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Elsässer A, Dreher A, Pietrowsky R, Flake F, Loerbroks A. Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany - a cross-sectional study. BMC Emerg Med 2024; 24:62. [PMID: 38616266 PMCID: PMC11017549 DOI: 10.1186/s12873-024-00983-2] [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: 01/22/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety. METHODS For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services - Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c). RESULTS The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress. CONCLUSIONS Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.
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Affiliation(s)
- Antonia Elsässer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Annegret Dreher
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Frank Flake
- German Association of Emergency Medical Services (Deutscher Berufsverband Rettungsdienst e. V.), Lübeck, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Girela-Lopez E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, Lopez-Valero M, Romero-Saldaña M. Measuring moral distress in health professionals using the MMD-HP-SPA scale. BMC Med Ethics 2024; 25:41. [PMID: 38570759 PMCID: PMC10993501 DOI: 10.1186/s12910-024-01041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.
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Affiliation(s)
- Eloy Girela-Lopez
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Lopez-Valero
- Dispositivo de Cuidados Críticos y Urgencias, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy. Faculty of Medicine and Nursing, University of Cordoba, Córdoba, Spain
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Wilson MA, Shay A, Harris JI, Faller N, Usset TJ, Simmons A. Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review. AJPM FOCUS 2024; 3:100173. [PMID: 38304024 PMCID: PMC10832382 DOI: 10.1016/j.focus.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction Healthcare clinicians are often at risk of psychological distress due to the nature of their occupation. Military healthcare providers are at risk for additional psychological suffering related to unique moral and ethical situations encountered in military service. This scoping review identifies key characteristics of moral distress and moral injury and how these concepts relate to the military healthcare clinician who is both a care provider and service member. Methods A scoping review of moral distress and moral injury literature as relates to the military healthcare clinician was conducted on the basis of the Joanna Briggs Institute scoping review framework. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid), PsycInfo, 2 U.S. Defense Department sources, conference papers index, and dissertation abstracts. Reference lists of all identified reports and articles were searched for additional studies. Results A total of 573 articles, published between the years 2009 and 2021, were retrieved to include a portion of the COVID-19 pandemic period. One hundred articles met the inclusion criteria for the final full-text review and analysis. Discussion This scoping review identified moral distress and moral injury literature to examine similarities, differences, and overlaps in the defining characteristics of the concepts and the associated implications for patients, healthcare clinicians, and organizations. This review included the unfolding influence of the COVID-19 pandemic on moral experiences in health care and the blurring of those lines between civilian and military healthcare clinicians. Future directions of moral injury and moral distress research, practice, and care are discussed.
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Affiliation(s)
- Melissa A. Wilson
- U.S. Air Force Research Laboratory, Dayton, Ohio
- College of Health, Education and Human Services Department of Nursing, Wright State University, Dayton, Ohio
| | - Amy Shay
- School of Nursing, Indiana University, Indianapolis, Indiana
| | | | | | - Timothy J. Usset
- Division of Health Policy & Management, University of Minnesota, Minneapolis, Minnesota
| | - Angela Simmons
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Glover J, Bock M, Reynolds R, Zaretsky M, Vemulakonda V. Prenatally-diagnosed renal failure: an ethical framework for decision-making. J Perinatol 2024; 44:333-338. [PMID: 37735209 DOI: 10.1038/s41372-023-01779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
The Children's Hospital Working Group has developed an ethical framework to guide patient care and research for prenatally diagnosed severe renal anomalies. It identifies ethical challenges in communication, timing of decisions and scarce resources. Key elements include shared decision-making, establishing a trusting relationship, and managing disagreement. The ethical framework will be used to develop a clinical pathway that operationalizes the key values of trust, honesty, transparency, beneficence, nonmaleficence, respecting parental authority, professional integrity, and justice.
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Affiliation(s)
- Jacqueline Glover
- Pediatrics, Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA.
