
19
|
McGill N, McLeod S. Waiting list management in speech-language pathology: translating research to practice. SPEECH LANGUAGE AND HEARING 2020. [DOI: 10.1080/2050571x.2020.1716471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nicole McGill
- School of Teacher Education, Charles Sturt University, Bathurst, Australia
| | - Sharynne McLeod
- School of Teacher Education, Charles Sturt University, Bathurst, Australia
| |
Collapse
|
20
|
Colville GA, Dawson D, Rabinthiran S, Chaudry-Daley Z, Perkins-Porras L. A survey of moral distress in staff working in intensive care in the UK. J Intensive Care Soc 2019; 20:196-203. [PMID: 31447911 PMCID: PMC6693114 DOI: 10.1177/1751143718787753] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Elevated rates of burnout and post-traumatic stress have been found in staff working in critical care settings, but the aspect of moral distress has been harder to quantify until a recent revision of a scale previously designed for nurses, was adapted for use with a range of health professionals, including physicians. In this cross-sectional survey, n = 171 nurses and physicians working in intensive care in the United Kingdom completed the Moral Distress Scale-Revised in relation to their experiences at work. Mean (SD) Moral Distress Scale-Revised score was 70.2 (39.6). Significant associations were found with female gender (female 74.1 (40.2) vs. male 55.5 (33.8), p = 0.010); depression (r = 0.165, p = 0.035) and with intention to leave job (considering leaving 85.5 (42.4) vs. not considering leaving 67.2 (38.6), p = 0.040). These results highlight the importance of considering the moral impact of work-related issues when addressing staff wellbeing in critical care settings.
Collapse
Affiliation(s)
- GA Colville
- Paediatric Psychology Service, St
George’s University Hospitals NHS Foundation Trust, London, UK
- Population Health Research Institute, St
George's, University of London, UK
| | - D Dawson
- Adult Intensive Care Units, St George’s
University Hospitals NHS Foundation Trust, London, UK
| | - S Rabinthiran
- Medical School, St George’s, University
of London, UK
| | | | - L Perkins-Porras
- Institute of Medical and Behavioural
Education, St George’s, University of London, UK
| |
Collapse
|
21
|
Bruun H, Pedersen R, Stenager E, Mogensen CB, Huniche L. Implementing ethics reflection groups in hospitals: an action research study evaluating barriers and promotors. BMC Med Ethics 2019; 20:49. [PMID: 31311525 PMCID: PMC6636139 DOI: 10.1186/s12910-019-0387-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background An ethics reflection group (ERG) is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. Methods The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Results The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. Conclusion The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services.
Collapse
Affiliation(s)
- Henriette Bruun
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark.
| | - Reidar Pedersen
- Center for medical Ethics, Institute of Health and Society, University of Oslo, Kirkevejen 166, 0450, Oslo, Norway
| | - Elsebeth Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark
| | - Christian Backer Mogensen
- Focused Research Unit in Emergency Medicine Institute for Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark
| | - Lotte Huniche
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| |
Collapse
|
22
|
Lluch-Canut T, Sequeira C, Falcó-Pegueroles A, Pinho JA, Rodrigues-Ferreira A, Olmos JG, Roldan-Merino J. Ethical conflicts and their characteristics among critical care nurses. Nurs Ethics 2019; 27:537-553. [PMID: 31303110 DOI: 10.1177/0969733019857785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. AIM The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version and, second, to analyse Portuguese critical care nurses' level of exposure to ethical conflict and its characteristics. METHODS A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. ETHICAL CONSIDERATIONS The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. FINDINGS The Portuguese version of the Ethical Conflict Nursing Questionnaire-Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources.
Collapse
|
23
|
Hudon A, Ehrmann Feldman D, Hunt M. Tensions Living Out Professional Values for Physical Therapists Treating Injured Workers. QUALITATIVE HEALTH RESEARCH 2019; 29:876-888. [PMID: 30304990 DOI: 10.1177/1049732318803589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Health care services provided by workers' compensation systems aim to facilitate recovery for injured workers. However, some features of these systems pose barriers to high quality care and challenge health care professionals in their everyday work. We used interpretive description methodology to explore ethical tensions experienced by physical therapists caring for patients with musculoskeletal injuries compensated by Workers' Compensation Boards. We conducted in-depth interviews with 40 physical therapists and leaders in the physical therapy and workers' compensation fields from three Canadian provinces and analyzed transcripts using concurrent and constant comparative techniques. Through our analysis, we developed inductive themes reflecting significant challenges experienced by participants in upholding three core professional values: equity, competence, and autonomy. These challenges illustrate multiple facets of physical therapists' struggles to uphold moral commitments and preserve their sense of professional integrity while providing care to injured workers within a complex health service system.
