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Moral distress

Maura Lusignani, Maria Lorella Giannì, Luca Giuseppe Re, Maria Luisa Buffon
AIM: To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. BACKGROUND: Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. METHODS: A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used...
October 11, 2016: Journal of Nursing Management
Rachele Pandolfi, Bianca Barreira, Enrique Moreno, Victor Lara-Acedo, Daniel Morales-Cano, Andrea Martínez-Ramas, Beatriz de Olaiz Navarro, Raquel Herrero, José Ángel Lorente, Ángel Cogolludo, Francisco Pérez-Vizcaíno, Laura Moreno
BACKGROUND: Pulmonary hypertension (PH) is frequently observed in patients with acute respiratory distress syndrome (ARDS) and it is associated with an increased risk of mortality. Both acid sphingomyelinase (aSMase) activity and interleukin 6 (IL-6) levels are increased in patients with sepsis and correlate with worst outcomes, but their role in pulmonary vascular dysfunction pathogenesis has not yet been elucidated. Therefore, the aim of this study was to determine the potential contribution of aSMase and IL-6 in the pulmonary vascular dysfunction induced by lipopolysaccharide (LPS)...
July 27, 2016: Thorax
Susan B Williams, Michael D Dahnke
Extracorporeal membrane oxygenation (ECMO) is temporary life-support technology that provides time to rest the cardiac and respiratory system of critically ill people with acute, reversible medical conditions. Health care providers face emotional and challenging situations, where death may result, when withdrawing ECMO. A deepening of understanding of the ethical issues involved can aid clinicians in handling such difficult situations, leading to a possible mitigation of the moral problems. Toward this end, the ethical issues raised in the consideration of ECMO withdrawal are analyzed with respect to the ethical principles and concepts of autonomy, nonmaleficence/beneficence, medical futility, moral distress, and justice...
October 2016: Critical Care Nurse
John McKinnon
Healthcare is in a turbulent place as society expects nurses to remain clinically robust while adapting to changes. That such changes have the potential to undermine care quality or nurses' health is too often a secondary consideration ( RCN 2013 ).
September 30, 2016: Nursing Management (Harrow)
Pei-Pei Chen, Hsiao-Lu Lee, Shu-He Huang, Ching-Ling Wang, Chiu-Mieh Huang
BACKGROUND: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses' reaction to dilemma such as moral distress is relatively less noticed. OBJECTIVE: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. RESEARCH DESIGN: This study applied Q methodology to explore the perspectives of nurses regarding moral distress...
September 28, 2016: Nursing Ethics
Roberta Meneses Oliveira, Lucilane Maria Sales da Silva, Maria Vilani Cavalcante Guedes, Adriana Catarina de Souza Oliveira, Rosario Gómez Sánchez, Raimundo Augusto Martins Torres
OBJECTIVE: To analyze the concept of disruptive behavior in healthcare work. METHOD: An integrative review carried out in the theoretical phase of a qualitative research substantiated by the theoretical framework of the Hybrid Model of Concept Development. The search for articles was conducted in the CINAHL, LILACS, PsycINFO, PubMed and SciVerse Scopus databases in 2013. RESULTS: 70 scientific articles answered the guiding question and lead to attributes of disruptive behavior, being: incivility, psychological violence and physical/sexual violence; with their main antecedents (intrapersonal, interpersonal and organizational) being: personality characteristics, stress and work overload; and consequences of: workers' moral/mental distress, compromised patient safety, labor loss, and disruption of communication, collaboration and teamwork...
July 2016: Revista da Escola de Enfermagem da U S P
Rafaela Schaefer, Elma Lourdes Campos Pavone Zoboli, Margarida Vieira
This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature...
September 28, 2016: Nursing Inquiry
Alastair Morgan
In this article, I argue that the recent emphasis on compassion in healthcare practice lacks conceptual richness and clarity. In particular, I argue that it would be helpful to focus on a larger concept of empathy rather than compassion alone and that compassion should be thought of as a component of this larger concept of empathy. The first part of the article outlines a critique of the current discourse of compassion on three grounds. This discourse naturalizes, individualizes, and reifies compassion leading to a decontextualized and simplified understanding of failures in healthcare practice...
September 27, 2016: Nursing Philosophy: An International Journal for Healthcare Professionals
Natalie Susan McAndrew, Jane Leske, Kathryn Schroeter
BACKGROUND: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. OBJECTIVES: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. REVIEW METHODS: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies...
