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Clinical Psychology Review Mar 2024Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the... (Review)
Review
BACKGROUND
Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use.
METHOD
We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale.
RESULTS
We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.
CONCLUSIONS
Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.
Topics: Humans; Stress Disorders, Post-Traumatic; Morals; Psychometrics; Surveys and Questionnaires; Reproducibility of Results
PubMed: 38218124
DOI: 10.1016/j.cpr.2023.102377 -
The Cochrane Database of Systematic... Jul 2019Decisions in clinical medicine can be associated with ethical challenges. Ethical case interventions (e.g. ethics committee, moral case deliberation) identify and... (Review)
Review
BACKGROUND
Decisions in clinical medicine can be associated with ethical challenges. Ethical case interventions (e.g. ethics committee, moral case deliberation) identify and analyse ethical conflicts which occur within the context of care for patients. Ethical case interventions involve ethical experts, different health professionals as well as the patient and his/her family. The aim is to support decision-making in clinical practice. This systematic review gathered and critically appraised the available evidence of controlled studies on the effectiveness of ethical case interventions.
OBJECTIVES
To determine whether ethical case interventions result in reduced decisional conflict or moral distress of those affected by an ethical conflict in clinical practice; improved patient involvement in decision-making and a higher quality of life in adult patients. To determine the most effective models of ethical case interventions and to analyse the use and appropriateness of the outcomes in experimental studies.
SEARCH METHODS
We searched the following electronic databases for primary studies to September 2018: CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO. We also searched CDSR and DARE for related reviews. Furthermore, we searched Clinicaltrials.gov, International Clinical Trials Registry Platform Search Portal and conducted a cited reference search for all included studies in ISI WEB of Science. We also searched the references of the included studies.
SELECTION CRITERIA
We included randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies which compared ethical case interventions with usual care or an active control in any language. The included population were adult patients. However, studies with mixed populations consisting of adults and children were included, if a subgroup or sensitivity analysis (or both) was performed for the adult population.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care review group. We used meta-analysis based on a random-effects model for treatment costs and structured analysis for the remaining outcomes, because these were heterogeneously reported. We used the GRADE approach to assess the certainty of the evidence.
MAIN RESULTS
We included four randomised trials published in six articles. The publication dates ranged from 2000 to 2014. Three studies were conducted in the USA, and one study in Taiwan. All studies were conducted on intensive care units and included 1165 patients. We judged the included studies to be of moderate or high risk of bias. It was not possible to compare different models of the intervention regarding effectiveness due to the diverse character of the interventions and the small number of studies. Included studies did not directly measure the main outcomes. All studies received public funding and one received additional funding from private sources.We identified two models of ethical case interventions: proactive and request-based ethics consultation. Three studies evaluated proactive ethics consultation (n = 1103) of which one study reported findings on one key outcome criterion. The studies did not report data on decisional conflict, moral distress of participants of ethical case interventions, patient involvement in decision-making, quality of life or ethical competency for proactive ethics consultation. One study assessed satisfaction with care on a 5-point Likert scale (1 = lowest rating, 5 = highest rating). The healthcare providers (nurses and physicians, n = 365) scored a value of 4 or 5 for 81.4% in the control group and 86.1% in the intervention group (P > 0.05). The patients or their surrogates (n = 275) scored a value of 4 or 5 for 83.6% in the control group and for 74.8% in the intervention group (P > 0.05). It was uncertain whether proactive ethics consultation led to high satisfaction with care, because the certainty of evidence was very low.One study evaluated request-based ethics consultation (n = 62). The study indirectly measured decisional conflict by assessing consensus regarding patient care. The risk (increase in consensus, reduction in decisional conflict) increased by 80% as a result of the intervention. The risk ratio was 0.20 (95% confidence interval 0.09 to 0.46; P < 0.01). It was uncertain whether request-based ethics consultation reduced decisional conflict, because the certainty of evidence was very low. The study did not report data on moral distress of participants of ethical case interventions, patient involvement in decision-making, quality of life, or ethical competency or satisfaction with care for request-based ethics consultation.