Collapse
Affiliation(s)
- Anne Hudon
- 1 University of Waterloo, Waterloo, Ontario, Canada
- 2 University of Ottawa, Ottawa, Ontario, Canada
| | - Debbie Ehrmann Feldman
- 3 University of Montreal, Montreal, Québec, Canada
- 4 Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Matthew Hunt
- 4 Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
- 5 McGill University, Montreal, Québec, Canada
| |
Collapse
|
24
|
Almutairi AF, Salam M, Adlan AA, Alturki AS. Prevalence of severe moral distress among healthcare providers in Saudi Arabia. Psychol Res Behav Manag 2019; 12:107-115. [PMID: 30804690 PMCID: PMC6375112 DOI: 10.2147/prbm.s191037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Moral distress is a serious problem in healthcare environments that requires urgent attention and management. It occurs when healthcare providers are unable to provide the care that they feel is right or take, what they believe to be, ethically appropriate actions for their patients. Thus, this study aims to examine moral distress among nurses and physicians working in tertiary teaching hospitals in Saudi Arabia, as well as to evaluate the level of association between moral distress and turnover. Methods This cross-sectional study, which employed an anonymous 21-item Moral Distress Scale, was undertaken at a large medical institution located in different regions of Saudi Arabia. The data were analyzed using bivariate analyses, and logistic regression. Results Of the 342 participants, 239 (69.9%) were nurses/staff physicians and 103 (30.1%) were fellows/consultants. Approximately 24.3% of respondents experienced severe moral distress, whereas 75.7% reported mild moral distress. There was no statistically significant difference between men and women in terms of moral distress. Age was found to be a notable factor: moral distress was significantly higher in those younger than 37 years compared to those 37 years and older (P=0.015). Less than half of the participants (137, 42.8%) indicated their willingness to leave their jobs. A significant association was observed between severe moral distress and leaving the career (OR=3.16; P<0.01). Job category was also an important factor: nurses/staff physicians were almost two times more likely (OR =1.95, P=0.038) to leave their positions compared to fellows/consultants. Conclusion This study revealed that moral distress, which is a serious problem that compromises the well-being of caregivers, was a predictive variable for the intention of healthcare providers to leave their jobs. Therefore, it should be routinely examined, and efficient action plans should be implemented to alleviate its consequences.
Collapse
Affiliation(s)
- Adel F Almutairi
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard health affairs, Riyadh, Saudi Arabia,
| | - Mahmoud Salam
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard health affairs, Riyadh, Saudi Arabia,
| | - Abdallah A Adlan
- Bioethics Section, King Abdullah International Medical Research center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdullah S Alturki
- Research operations, King Abdullah International Medical Research center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
25
|
Sannino P, Giannì ML, Carini M, Madeo M, Lusignani M, Bezze E, Marchisio P, Mosca F. Moral Distress in the Pediatric Intensive Care Unit: An Italian Study. Front Pediatr 2019; 7:338. [PMID: 31456996 PMCID: PMC6700377 DOI: 10.3389/fped.2019.00338] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: There is paucity of data within the Italian context regarding moral distress in intensive pediatric settings. The aim of the present study was to assess the frequency, intensity, and level of moral distress experienced by nurses working in a sample of pediatric intensive care units (PICUs). Materials and Methods: A cross-sectional questionnaire survey was conducted in eight PICUs from five northern Italian regions in a convenience sample of 136 nurses. Moral distress was evaluated using the modified Italian version of the Moral Distress Scale Neonatal-Pediatric Version (MDSNPV). Each item was scored in terms of frequency and intensity on a five-point Likert scale, ranging from 0 to 4. The total frequency and intensity scores for all the 21 clinical items were comprised between 0 and 84. For each item, the level of moral distress was derived by multiplying the frequency score by the intensity score and quantified with a score ranging from 0 to 16. The total score of the moral distress level for the 21 items ranged from 0 to 336. Results: The mean total scores for the frequency, intensity and level of moral distress were 24.1 ± 10.4, 36.2 ± 18.6, and 57.7 ± 37.1, respectively. The clinical situations identified as the major causes of moral distress among nurses in the present study involved end-of-life care and resuscitation. At multivariate logistic regression analysis, number of deaths occurring in PICUs, having children and intention to leave work due to moral distress resulted to be independently associated with a higher total moral distress level. Conclusions: The results of the present study contribute to the understanding of moral distress experience in acute pediatric care settings, including the clinical situations associated with a higher moral distress level, and highlight the importance of sharing thoughts, feelings and information within the multidisciplinary health care professional team for effective shared decision making, particularly in situations involving end-of-life care and resuscitation.