September 22, 2016: Nursing Ethics
Shahla Siddiqui
OBJECTIVES: We describe a case where a patient at the end of life with an advanced medical directive in place presents to the ED in distress. CASE REPORT: Our case is of a middle aged male with advanced cancer who presents in the ED with his family in respiratory distress requiring intubation. Even though his advanced medical directive states not for prolonged life sustaining support his wife and daughters plead with the physicians to save his life in order to end his suffering as well as prepare them for a more peaceful death...
September 19, 2016: Journal of Emergency Medicine
Lisa Wolf, Connie M Ulrich, Christine Grady
Excellent patient care within the emergency department requires interdisciplinary training, teamwork, and communication to manage the chaos of the environment. Specifically, invasive procedures required to manage airway, breathing, and circulation via intubation, chest compressions, and establishing intravenous access can provide a direct benefit to save lives but also have the potential to harm both patients and health care clinicians alike; emergency health care clinicians can be exposed to significant amounts of blood and body fluids as well as other threats of physical and psychological harm...
September 2016: Hastings Center Report
Cynda Hylton Rushton
Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances...
September 2016: Hastings Center Report
Sean M Bagshaw, Dawn Opgenorth, Melissa Potestio, Stephanie E Hastings, Shelanne L Hepp, Elaine Gilfoyle, David McKinlay, Paul Boucher, Michael Meier, Jeanna Parsons-Leigh, R T Noel Gibney, David A Zygun, Henry T Stelfox
OBJECTIVES: Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain. DESIGN: Qualitative study using a conventional thematic analysis...
September 15, 2016: Critical Care Medicine
Daniel Garros
No abstract text is available yet for this article.
2016: Frontiers in Pediatrics
Ann Gallagher
No abstract text is available yet for this article.
September 2016: Nursing Ethics
Marco Atzori, Roberto Cuevas-Olguin, Eric Esquivel-Rendon, Francisco Garcia-Oscos, Roberto C Salgado-Delgado, Nadia Saderi, Marcela Miranda-Morales, Mario Treviño, Juan C Pineda, Humberto Salgado
Norepinephrine (NE) is synthesized in the Locus Coeruleus (LC) of the brainstem, from where it is released by axonal varicosities throughout the brain via volume transmission. A wealth of data from clinics and from animal models indicates that this catecholamine coordinates the activity of the central nervous system (CNS) and of the whole organism by modulating cell function in a vast number of brain areas in a coordinated manner. The ubiquity of NE receptors, the daunting number of cerebral areas regulated by the catecholamine, as well as the variety of cellular effects and of their timescales have contributed so far to defeat the attempts to integrate central adrenergic function into a unitary and coherent framework...
2016: Frontiers in Synaptic Neuroscience
McAleese Aisling, Diamond Aisling, Curran David
SETTING: Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? PARTICIPANTS: Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107)...
May 2016: Ulster Medical Journal
Eleonora Canciani, Daniela Spotti, Loris Bonetti
AIM: Moral distress (MD) is a painful feeling and/or psychological disequilibrium, which may lead to negative consequences into the wellness of a nurse's working life. Nurses who work in psychiatry are more likely to experience a different type of MD compared with nurses of other contexts. In Italy a tool to evaluate MD in nurses who work in psychiatry doesn't exist. The aim of this study is to validate the Moral Distress Scale for Psychiatric Nurses (MDS-P) in Italian language. METHOD: For translation the forward and back-translation has been used; the effectiveness regarding content and face validity of the translated scale has been analyzed through a focus group with experts of the field...
April 2016: Professioni Infermieristiche
Wu Xiaoyan, Zhan Yufang, Ci Lifeng, Sun Congcong
OBJECTIVE: The purpose of this study was to describe the current situation of moral distress and to explore its influencing factors among Chinese nurses. METHODS: This is an exploratory, descriptive design study. A total of 465 clinical nurses from different departments in three Grade-III, Level-A hospitals in Jinan, Shandong Province, completed the questionnaires, including demographics questionnaire, Chinese version of Moral Distress Scale-Revised, and Job Diagnostic Survey...
September 1, 2016: Nursing Ethics
Courtney L Ball, Judith G Smetana, Melissa L Sturge-Apple
Associations among hypothetical, prototypic moral, and conventional judgments; theory of mind (ToM); empathy; and personal distress were examined in 108 socioeconomically diverse preschoolers (Mage  = 42.94 months, SD = 1.42). Repeated measures analysis of covariance with empathy, false beliefs, and their interaction as covariates indicated that empathy was significantly associated with judgments of greater moral but not conventional transgression severity, particularly for psychological harm, and with deserved punishment for unfairness...
August 25, 2016: Child Development
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