| | - Margret Bock
- Pediatrics, Nephrology, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Regina Reynolds
- Pediatrics, Neonatology, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael Zaretsky
- OB, GYN, Maternal-Fetal Medicine, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Vijaya Vemulakonda
- Surgery, Pediatric Urology, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
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Buchberger B, Weishaar H, Evans M, Böttcher R, Umlauf R, Muminow S, Montt Maray E, Muller N, Chemali S, Geurts B, Fischer HT, El Bcheraoui C. Listening to the Voices of Health Care Workers During the COVID-19 Pandemic: A Qualitative Study Providing In-Depth Insights Into Ethical and Individual Challenges. QUALITATIVE HEALTH RESEARCH 2024:10497323241231521. [PMID: 38406882 DOI: 10.1177/10497323241231521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
In their daily practice, health care workers (HCWs) experience the effects of tensions between professional ethos and work realities, which can lead to ethical dilemmas. We aim to explore the ethical dilemmas that affected HCWs in Germany during the COVID-19 pandemic and to understand these in the context of the German health system. Between April and December 2022, we interviewed HCWs from various levels of care and key informants responsible for decisions related to HCWs in Germany. Three themes were identified in the data analyzed from 78 participants. The first highlighted the potency of pre-existing health system problems during the COVID-19 pandemic. The second captured the ethical dilemmas that were described as having arisen due to the tension between professional ethos and structural constraints. The third included factors related to increasing or diminishing the implications of ethical dilemmas. A lack of opportunities for HCWs to participate in political and managerial decisions was suggested to result in policies that do not meet the needs of HCWs and patients. Positive interpersonal interactions were described as helpful when coping with dilemmatic decision-making situations. In order to avoid negative consequences caused by unresolved ethical dilemmas, including moral distress, among HCWs, staff shortages and decision-making in the German health system urgently need to be addressed. HCWs' working conditions regularly evoke ethical dilemmas, particularly during public health emergencies. Together with HCWs, decision-makers must develop new models for working in health care settings that are in line with HCWs' professional ethos.
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Affiliation(s)
- Barbara Buchberger
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Heide Weishaar
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Megan Evans
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Rike Böttcher
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - René Umlauf
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Swetlana Muminow
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Eloisa Montt Maray
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Nadine Muller
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Souaad Chemali
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Brogan Geurts
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Hanna-Tina Fischer
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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Gibson J, Brennan ML, Oxtoby C, Mossop L, White K. Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study. Vet Rec 2023; 193:e3601. [PMID: 37902565 DOI: 10.1002/vetr.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/07/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Understanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing. METHODS A qualitative exploration of UK veterinary practitioners' experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique. RESULTS Questions surrounding acceptable boundaries of care, decision-making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events. LIMITATIONS The qualitative nature of this study limits the generalisability of the findings. CONCLUSIONS Ethical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.
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Affiliation(s)
- Julie Gibson
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
- Centre for Evidence-Based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Marnie L Brennan
- Centre for Evidence-Based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | | | - Liz Mossop
- Brayford Campus, University of Lincoln, Lincoln, UK
| | - Kate White
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
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Liu Y, Ying L, Zhang Y, Jin J. The experiences of intensive care nurses coping with ethical conflict: a qualitative descriptive study. BMC Nurs 2023; 22:449. [PMID: 38037055 PMCID: PMC10687825 DOI: 10.1186/s12912-023-01612-2] [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: 05/28/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. AIMS This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. METHODS From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. RESULTS Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. CONCLUSION This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.
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Affiliation(s)
- Yuanfei Liu
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Liying Ying
- Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Zhejiang University, Hangzhou, China.
- Changxing Branch Hospital of SAHZU, No.66 Taihu middle road, Changxing Country, Huzhou, 313100, Zhejiang, China.
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
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Jacobs BB. An alternate explanation for the 2023 Match: Emergency medicine physicians endure repeated workplace moral distress and our students are watching. Acad Emerg Med 2023; 30:1176-1178. [PMID: 37285078 DOI: 10.1111/acem.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/28/2023] [Accepted: 06/03/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Breanne B Jacobs
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Grünebaum A, McLeod-Sordjan R, Pollet S, Moreno J, Bornstein E, Lewis D, Katz A, Warman A, Dudenhausen J, Chervenak F. Anger: an underappreciated destructive force in healthcare. J Perinat Med 2023; 51:850-860. [PMID: 37183729 DOI: 10.1515/jpm-2023-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Anger is an emotional state that occurs when unexpected things happen to or around oneself and is "an emotional state that varies in intensity from mild irritation to intense fury and rage." It is defined as "a strong feeling of displeasure and usually of antagonism," an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. "Why is everyone so angry?" the New York Times asked in the article "The Year We Lost It." We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca's writings about anger and implement his wisdom on anger from over 2000 years ago.