Collapse
Affiliation(s)
- Patrizio Sannino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, Milan, Italy
| | - Maria Lorella Giannì
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Micaela Carini
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Madeo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, Milan, Italy
| | - Maura Lusignani
- ASST Grande Ospedale Metropolitano Niguarda, Bachelor of Nursing, Course Session, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elena Bezze
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
26
|
Zolala S, Almasi-Hashiani A, Akrami F. Severity and frequency of moral distress among midwives working in birth centers. Nurs Ethics 2018; 26:2364-2372. [PMID: 30348054 DOI: 10.1177/0969733018796680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When individuals are aware of the appropriate ethical practice, but lack the ability to do it, they will suffer from moral distress. Moral distress is a frequent phenomenon in clinical practice which can have different effects on the performance of physicians, nurses, and midwives, and therefore patients and health care systems. RESEARCH OBJECTIVE The present study aimed to determine the severity and frequency of moral distress in midwives working in birth centers. RESEARCH DESIGN This study is a descriptive cross-sectional research. Researcher-made questionnaire was used to gather data. PARTICIPANTS AND RESEARCH CONTEXT A total of 180 midwives working in the labor ward of the public birth centers affiliated to Shahid Beheshti University of Medical Sciences were included to the study by census. ETHICAL CONSIDERATIONS Official permission for data collecting was obtained from the directors of the birth centers affiliated to Shahid Beheshti University of Medical Sciences. Then, after explaining the objectives of the study and assuring the confidentially of information, verbal consent of the participants was obtained. FINDINGS The total mean ± standard deviation of the severity and frequency of moral distress were 3.85 ± 0.75 and 3.03 ± 0.48, respectively. The highest severity and the lowest frequency of moral distress were obtained for the assistance for abortion and the lowest severity of moral distress was related to the organizational domain. However, the highest frequency of moral distress was related to futile care field. The mean of moral distress severity in the midwives with associate degree was significantly lower than other levels of education. Also, there was a significant relationship between age and moral distress frequency (p = 0.010). DISCUSSION The midwives' moral distress was relatively high as expected. This finding is consistent with the results of similar studies in intensive care unit nurses. CONCLUSION After identifying the level and most important factors of moral distress among midwives, the next step is empower them to prevent moral distress, in particular efforts to change structures.
Collapse
Affiliation(s)
- Shahrzad Zolala
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Forouzan Akrami
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
27
|
Rosta J, Aasland OG. Perceived bullying among Norwegian doctors in 1993, 2004 and 2014-2015: a study based on cross-sectional and repeated surveys. BMJ Open 2018; 8:e018161. [PMID: 29431127 PMCID: PMC5829781 DOI: 10.1136/bmjopen-2017-018161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine 12-month prevalence of perceived bullying at work for doctors in different job categories and medical disciplines in 1993, 2004 and 2014-2015, and personality traits, work-related and health-related factors associated with perceived workplace bullying. DESIGN Cross-sectional questionnaire surveys in 1993, 2004 and 2014-2015 where the 2004 and the 2012-2015 samples are partly overlapping. SETTING Norway. PARTICIPANTS Response rates were 72.8% (2628/3608) in 1993, 67% (1004/1499) in 2004 and 78.2% (1261/1612) in 2014-2015. 485 doctors responded both in 2004 and 2014-2015. OUTCOME MEASURE Perceived bullying at work from colleagues or superiors at least a few times a month during the last year. RESULTS Between the samples from 1993, 2004 and 2014-2015, there were no significant differences in the prevalence of perceived bullying at work. More senior hospital doctors and surgeons reported being bullied. Doctors with higher scores on the personality trait neuroticism were more likely to perceive bullying, as were female doctors, doctors with poor job satisfaction and poor self-rated health. CONCLUSIONS The fraction of doctors who experienced bullying at work was stable over a 20-year period. Psychological, psychosocial and cultural factors are predictors of perceived bullying.