AUTHORS' CONCLUSIONS
It is not possible to determine the effectiveness of ethical case interventions with certainty due to the low certainty of the evidence of included studies in this review. The effectiveness of ethical case interventions should be investigated in light of the outcomes reported in this systematic review. In addition, there is need for further research to identify and measure outcomes which reflect the goals of different types of ethical case intervention.
PubMed: 31424106
DOI: 10.1002/14651858.CD012636.pub2 -
Clinical Medicine Insights. Oncology 2021Operating rooms are a scarce resource but often used inefficiently. Operating room efficiency emerges as an important part of maximizing surgical capacity and... (Review)
Review
INTRODUCTION
Operating rooms are a scarce resource but often used inefficiently. Operating room efficiency emerges as an important part of maximizing surgical capacity and productivity, minimizing delays, and optimizing lung cancer outcomes. The operative time (time between patient entering and leaving the operating room) is discrete and the one that the surgical team can most directly influence. We performed a systematic review to evaluate the literature and identify methods to improve the efficiency of the intraoperative phase of operations for lung cancer.
METHODS
A literature search (in PubMed, Embase, Cochrane, and Scopus) was performed from inception up to March 9, 2020, according to the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
RESULTS
We identified 3 articles relevant to the intraoperative phase of lung cancer operating room efficiency. All 3 were consistent in showing clinically relevant time reductions in the intraoperative phase or procedures relevant to this phase. The authors demonstrated that the application of various improvement methodologies resulted in a substantial reduction in operative time, which was associated with a reduction in complications, and improved staff morale.
CONCLUSIONS
Our systematic review found that various improvement methodologies have the potential to significantly reduce operative time for lung cancer surgery. This increases the value of lung cancer surgery. These findings are consistent with the wider literature on improving surgical efficiency.
PubMed: 33795942
DOI: 10.1177/1179554920987105 -
Adolescent Research Review 2022Adolescence is a developmentally sensitive period for emotion regulation with potentially lifelong implications for mental health and well-being. Although substantial... (Review)
Review
UNLABELLED
Adolescence is a developmentally sensitive period for emotion regulation with potentially lifelong implications for mental health and well-being. Although substantial empirical research has addressed this topic, the literature is fragmented across subdisciplines, and an overarching theoretical framework is lacking. The first step toward constructing a unifying framework is identifying relevant phenomena. This systematic review of 6305 articles used text mining to identify phenomena relevant to adolescents' emotion regulation. First, a baseline was established of relevant phenomena discussed in theory and recent narrative reviews. Then, article keywords and abstracts were analyzed using text mining, examining term frequency as an indicator of relevance and term co-occurrence as an indicator of association. The results reflected themes commonly featured in theory and narrative reviews, such as socialization and neurocognitive development, but also identified undertheorized themes, such as developmental disorders, physical health, external stressors, structural disadvantage, substance use, identity and moral development, and sexual development. The findings illustrate how text mining systematic reviews, a novel approach, may complement narrative reviews. Future theoretical work might integrate these undertheorized themes into an overarching framework, and empirical research might consider them as promising areas for future research, or as potential confounders in research on adolescents' emotion regulation.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40894-021-00160-7.
PubMed: 34036150
DOI: 10.1007/s40894-021-00160-7 -
Nursing Ethics Mar 2018The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing... (Review)
Review
BACKGROUND
The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients' rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.
OBJECTIVES
To examine ethics interventions conducted on healthcare professionals and healthcare students to achieve ethics-related outcomes.
RESEARCH DESIGN
A systematic review.
METHODS
Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher's Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis. Ethical consideration: This systematic review was conducted following good scientific practice in every phase.
FINDINGS
It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.
CONCLUSION
Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals.
