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Dorman JD, Raffin Bouchal S. Moral distress and moral uncertainty in medical assistance in dying: A simultaneous evolutionary concept analysis. Nurs Forum 2020; 55:320-330. [PMID: 31957042 DOI: 10.1111/nuf.12431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To develop a simultaneous, evolutionary concept analysis of moral distress and moral uncertainty in the context of medical assistance in dying (MAiD). BACKGROUND Moral distress is well represented in nursing literature but disagreement persists in how the concept is defined and understood. Moral uncertainty has not been investigated in-depth. Further definition and conceptual clarity is required to understand these concepts within the context of MAiD. DESIGN Simultaneous concept analysis. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and PubMed databases were searched for articles in English. The final sample consisted of 44 documents published from 1984 to 2019. METHOD An adapted combination of Rodgers's Evolutionary Model and Haase et al's Simultaneous Concept Analysis method. RESULTS Despite the significant overlap, moral distress and moral uncertainty have subtle distinguishing differences. Attributes of moral distress in the context of MAiD focus on knowing the right course of action but being unable to act, especially when conflict or suffering occurs. Attributes of moral uncertainty center on an inability to decide on which course of action to take or knowing what outcome is preferable. CONCLUSION More research is required to bring further clarity to these concepts and develop interventions to support nurses who receive requests for or participate in MAiD.
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Jones-Bonofiglio K. Acute Care Contexts. HEALTH CARE ETHICS THROUGH THE LENS OF MORAL DISTRESS 2020. [DOI: 10.1007/978-3-030-56156-7_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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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.
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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
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Rushton CH. Moral Resilience: A Capacity for Navigating Moral Distress in Critical Care. AACN Adv Crit Care 2017; 27:111-9. [PMID: 26909461 DOI: 10.4037/aacnacc2016275] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics, Berman Institute of Bioethics, Johns Hopkins University School of Nursing, and Johns Hopkins University School of Medicine, 1809 Ashland Avenue, Baltimore, MD 21205
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Abstract
Moral distress is defined as knowing the right thing to do when policy constraints do not allow for appropriate choices. The purpose of the current study was to explore the existence of moral distress in oncology nurses with a cross-sectional survey completed by nurses working on inpatient units at a midwestern cancer hospital. Investigators distributed the Moral Distress Scale-Revised to all direct care staff nurses. The main research variables were moral distress, level of education, age, and type of unit. Most of the 73 nurses had low to moderate scores, and two had high scores. No significant correlations were observed among age or years of experience. Type of unit and level of moral distress were correlated, and an inverse relationship between level of education and moral distress was found. Moral distress exists in nurses who work on oncology units irrespective of experience in oncology or the specific unit. Nurses must be aware of the existence of moral distress and finds ways to reduce potential emotional problems.
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Affiliation(s)
- Janet Sirilla
- Service Line Administrator for Blood and Marrow Transplantation and Hematology, Ohio State University Comprehensive Cancer
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Abstract
Background: Despite their negative consequences, evidence shows that futile medical treatments are still being provided, particularly to terminally ill patients. Uncovering the reasons behind providing such treatments in different religious and sociocultural contexts can create a better understanding of medical futility and help manage it effectively. Research objectives: This study was undertaken to explore Iranian nurses’ and physicians’ perceptions of the reasons behind providing futile medical treatments. Research design: This was a qualitative exploratory study. Study data were gathered through conducting in-depth semi-structured personal interviews and analyzed using the conventional content analysis method. Participants and research context: Twenty-one nurses and nine medical specialists were recruited purposively from four teaching hospitals affiliated to Tehran University of Medical Sciences. Ethical considerations: This study was approved by the Nursing and Midwifery Research Center and the Research Ethics Committee of Tehran University of Medical Sciences. All participants gave informed consent for the research and that their anonymity was preserved. Findings: The main theme of the study was “having an obligation to provide medical treatments despite knowing their futility.” This theme consisted of three main categories including patients’ and family members’ request for continuing life-sustaining treatments, healthcare professionals’ personal motives, and organizational atmosphere and structure. Discussion and conclusion: Different personal and organizational factors contribute to providing futile medical treatments. Promoting the structure and the function of hospital ethics committees, establishing and developing home care facilities, increasing the number of palliative care centers and hospices, and educating healthcare professionals, patients, and family members about the services and the benefits of such centers can facilitate making wise decisions about continuing or discontinuing treatments which have been labeled as futile.
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Abstract
Health care professionals believe that futile care must not be provided; however, there is no clear agreement over the definition and the manifestations of futile care. The aim of this study was to explore Iranian nurses' perceptions of futile care. In this qualitative exploratory study, the conventional content analysis approach was used for collecting and analyzing the study data. Three main themes were extracted from the data: nonfutility of care: care tantamount with outcome; sense of burnout; and subjectivity and relativity of medical futility concept.