Collapse
Affiliation(s)
- Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
| | - Olaf G Aasland
- Institute for Studies of the Medical Profession, Oslo, Norway
| |
Collapse
|
28
|
Abstract
INTRODUCTION Ethics support services for hospital clinicians have become increasingly common globally but not as yet in New Zealand. However, an initiative to change this is gathering momentum. Its slogan 'Clinical ethics is everyone's business' indicates that the aim is to encompass all of health care, not just the hospital sector. General Practitioners (GPs) deal with ethical issues on a daily basis. These issues are often quite different from ethical issues in hospitals. To make future ethics support relevant for primary care, local GPs were interviewed to find out how they might envisage ethics support services that could be useful to them. METHODS A focus group interview with six GPs and semi-structured individual interviews with three GPs were conducted. Questions included how they made decisions on ethical issues at present, what they perceived as obstacles to ethical reflection and decision-making, and what support might be helpful. FINDINGS Three areas of ethics support were considered potentially useful: Formal ethics education during GP training, access to an ethicist for assistance with analysing an ethical issue, and professional guidance with structured ethics conversations in peer groups. CONCLUSION The complex nature of general practice requires GPs to be well educated and supported for handling ethical issues. The findings from this study could serve as input to the development of ethics support services. KEYWORDS General practice; primary care; ethics; support; education.
Collapse
Affiliation(s)
- Monika Clark-Grill
- Correspondence to: Dr Monika Clark-Grill Department of Primary Health Care and General Practice, Wellington, University of Otago, 45 Melville Street, Dunedin 9016, New Zealand.
| |
Collapse
|
29
|
Abstract
OBJECTIVES To examine the associations with symptoms of 1) burnout and 2) work-related posttraumatic stress, in adult and pediatric intensive care staff, focusing on the particular contributions of resilience and coping strategies. DESIGN Point prevalence cross-sectional study. SETTING Three adult ICUs and four PICUs. SUBJECTS Three hundred seventy-seven ICU staff. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Brief Resilience Scale, abbreviated Maslach Burnout Inventory, Trauma Screening Questionnaire, and Hospital Anxiety and Depression Scale. Prevalence of burnout (defined as high emotional exhaustion or high depersonalization) was 37%. Prevalence of clinically significant posttraumatic stress symptoms was 13%. There was a degree of overlap between burnout and other measures of distress, most notably for anxiety (odds ratio, 10.56; 95% CI, 4.12-27.02; p < 0.001). Hierarchical logistic regression demonstrated that self-reported resilience was strongly associated with decreased likelihood of meeting criteria for both forms of work-related distress (burnout: odds ratio, 0.52; 95% CI, 0.36-0.74; p < 0.001 and posttraumatic stress: odds ratio, 0.28; 95% CI, 0.16-0.46; p < 0.001) and that physicians were twice as likely as nurses to be at risk of reporting burnout (odds ratio, 2.11; 95% CI, 1.18-3.78; p = 0.012). After controlling for resilience, profession, and setting, the following coping strategies were independently associated with outcomes: attending debriefing reduced risk of burnout (odds ratio, 0.45; 95% CI, 0.21-0.95; p = 0.036), whereas the odds of posttraumatic stress were less if staff used talking to seniors (odds ratio, 0.43; 95% CI, 0.20-0.92; p = 0.029) or hobbies (odds ratio, 0.46; 95% CI, 0.23-0.93; p = 0.030) to cope with stress at work. Venting emotion (odds ratio, 1.92; 95% CI, 1.12-3.31; p = 0.018) and using alcohol (odds ratio, 2.30; 95% CI, 1.26-4.20; p = 0.006) were associated with a doubling in risk of reporting burnout. CONCLUSIONS The use of particular coping strategies was systematically associated with symptoms of burnout and work-related posttraumatic stress in this group of intensive care staff, even after controlling for resilience and other factors. More research on how best to promote adaptive coping is needed in these challenging settings.
Collapse
|
30
|
Skirbekk H, Hem MH, Nortvedt P. Prioritising patient care: The different views of clinicians and managers. Nurs Ethics 2017; 25:746-759. [PMID: 28134008 DOI: 10.1177/0969733016664977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little research comparing clinicians' and managers' views on priority settings in the healthcare services. During research on two different qualitative research projects on healthcare prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare professionals talked about and understood prioritisations. AIM The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians and to explore how moral dilemmas are balanced and reconciled. Research design and participants: We conducted qualitative observations, interviews and focus groups with medical doctors, nurses and other clinical members of the interdisciplinary team in both somatic medical and mental health wards in hospitals in Norway. The interviews were recorded and transcribed verbatim. Ethical considerations: Basic ethical principles for research ethics were followed. The respondents signed an informed consent for participation. They were assured anonymity and confidentiality. The studies were approved by relevant ethics committees in line with the Helsinki Convention. FINDINGS Our findings showed a widening gap between the views of clinicians on one hand and managers on the other. Clinicians experienced a threat to their autonomy, to their professional ideals and to their desire to perform their job in a professional way. Prioritisations were a cause of constant concern and problematic decisions. Even though several managers understood and empathised with the clinicians, the ideals of patient flow and keeping budgets balanced were perceived as more important. DISCUSSION We discuss our findings in light of the moral challenges of patient-centred individual healthcare versus demands of distributive justice from healthcare management. CONCLUSION The clinicians' ideals of autonomy and good medical and nursing care for the individual patients were perceived as endangered.