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Affiliation(s)
- Amos Grünebaum
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Renee McLeod-Sordjan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Susan Pollet
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - John Moreno
- University of Pennsylvania, Philadelphia, PA, USA
| | - Eran Bornstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Dawnette Lewis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Adi Katz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Ashley Warman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
| | - Joachim Dudenhausen
- Humboldt-Universitaet zu Berlin/Charite, Campus Rudolf-Virchow-Klinikum, Berlin, DE, Germany
| | - Frank Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
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Iskender MD, Eren H, Çalışkan N, Yılmaz E. The relationship between emotional labor level and moral distress. Nurs Ethics 2023; 30:500-512. [PMID: 36735277 DOI: 10.1177/09697330221140489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has implications for health professionals. AIM The aim of this study was to explain the relationship between emotional labor levels and moral distress in health professionals during the COVID-19 pandemic using the Structural Equation Modeling (SEM) technique. RESEARCH DESIGN A descriptive and cross-sectional study was adopted. PARTICIPANTS AND RESEARCH CONTEXT Data were collected between 7 February and 7 March 2021. 302 health professionals who were not on leave (annual leave, sick leave, prenatal and postnatal leave, etc.) at the time of the research and who volunteered to participate in the research were included. Research data were collected using a "Personal Information Form," the "Emotional Labor Scale" and the "Moral Distress Thermometer." ETHICAL CONSIDERATIONS The Ethics Committee approved the study (dated 07.01.2021 and numbered 2021/1-3). The participants were informed of the study aim and written consent was obtained before completing the survey. FINDINGS In the present study, the mediator role of emotional labor in the effect of providing service to a patient with COVID-19 and having had COVID-19 on moral distress was examined in health professionals and it was found that there was a correlation between providing service to a patient with COVID-19 and moral distress regardless of whether or not emotional labor had a role in this relationship. CONCLUSION In this study, the relationship between the level of emotional labor and moral distress in health professionals during the COVID-19 pandemic was evaluated with a structural equation model.
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Affiliation(s)
| | - Handan Eren
- Health Sciences Faculty, Department of Nursing, Yalova University, Turkey
| | - Nurcan Çalışkan
- Health Sciences Faculty, Department of Nursing, Gazi University, Turkey
| | - Elmas Yılmaz
- Nurse, Kastamonu Training and Research Hospital Kastamonu, Turkey
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The experiences of adult patients, families, and healthcare professionals of CPR decision-making conversations in the United Kingdom: A qualitative systematic review. Resusc Plus 2023; 13:100351. [PMID: 36686325 PMCID: PMC9850060 DOI: 10.1016/j.resplu.2022.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/08/2023] Open
Abstract
Aim To conduct a qualitative systematic review on the experiences of patients, families, and healthcare professionals (HCPs) of CPR decision-making conversations in the United Kingdom (UK). Methods The databases PubMed, Embase, Emcare, CINAHL, and PsycInfo were searched. Studies published from 1 January 2012 describing experiences of CPR decision-making conversations in the UK were included. Included studies were critically appraised using the CASP tool. Thematic synthesis was conducted. Results From 684 papers identified, ten studies were included. Four key themes were identified:(i) Initiation of conversations - Key prompts for the discussion included clinical deterioration and poor prognosis. There are different perspectives about who should initiate conversations.(ii) Involvement of patients and families - HCPs were reluctant to involve patients who they thought would become distressed by the conversation, while patients varied in their desire to be involved. Patients wanted family support while HCPs viewed families as potential sources of conflict.(iii) Influences on the content of conversations - Location, context, HCPs' attitudes and emotions, and uncertainty of prognosis influenced the content of conversations.(iv) Conversation outcomes - Range of outcomes included emotional distress, sense of relief and value, disagreements, and incomplete conversations. Conclusions There is inconsistency in how these conversations occur, patients' desire to be involved, and between patients' and HCPs' views on the role of families in these conversations. CPR discussions raise ethical challenges for HCPs. HCPs need training and pastoral support in conducting CPR discussions. Patients and families need education on CPR recommendations and support after discussions.
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Girela-López E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, García-Linares M, Llergo-Muñoz A, Romero-Saldaña M. Study of the Psychometric Properties of the Spanish Version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15649. [PMID: 36497724 PMCID: PMC9735761 DOI: 10.3390/ijerph192315649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND The early detection of moral distress requires a validated and reliable instrument. The aim of this study was to carry out an advanced analysis of the psychometric properties of the moral distress scale for health professionals (MMD-HP-SPA) by performing a validation of the construct and its internal and external reliability. METHODS We performed a multicentre cross-sectional study in health professionals belonging to the Andalusian public health system. Construct validity was performed by exploratory (n = 300) and confirmatory (n = 275) factor analysis (EFA/CFA) in different subgroups; we also analysed the internal consistency and temporal reliability of the scale. RESULTS 384 doctors and 191 nurses took part in the survey. The overall mean for moral distress was 128.5 (SD = 70.9), 95% CI [122.7-134.3], and it was higher in nurses at 140.5 (SD = 74.9) than in doctors at 122.5 (SD = 68.1), F = 8.37 p < 0.01. The EFA produced a model of five components which accounted for 54.8% of the variance of the model. The CFA achieved a goodness of fit of Chi2 = 972.4; AIC = 1144.3; RMSEA = 0.086; CFI = 0.844; TLI = 0.828; NFI = 0.785. CONCLUSIONS The MMD-HP-SPA scale has solid construct validity, excellent internal consistency, optimal temporal reliability, and underlying dimensions which effectively explore the causes of moral distress in health professionals, thus guaranteeing its use in hospital and community settings.
