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"Moral distress"

Nicholas Rubashkin, Nicole Minckas
Argentina passed a law for humanized birth in 2004 and another law against obstetric violence in 2009, both of which stipulate the rights of women to achieve respectful maternity care. Clinicians and women might still be unaware of these laws, however. In this article, we discuss the case of a fourth-year medical student who, while visiting Argentina from the United States for his obstetric rotation, witnesses an act of obstetric violence. We show that the student's situation can be understood as one of moral distress and argue that, in this specific instance, it would be appropriate for the student to intervene by providing supportive care to the patient...
March 1, 2018: AMA Journal of Ethics
Trisha M Prentice, Lynn Gillam
When healthcare professionals feel constrained from acting in a patient's best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be "constrained" in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized...
March 14, 2018: Journal of Bioethical Inquiry
Aditya Simha, Camille Maria Webb, Ramakrishna Prasad, N Randall Kolb, Peter J Veldkamp
BACKGROUND AND OBJECTIVE: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical. DESIGN: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment...
March 2018: Journal of the American Board of Family Medicine: JABFM
Raissa Passos Dos Santos, Eliane Tatsch Neves, Franco Carnevale
BACKGROUND: Pediatric nursing care involves many significant ethical challenges. Although nurses are broadly recognized as professionals with relevant knowledge about children and families, little is known about how nurses experience ethical concerns in their everyday practice. OBJECTIVE: The objective of this study was to better understand the moral experiences and related moral distress experiences of nurses working in pediatric settings in Brazil. DESIGN: Interpretative phenomenological study conducted through narrative interviews...
January 1, 2018: Nursing Ethics
Kayoko Ohnishi, Kazuyo Kitaoka, Jun Nakahara, Maritta Välimäki, Raija Kontio, Minna Anttila
BACKGROUND: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress...
January 1, 2018: Nursing Ethics
Georgina Morley
Interest in moral distress (MD) as a research topic has soared in recent years. What is it about this concept that makes it so intriguing? Why does it create such debate amongst healthcare professionals? Why has there been so much conceptual confusion regarding the concept? This article is protected by copyright. All rights reserved.
March 1, 2018: Journal of Clinical Nursing
Mary OʼConnor
Advocacy is a core competency of the nurse, and especially the nurse leader. It is a multidimensional concept that requires knowledge, experience, self-confidence, and above all, courage. This article describes and illustrates the perspectives of nursing administration graduate students, as they depict advocacy in many relationships. These include advocacy for the patient, family, self, community, organization, profession, and society. The themes that emerged from narratives written by these nurse leaders were the development of courage and the finding of their voices...
April 2018: Nursing Administration Quarterly
Danton S Char, Sandra Soo-Jin Lee, David Magnus, Mildred Cho
PurposeTo investigate the potential impacts of whole-genome sequencing (WGS) in the pediatric critical-care context, we examined how clinicians caring for critically ill children with congenital heart disease (CHD) anticipate and perceive the impact of WGS on their decision-making process and treatment recommendations.MethodsWe conducted semistructured in-person and telephone interviews of clinicians involved in the care of critically ill children with CHD at a high-volume pediatric heart center. We qualitatively analyzed the transcribed interviews...
March 1, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Joan McCarthy, Settimio Monteverde
In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that-if unaddressed-it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms...
February 28, 2018: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
Emily D Browning, Jourdan S Cruz
Health-care workers may experience moral distress when they are unable to act as they believe is ethically appropriate in their clinical work. A social worker-facilitated protocol called Reflective Debriefing was developed and tested for alleviating moral distress through regular debriefings with nursing staff on an intensive care unit (ICU). Forty-two ICU nurses completed a Moral Distress Scale-Revised (MDS-R) at the beginning and end of a 6-month period, during which time regular debriefings were offered...
February 28, 2018: Journal of Social Work in End-of-life & Palliative Care
D Robin Taylor, Calvin J Lightbody
The provision of healthcare is being challenged by a 'perfect storm' of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the 'curative medical model'. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives...
February 24, 2018: Postgraduate Medical Journal
Aalia Shariff, Joanne Olson, Anna Santos Salas, Lisa Cranley
BACKGROUND: Death is a common occurrence in intensive care units (IC Us) and the complexity of care makes it difficult for nurses to find a balance between the patient's physical needs and the family's emotional needs, especially in circumstances of unexpected death. Cumulative or unresolved grief for families can have lasting negative repercussions. Nurses, therefore, need access to bereavement education in order to provide optimal- bereavement support. PURPOSE: The purpose of this review is to identify challenges and facilitators that nurses experience in delivering bereavement support during and after sudden or unexpected death in ICUs...