Collapse
Affiliation(s)
- Helge Skirbekk
- Lovisenberg Diaconal University College, Norway; University of Oslo, Norway.,University of Oslo, Norway
| | | | | |
Collapse
|
31
|
Silveira LR, Ramos FRS, Schneider DG, Vargas MADO, Barlem ELD. Sofrimento moral em enfermeiros dos departamentos de fiscalização do Brasil. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar a frequência e a intensidade das causas de sofrimento moral vivenciado por enfermeiros nos departamentos de fiscalização do Brasil. Métodos Estudo transversal realizado com 28 profissionais de competência gerencial e 113 profissionais de competência fiscalizatória. A amostra foi intencional e não probabilística. Os dados foram obtidos por meio de questionário e submetidos à análise descritiva e bivariada. Resultados Os participantes revelaram causas do sofrimento moral em dois momentos: Primeiro associado ao processo de fiscalização lento por parte das instituições fiscalizadas e Corens; e insuficiência de recursos humanos. Segundo associado aos problemas éticos; condições de trabalho; e qualidade da assistência de enfermagem. Conclusão Refletir sobre as causas do sofrimento moral neste cenário é reconhecer a necessidade de algumas mudanças que devem acontecer na base que sustenta os preceitos éticos e condutas morais da profissão, para assim fortalecer a categoria.
Collapse
|
32
|
Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol 2016. [PMID: 26220460 DOI: 10.1177/1359105315595120] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians' wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.
Collapse
Affiliation(s)
- Giulia Lamiani
- 1 University of Milan, Italy.,2 University of Pavia, Italy
| | | | | |
Collapse
|
33
|
Lievrouw A, Vanheule S, Deveugele M, Vos M, Pattyn P, Belle V, Benoit D. Coping With Moral Distress in Oncology Practice: Nurse and Physician Strategies. Oncol Nurs Forum 2016; 43:505-12. [DOI: 10.1188/16.onf.505-512] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Doran E, Fleming J, Jordens C, Stewart CL, Letts J, Kerridge IH. Managing ethical issues in patient care and the need for clinical ethics support. AUST HEALTH REV 2016; 39:44-50. [PMID: 25514126 DOI: 10.1071/ah14034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/22/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. METHODS A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. RESULTS Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. CONCLUSION Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia.
Collapse
Affiliation(s)
- Evan Doran
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| | - Jennifer Fleming
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| | - Christopher Jordens
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| | - Cameron L Stewart
- Centre for Health Governance, Law and Ethics, University of Sydney, New Law Building, Camperdown, NSW 2006, Australia. Email
| | - Julie Letts
- Office of the Chief Health Officer, NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia. Email
| | - Ian H Kerridge
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2006, Australia.
| |
Collapse
|
35
|
Falcó-Pegueroles A, Lluch-Canut MT, Martínez-Estalella G, Zabalegui-Yarnoz A, Delgado-Hito P, Via-Clavero G, Guàrdia-Olmos J. Levels of exposure to ethical conflict in the ICU: Correlation between sociodemographic variables and the clinical environment. Intensive Crit Care Nurs 2016; 33:12-20. [PMID: 26796289 DOI: 10.1016/j.iccn.2015.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyse the level of exposure of nurses to ethical conflict and determine the relationship between this exposure, sociodemographic variables and perceptions of the clinical environment. DESIGN AND SETTING Prospective and descriptive correlational study conducted at 10 intensive care units in two tertiary hospitals affiliated to the University of Barcelona. Sociodemographic and professional data were recorded from a questionnaire and then the previously validated Ethical Conflict in Nursing Questionnaire-Critical Care Version was administered to obtain data regarding experiences of ethical conflict. RESULTS Two hundred and three nurses (68.6%) participated in the study, of whom only 11.8% had training in bioethics. Exposure to ethical conflict was moderate with a x¯=182.35 (SD=71.304; [0-389]). The realisation that analgesia is ineffective and the administration of treatment without having participated in the decision-making process were the most frequently reported ethical conflicts. Professionals who perceived their environment as supportive for dealing with ethical conflicts reported lower levels of these events (p=0.001). CONCLUSIONS Ethical conflict is an internal problem but it is strongly influenced by certain variables and environmental conditions. The involvement of nurses in the decision-making processes regarding the care of critically ill patients emerges as a factor that protects against ethical conflicts.