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Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum. PLoS One 2015; 10:e0143088. [PMID: 26580406 PMCID: PMC4651489 DOI: 10.1371/journal.pone.0143088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/17/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To engage the public to understand how to improve the care of critically ill patients. Design A qualitative content analysis of an open community forum (Café Scientifique). Setting Public venue in Calgary, Alberta, Canada. Participants Members of the general public including patients, families of patients, health care providers, and members of the community at large. Methods A panel of researchers, decision-makers, and a family member led a Café Scientifique, an informal dialogue between the populace and experts, over three-hours to engage the public to understand how to improve the care of critically ill patients. Conventional qualitative content analysis was used to analyze the data. The inductive analysis occurred in three phases: coding, categorizing, and developing themes. Results Thirty-eight members of the public (former ICU patients, family members of patients, providers, community members) attended. Participants focused the discussion and provided concrete suggestions for improvement around communication (family as surrogate voice, timing of conversations, decision tools) and provider well-being and engagement, as opposed to medical interventions in critical care. Conclusions Café participants believe patient and family centered care is important to ensure high-quality care in the ICU. A Café Scientifique is a valuable forum to engage the public to contribute to priority setting areas for research in critical care, as well as a platform to share lived experience. Research stakeholders including health care organizations, governments, and funding organizations should provide more opportunities for the public to engage in meaningful conversations about how to best improve healthcare.
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Medical futility and end-of-life care: perspectives from practice. Coping with medical futility. J Christ Nurs 2015; 32:94-7. [PMID: 25898443 DOI: 10.1097/cnj.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Advances in technology a nd medical knowledge have dramatically altered our ability to sustain life in the Intensive Care Unit (ICU). Many things come into play for the nurse when establishing patient goals, respecting patient's wishes, and valuing spiritual and cultural beliefs in end-of-life care. A veteran ICU nurse shares the challenges of caring and how, she copes when medical interventions seem futile.
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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.
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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
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Bohnenkamp S, Pelton N, Reed P, Rishel C. An Inpatient Surgical Oncology Unit’s Experience With Moral Distress: Part I. Oncol Nurs Forum 2015; 42:308-10. [DOI: 10.1188/15.onf.308-310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Molloy J, Evans M, Coughlin K. Moral distress in the resuscitation of extremely premature infants. Nurs Ethics 2014; 22:52-63. [PMID: 24714050 DOI: 10.1177/0969733014523169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. DESIGN A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. SETTING A regional, tertiary academic referral hospital in Ontario offering a perinatal program. PARTICIPANTS A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. METHODS Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. ETHICAL CONSIDERATIONS Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. RESULTS Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses' perceived lack of power and influence in the neonatal resuscitation decision-making process. CONCLUSION Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration.
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Affiliation(s)
| | - Marilyn Evans
- School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Kevin Coughlin
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, University of Western Ontario, London, ON, Canada
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Abstract
PURPOSE OF REVIEW The present review addresses the question of whether perioperative futility can be defined. RECENT FINDINGS Although attempts have been made to define futility in medicine, all proposed definitions are inadequate and as a result there has been a shift to a procedural conflict de-escalation approach to addressing clinical questions of futility. Informed consent is central to the problem of deciding whether an operative procedure may be futile and the criteria for adequate consent by either a patient or surrogate decision-maker are reviewed. An adequately informed patient or surrogate may, nevertheless, desire to proceed with a procedure considered futile by some members of the medical team as a result of conflicting values. The basis for this and the 'economy of hope' in which extremely ill patients with few treatment options are invested, is explored. The particular role of the anesthesiologist in deciding whether an operative procedure may be futile is examined. Three potential positions are suggested: the anesthesiologist as service provider, consultant, or gatekeeper. SUMMARY The present review will provide anesthesiologists with critical insight into the historical scholarship and current recommended process to address questions of perioperative futility.
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Meade K, Pope J, Weise K, Prince L, Friebert S. ‘Distress at the bedside in the PICU: Nurses’ and respiratory therapists’ experiences in caring for children with complex medical or neurologic conditions’. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x12y.0000000028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kadooka Y, Asai A, Fukuyama M, Bito S. A comparative survey on potentially futile treatments between Japanese nurses and laypeople. Nurs Ethics 2013; 21:64-75. [PMID: 23702889 DOI: 10.1177/0969733013484490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the issue of futile treatments, patients and healthcare professionals tend to disagree. We conducted an Internet questionnaire survey and explored the Japanese nurses' attitude toward this topic, comparing with that of laypeople. In total, 522 nurses and 1134 laypeople completed the questionnaire. Nurse respondents were significantly less in favor of providing potentially futile treatments in hypothetical vignettes and stressed quality of life of the patient for judging the futility of a certain treatment. Of them, 85.4% reported having experienced providing such treatments. Reasons for providing them included factors related to not only patients but also healthcare teams. Our results indicate that attitudes among Japanese nurses toward the issue of futile treatments are different from patients and that their actual practice is influenced by several situational factors.
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Affiliation(s)
- Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yong Sup Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Bailey FA, Allen RS, Williams BR, Goode PS, Granstaff S, Redden DT, Burgio KL. Do-Not-Resuscitate Orders in the Last Days of Life. J Palliat Med 2012; 15:751-9. [DOI: 10.1089/jpm.2011.0321] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- F. Amos Bailey
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rebecca S. Allen
- Department of Psychology/CMHA, University of Alabama, Tuscaloosa, Alabama
| | - Beverly R. Williams
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia S. Goode
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shanette Granstaff
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Department of Biostatistics, University of Alabama, Tuscaloosa, Alabama
| | - David T. Redden
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn L. Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Bolmsjö I, Edberg AK, Andersson PL. The use of drama to support reflection and understanding of the residents’ situation in dementia care: a pilot study. Int J Older People Nurs 2012; 9:183-91. [PMID: 22676777 DOI: 10.1111/j.1748-3743.2012.00333.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ingrid Bolmsjö
- Associate Professor, Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, SwedenProfessor, The Swedish Institute for Health Sciences, Lund University and Kristianstad University, Lund, SwedenSenior Lecturer, The Swedish Institute for Health Sciences, Lund University, Lund, Sweden
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