May 2017: Canadian Journal of Critical Care Nursing
Kelsey Watt, Matthew P Kirschen, Joel A Friedlander
OBJECTIVES: Pediatric ethical consultation services (ECSs) have been proliferating at medical centers, with little data available on evaluating their implementation. The objective of this study was to evaluate the pediatric ECS and understand the ethical issues occurring within a single quaternary-level pediatric hospital. METHODS: A retrospective chart review of documented ethics consultations at a large pediatric hospital from November 2010 to November 2013 was performed and data was abstracted per the US Department of Veterans Affairs' Domains of Ethics in Health Care...
March 2018: Hospital Pediatrics
Sondra Badolamenti, Roberto Fida, Valentina Biagioli, Rosario Caruso, Francesco Zaghini, Alessandro Sili, Teresa Rea
BACKGROUND: Moral distress (MD) has significant implications on individual and organizational health. However there is a lack of an instrument to assess it among Italian nurses. AIM: The main aim of this study was to validate a brief instrument to assess MD, developed from the Corley's Moral Distress Scale (MDS). METHOD: The modified MDS scale was subjected to content and cultural validity. The scale was administered to 347 nurses. Psychometric analysis were performed to assess construct validity...
October 2017: Professioni Infermieristiche
Andrea Simpson, Kendall Phillips, Danny Wong, Sandy Clarke, Michelle Thornton
OBJECTIVE: The purpose of this study was to assess audiologists' perceptions of ethics and moral climate in the workplace. DESIGN: The Ethics Environmental Questionnaire (EEQ) was sent out to all audiologists registered with the professional body Audiology Australia. Participants were also invited to undertake a semi-structured interview. STUDY SAMPLE: A total of 301 audiologists completed the questionnaire. Eight of these participants also agreed to complete the interview...
February 19, 2018: International Journal of Audiology
Jay M Brenner, Andrew L Aswegan, Laura E Vearrier, Jesse B Basford, Kenneth V Iserson
Ethical dilemmas can create moral distress in even the most experienced emergency physicians (EPs). Following reasonable and justified approaches can help alleviate such distress. The purpose of this article is to guide EPs providing Emergency Medical Services (EMS) direction to navigate through common ethical issues confronted in the prehospital delivery of care, including protecting privacy and confidentiality, decision-making capacity and refusal of treatment, withholding of treatment, and termination of resuscitation (TOR)...
February 14, 2018: Prehospital and Disaster Medicine
Sagit Lev, Liat Ayalon
This article explores moral distress among long-term care facility (LTCF) social workers by examining the relationships between moral distress and environmental and personal features. Based on these features, authors identified a typology of LTCF social workers and how they handle moral distress. Such a typology can assist in the identification of social workers who are in a particular need for assistance. Overall, 216 LTCF social workers took part in the study. A two-step cluster analysis was conducted to identify a typology of LTCF social workers based on features such as ethical environment, support in workplace, mastery, and resilience...
February 2, 2018: Social Work
Keren Ladin, Renuka Pandya, Allison Kannam, Rohini Loke, Tira Oskoui, Ronald D Perrone, Klemens B Meyer, Daniel E Weiner, John B Wong
BACKGROUND: Although dialysis may not provide a large survival benefit for older patients with kidney failure, few are informed about conservative management. Barriers and facilitators to discussions about conservative management and nephrologists' decisions to present the option of conservative management may vary within the nephrology provider community. STUDY DESIGN: Interview study of nephrologists. SETTING & PARTICIPANTS: National sample of US nephrologists sampled based on sex, years in practice, practice type, and region...
January 31, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
I H Zaal-Schuller, D I Willems, F Ewals, J B van Goudoever, M A de Vos
BACKGROUND: In children with profound intellectual and multiple disabilities (PIMD), discussions about end-of-life decisions (EoLDs) are comparatively common. Nurses play a crucial role in the care for these children, yet their involvement in EoLD discussions is largely unknown. The objective of this research was to investigate the involvement in the hospital of nurses in discussions with parents and physicians about EoLDs for children with PIMD. METHOD: In a retrospective, qualitative study, we conducted semi-structured interviews with the nurses of 12 children with PIMD for whom an EoLD was made within the past 2 years...
January 31, 2018: Journal of Intellectual Disability Research: JIDR
Connie M Ulrich
Futility is a term that is distressing for many, but it is a concept that merits revisiting for its normative, empirical, and ethical value in understanding end-of-life issues. Ethical concerns surrounding aggressive care and the suffering of patients at end of life are frequently cited as significant ethical issues within institutional settings, leading to clinicians' moral distress. The author responds to the essay on "The Abuse of Futility" by Schneiderman, Jecker, and Jonsen (2017), who support the continual use of futility language with patients and families...
2018: Perspectives in Biology and Medicine
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