Collapse
Affiliation(s)
- Anna Falcó-Pegueroles
- School of Nursing, Consolidated Research Group 2014-326 Advanced Statistical Techniques Applied Psychology, University of Barcelona, Spain.
| | - M Teresa Lluch-Canut
- School of Nursing, Consolidated Research Group 2014-1139 GEIMAC, University of Barcelona, Spain
| | - Gemma Martínez-Estalella
- Hospital Universitari Bellvitge, University of Barcelona l'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Gemma Via-Clavero
- Hospital Universitari Bellvitge, University of Barcelona l'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Faculty of Psychology, Consolidated Research Group 2014-326 Advanced Statistical Techniques Applied Psychology, Research Institute on Brain, Cognition and Behaviour (IR3C), University of Barcelona, Spain
| |
Collapse
|
36
|
Skirbekk H, Nortvedt P. Inadequate treatment for elderly patients: professional norms and tight budgets could cause "ageism" in hospitals. HEALTH CARE ANALYSIS 2015; 22:192-201. [PMID: 22528026 DOI: 10.1007/s10728-012-0207-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We have studied ethical considerations of care among health professionals when treating and setting priorities for elderly patients in Norway. The views of medical doctors and nurses were analysed using qualitative methods. We conducted 21 in depth interviews and 3 focus group interviews in hospitals and general practices. Both doctors and nurses said they treated elderly patients different from younger patients, and often they were given lower priorities. Too little or too much treatment, in the sense of too many interventions and too much drugs, combined with too little care and comfort, was admitted as a relatively frequent yet unwanted consequence of the way clinical priorities were set for elderly patients. This was explained in terms of elderly patients not tolerating the same treatment as younger patients, and questions were raised about the quality of life of many elderly patients after treatment. These explanations were frequently referred to as medically sound decision making. Other explanations had little to do with medically sound decisions. These often included deep frustration with executive guidelines and budget constraints.
Collapse
Affiliation(s)
- Helge Skirbekk
- Medical Faculty, Institute of Health and Society, Centre for Medical Ethics, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway,
| | | |
Collapse
|
37
|
de Boer JC, van Rosmalen J, Bakker AB, van Dijk M. Appropriateness of care and moral distress among neonatal intensive care unit staff: repeated measurements. Nurs Crit Care 2015; 21:e19-27. [DOI: 10.1111/nicc.12206] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jacoba Coby de Boer
- Department of Pediatrics; Erasmus University Medical Centre, Sophia Children's Hospital; Rotterdam The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics; Erasmus University Medical Centre; Rotterdam The Netherlands
| | - Arnold B. Bakker
- Department of Work and Organizational Psychology; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Monique van Dijk
- Department of Pediatrics; Erasmus University Medical Centre, Sophia Children's Hospital; Rotterdam The Netherlands
| |
Collapse
|
38
|
Monrouxe LV, Rees CE, Dennis I, Wells SE. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies. BMJ Open 2015; 5:e007518. [PMID: 25991457 PMCID: PMC4442195 DOI: 10.1136/bmjopen-2014-007518] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To understand the prevalence of healthcare students' witnessing or participating in something that they think unethical (professionalism dilemmas) during workplace learning and examine whether differences exist in moral distress intensity resulting from these experiences according to gender and the frequency of occurrence. DESIGN Two cross-sectional online questionnaires of UK medical (study 1) and nursing, dentistry, physiotherapy and pharmacy students (study 2) concerning professionalism dilemmas and subsequent distress for (1) Patient dignity and safety breaches; (2) Valid consent for students' learning on patients; and (3) Negative workplace behaviours (eg, student abuse). PARTICIPANTS AND SETTING 2397 medical (67.4% female) and 1399 other healthcare students (81.1% female) responded. MAIN RESULTS The most commonly encountered professionalism dilemmas were: student abuse and patient dignity and safety dilemmas. Multinomial and logistic regression identified significant effects for gender and frequency of occurrence. In both studies, men were more likely to classify themselves as experiencing no distress; women were more likely to classify themselves as distressed. Two distinct patterns concerning frequency were apparent: (1) Habituation (study 1): less distress with increased exposure to dilemmas 'justified' for learning; (2) Disturbance (studies 1 and 2): more distress with increased exposure to dilemmas that could not be justified. CONCLUSIONS Tomorrow's healthcare practitioners learn within a workplace in which they frequently encounter dilemmas resulting in distress. Gender differences could be respondents acting according to gendered expectations (eg, males downplaying distress because they are expected to appear tough). Habituation to dilemmas suggests students might balance patient autonomy and right to dignity with their own needs to learn for future patient benefit. Disturbance contests the 'accepted' notion that students become less empathic over time. Future research might examine the strategies that students use to manage their distress, to understand how this impacts of issues such as burnout and/or leaving the profession.