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Affiliation(s)
- Eloy Girela-López
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Cordoba, Spain
| | - Cristina M. Beltran-Aroca
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Cordoba, Spain
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
| | | | | | - Miguel García-Linares
- Equipo de Soporte Domiciliario de Cuidados Paliativos, Distrito Sevilla Norte-Aljarafe, 41008 Sevilla, Spain
| | - Antonio Llergo-Muñoz
- UGC Cuidados Paliativos, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Cordoba, Spain
- Grupo Asociado GA-16 Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Cordoba, Spain
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13
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Pathman DE, Sonis J, Rauner TE, Alton K, Headlee AS, Harrison JN. Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study. BMJ Open 2022; 12:e061369. [PMID: 36008061 PMCID: PMC9421917 DOI: 10.1136/bmjopen-2022-061369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic. DESIGN Cross-sectional survey in late 2020, employing quantitative and qualitative analyses. SETTING Safety net practices in 20 US states. PARTICIPANTS 2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes. MEASURES Ordinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress. RESULTS Weighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported 'mild' or 'uncomfortable' levels and 26.8% characterised their moral distress as 'distressing', 'intense' or 'worst possible'. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress. CONCLUSIONS During the pandemic's first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study's clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians' moral distress from witnessing inequities and other injustices for their patients and communities.
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Affiliation(s)
- Donald E Pathman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Jeffrey Sonis
- Departments of Social Medicine and Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Thomas E Rauner
- Office of Rural Health, Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, USA
| | - Kristina Alton
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna S Headlee
- College of Architecture, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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14
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Robertson C, Houtz M. When Desperate Patients Go to Court for Unproven Treatments - The Battle for Hospital Independence. N Engl J Med 2022; 386:1200-1202. [PMID: 35263516 DOI: 10.1056/nejmp2200209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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15
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A clinical catharsis: Moral distress and the uses of tragedy in palliative care. Palliat Support Care 2022; 21:554-555. [PMID: 35317882 DOI: 10.1017/s1478951522000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Smith-MacDonald L, Lusk J, Lee-Baggley D, Bright K, Laidlaw A, Voth M, Spencer S, Cruikshank E, Pike A, Jones C, Bremault-Phillips S. Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic. Front Psychiatry 2021; 12:801680. [PMID: 35115972 PMCID: PMC8805113 DOI: 10.3389/fpsyt.2021.801680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION In the context of the global pandemic of the SARS-CoV-2 coronavirus (COVID-19), healthcare providers (HCPs) have experienced difficult moral and ethical dilemmas. Research is highlighting the importance of moral injury (MI)-a trauma syndrome related to transgressing personal morals and values-in understanding the psychological harm and occupational impairment experienced by HCPs. To date, MI treatments have largely been developed for military personnel and veterans and rely on in-person one-on-one psychotherapy. PURPOSE This project aims to explore the feasibility and acceptability of an evidence-informed online Acceptance and Commitment Therapy-based group therapy for MI in HCPs called "Accepting Moral Pain and Suffering for Healthcare Providers" (AMPS-HCP). METHOD This feasibility and acceptability study included three separate phases with the first two phases focused on the development of the psychotherapeutic intervention and the third phase focused on the evaluation of the psychotherapeutic intervention. Eight participants (including registered nurses, practical nurses and respiratory therapists) completed seven 90-min sessions in an online group format. The focus of these sessions included ACT and MI psychoeducation and experientials. Qualitative semi-structured interview data was thematically analyzed while demographic and quantitative self-reported outcome data underwent descriptive analysis and non-parametric testing. RESULTS Results show that the intervention was highly feasible and acceptable to healthcare providers who worked on the frontline during COVID-19. Feasibility (referrals, eligibility, retention, participation engagement) was strong (8 out of 10 participants; 80% vs. desired >70% eligibility) and overall, 80% of participants completed 71% of the intervention. Data further supported the applicability and acceptability of the intervention. Preliminary data suggests that AMPS-HCP may supports HCPs to address MI. DISCUSSION This study is the first to report on the development and evaluation of an online MI group intervention for registered nurses, registered practical nurses, and respiratory therapists working during COVID-19. Results showed the use of both the online and group components of the intervention were acceptable and feasible during the third wave of COVID-19.
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Affiliation(s)
| | - Jaimie Lusk
- Department of Veterans Affairs, Portland Medical Center, Portland, OR, United States
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Katherine Bright
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Alexa Laidlaw
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Melissa Voth
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Shaylee Spencer
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Emily Cruikshank
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Ashley Pike
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Chelsea Jones
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Medical Centre, Department of Psychiatry, Leiden University, Leiden, Netherlands
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