Collapse
Affiliation(s)
- Lynn V Monrouxe
- Institute of Medical Education, Cardiff University, Cardiff, UK
| | - Charlotte E Rees
- Centre for Medical Education, Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Ian Dennis
- School of Psychology, Portland Square, Plymouth University, Plymouth, UK
| | | |
Collapse
|
39
|
Bollig G, Schmidt G, Rosland JH, Heller A. Ethical challenges in nursing homes--staff's opinions and experiences with systematic ethics meetings with participation of residents' relatives. Scand J Caring Sci 2015; 29:810-23. [PMID: 25918868 DOI: 10.1111/scs.12213] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many ethical problems exist in nursing homes. These include, for example, decision-making in end-of-life care, use of restraints and a lack of resources. AIMS The aim of the present study was to investigate nursing home staffs' opinions and experiences with ethical challenges and to find out which types of ethical challenges and dilemmas occur and are being discussed in nursing homes. METHODS The study used a two-tiered approach, using a questionnaire on ethical challenges and systematic ethics work, given to all employees of a Norwegian nursing home including nonmedical personnel, and a registration of systematic ethics discussions from an Austrian model of good clinical practice. RESULTS Ninety-one per cent of the nursing home staff described ethical problems as a burden. Ninety per cent experienced ethical problems in their daily work. The top three ethical challenges reported by the nursing home staff were as follows: lack of resources (79%), end-of-life issues (39%) and coercion (33%). To improve systematic ethics work, most employees suggested ethics education (86%) and time for ethics discussion (82%). Of 33 documented ethics meetings from Austria during a 1-year period, 29 were prospective resident ethics meetings where decisions for a resident had to be made. Agreement about a solution was reached in all 29 cases, and this consensus was put into practice in all cases. Residents did not participate in the meetings, while relatives participated in a majority of case discussions. In many cases, the main topic was end-of-life care and life-prolonging treatment. CONCLUSIONS Lack of resources, end-of-life issues and coercion were ethical challenges most often reported by nursing home staff. The staff would appreciate systematic ethics work to aid decision-making. Resident ethics meetings can help to reach consensus in decision-making for nursing home patients. In the future, residents' participation should be encouraged whenever possible.
Collapse
Affiliation(s)
- Georg Bollig
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum Schleswig, Schleswig, Germany
| | - Gerda Schmidt
- Caritas Socialis Vienna, Nursing Home Pramergasse, Vienna, Austria
| | - Jan Henrik Rosland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.,Centre for Pain Management and Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - Andreas Heller
- Institute of Palliative Care and Organizational Ethics, IFF (Faculty for Interdisciplinary Research and Further Education), Faculty of University Klagenfurt, Vienna, Graz, Austria
| |
Collapse
|
40
|
Thomas TA, McCullough LB. A Philosophical Taxonomy of Ethically Significant Moral Distress: Figure 1. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2014; 40:102-20. [DOI: 10.1093/jmp/jhu048] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
41
|
|
42
|
Falcó-Pegueroles A, Lluch-Canut T, Roldan-Merino J, Goberna-Tricas J, Guàrdia-Olmos J. Ethical conflict in critical care nursing: Correlation between exposure and types. Nurs Ethics 2014; 22:594-607. [PMID: 25335920 DOI: 10.1177/0969733014549883] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. OBJECTIVES The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. RESEARCH DESIGN This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. PARTICIPANTS AND RESEARCH CONTEXT A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. FINDINGS The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. DISCUSSION The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. CONCLUSION The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.
Collapse
|
43
|
Abbasi M, Nejadsarvari N, Kiani M, Borhani F, Bazmi S, Nazari Tavaokkoli S, Rasouli H. Moral distress in physicians practicing in hospitals affiliated to medical sciences universities. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e18797. [PMID: 25558387 PMCID: PMC4270679 DOI: 10.5812/ircmj.18797] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/09/2014] [Accepted: 06/02/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them. OBJECTIVES This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran. MATERIALS AND METHODS This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables. RESULTS Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated. CONCLUSIONS Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.
Collapse
Affiliation(s)
- Mahmoud Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Nejadsarvari
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Nasrin Nejadsarvari, Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9127990798, E-mail:
| | - Mehrzad Kiani
- Nursing Ethics Department, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fariba Borhani
- Nursing Ethics Department, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Shabnam Bazmi
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Hamidreza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
44
|
|
45
|
Tyssen R, Palmer KS, Solberg IB, Voltmer E, Frank E. Physicians' perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States. BMC Health Serv Res 2013; 13:516. [PMID: 24330820 PMCID: PMC3904199 DOI: 10.1186/1472-6963-13-516] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background We lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. Methods We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,083), the U.S. (n = 6,628), and Norway (n = 638), examining demographics, job satisfaction, and professional autonomy. Results Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians’ perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. Conclusions U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.
Collapse
Affiliation(s)
- Reidar Tyssen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111, Blindern, Oslo NO-0317, Norway.
| | | | | | | | | |
Collapse
|
46
|
Nuttgens S, Chang J. Moral Distress Within the Supervisory Relationship: Implications for Practice and Research. COUNSELOR EDUCATION AND SUPERVISION 2013. [DOI: 10.1002/j.1556-6978.2013.00043.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Simon Nuttgens
- Graduate Centre for Applied Psychology; Athabasca University; Edmonton Alberta Canada
| | - Jeff Chang
- Graduate Centre for Applied Psychology; Athabasca University; Edmonton Alberta Canada
| |
Collapse
|
47
|
Førde R, Aasland OG. Moral distress and professional freedom of speech among doctors. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:1310-4. [PMID: 23817260 DOI: 10.4045/tidsskr.12.1385] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Previous studies indicate that Norwegian doctors experience distress in their encounter with differing and partly contradictory ideals, such as the obligation to criticise unethical and inappropriate practices. The objective of this study was to investigate the perception of moral distress and professional freedom of speech among Norwegian doctors as of today, as well as identify changes that have occurred since the previous study undertaken in 2004. MATERIAL AND METHODS A total of 1,522 economically active doctors received a questionnaire listing various statements describing the perception of moral distress and professional freedom of speech. The responses were compared to responses to the 2004 study. RESULTS Altogether 67% of the doctors responded to the questionnaire. The proportion who reported «fairly strong» or «strong» moral distress varied from 24% to 70% among the different statements. On the whole, the «rank and file» hospital doctors reported the highest degree of moral distress. Nevertheless, a decrease in the scores for moral distress could be observed from 2004 to 2010. During the same period, the perception of professional freedom of speech increased slightly. INTERPRETATION A reduced level of distress associated with ethical conflicts in working life may be due to improved methods for handling distressing situations, or because the consequences of the health services reorganisations are perceived as less threatening now than in 2004, immediately after the introduction of the hospital reform. However, the perceived lower distress level may also be due to professional and ethical resignation. These findings should be followed up by a qualitative study.
Collapse
Affiliation(s)
- Reidun Førde
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Norway.
| | | |
Collapse
|
48
|
Falcó-Pegueroles A, Lluch-Canut T, Guàrdia-Olmos J. Development process and initial validation of the Ethical Conflict in Nursing Questionnaire-Critical Care Version. BMC Med Ethics 2013; 14:22. [PMID: 23725477 PMCID: PMC3711987 DOI: 10.1186/1472-6939-14-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 05/20/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables 'frequency' and 'degree of conflict'. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable 'exposure to conflict', as well as considering six 'types of ethical conflict'. An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). METHODS The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach's alpha was used to evaluate the instrument's reliability. All analyses were performed using the statistical software PASW v19. RESULTS Cronbach's alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance. CONCLUSIONS The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.
Collapse
Affiliation(s)
- Anna Falcó-Pegueroles
- Department of Fundamental Care and Medical-Surgical Nursing, Campus of Health Science of Bellvitge, Nursing School, University of Barcelona, Central Pavilion, 3r floor, L’08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Midwife Nursing, Health Science Campus of Bellvitge, Nursing School, University of Barcelona, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Methodology of Behavioural Sciences, Faculty of Psychology, Research Institute on Brain, Cognition and Behaviour (IR3C), University of Barcelona, Barcelona, Spain
| |
Collapse
|
49
|
Losa Iglesias ME, Becerro de Bengoa Vallejo R, Fuentes PS, Trepal MJ. Comparative analysis of moral distress and values of the work organization between American and Spanish podiatric physicians. J Am Podiatr Med Assoc 2013; 102:57-63. [PMID: 22232323 DOI: 10.7547/1020057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. METHODS A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace. RESULTS Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients' treatment and economic constraints, overload of paperwork, and acting against one's conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. CONCLUSIONS The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources.
Collapse
|
50
|
A Pilot Study Examining Moral Distress in Nurses Working in One United States Burn Center. J Burn Care Res 2013; 34:521-8. [DOI: 10.1097/bcr.0b013e31828c7397] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|