Topics: Ethics, Medical; Health Personnel; Humans; Randomized Controlled Trials as Topic; Students, Health Occupations
PubMed: 28393607
DOI: 10.1177/0969733017700237 -
Philosophy, Ethics, and Humanities in... Sep 2021The acceptance or practical application of the do-not-resuscitate order is substantially dependent on internal or personal factors; in a way that decision-making about... (Review)
Review
BACKGROUND
The acceptance or practical application of the do-not-resuscitate order is substantially dependent on internal or personal factors; in a way that decision-making about this issue can be specific to each person. Moreover, most nurses feel morally and emotionally stressed and confused during the process decision-making regarding DNR order. Therefore, the purpose of the present study was to evaluate nurses' attitudes towards DNR order in a systematic review.
METHODS
This critical survey was conducted using a systematic review protocol. To this end, the most relevant articles published in domestic and foreign databases with no time limits until October 2018 were searched. The inclusion and exclusion criteria were articles on DNR order, studies about nurses' attitudes, descriptive and analytical research papers, as well as those with download links and full texts. The given articles were also assessed in terms of their quality and their main results were extracted.
RESULTS
Of the total number of 1663 articles searched in the process of systematic review to investigate nurses' attitudes towards DNR order, 88 articles were included in the full-text review step and finally 10 articles, meeting the inclusion criteria, were found. Assessing the quality of articles included in this review showed that 8 articles, in general, were of good quality and 2 studies were characterized with moderate quality. The main factors associated with nurses' attitudes towards DNR order were grouped into three categories of (1) nurses' attitudes towards DNR order, (2) guidelines for DNR order, and (3) decision-making by patients and their families about DNR order. In most of the studies examined, nurses' attitudes towards DNR order were reported positive.
CONCLUSION
It seemed that nurses were willing to get involved in DNR order and each hospital was recommended to develop a written DNR policy directing individuals and avoiding their confusion in this respect.
Topics: Attitude of Health Personnel; Health Knowledge, Attitudes, Practice; Humans; Nurses; Nursing Staff, Hospital; Resuscitation Orders
PubMed: 34488819
DOI: 10.1186/s13010-021-00103-z -
Frontiers in Psychology 2023The impact of social movements (SMs) and collective behavior (CB) supports the relevance of approaching this phenomenon from social psychology. Several systematic... (Review)
Review
BACKGROUND
The impact of social movements (SMs) and collective behavior (CB) supports the relevance of approaching this phenomenon from social psychology. Several systematic reviews (10) and meta-analyses (6) have been carried out in the 21st century, but there is a lack of integration.
AIM
This study seeks to review the patterns of CB and corroborate the psychosocial factors that explain participation in CB and SMs, as well as the long-term psychological effects of participating in them.
METHOD
A systematic search was carried out in the databases Web of Science, Scopus, ProQuest, ScienceDirect, Willey Online Library, EBSCO, and JSTOR for articles dated between 1969 and 2022. We searched for meta-analyses and systematic reviews that empirically evaluated social movements and collective behavior. Of the 494 initial records, after scanning and eligibility phases, 16 meta-analyses and systematic reviews were analyzed in the present work.
RESULTS
The evidence reviewed shows that participation in collective gatherings and CB are common. A cross-cultural survey suggests that collective gatherings are mostly of a leisure type, to a lesser extent religious and sporting, and to an even lesser extent, demonstrations and large religious rites. World Value surveys found that one to three persons out of 10 participate in protests or CB related to SMs and four out of 10 movements achieved some kind of success. Studies challenged that CBs were characterized by unanimity of beliefs, identification and behavior, generalized excitement, as well as mass panic and riot after catastrophes. Only two out of 10 CB are violent. Meta-analysis and systematic reviews confirm that participation in CB and SMs was associated with (a) intergroup conflict and realistic threat ( = 0.30); (b) positive attitudes, expectations, or agreement with goals or collective motive ( = 0.44); (c) cognitive fraternal relative deprivation ( = 0.25); (d) collective efficacy ( = 0.36); (e) collective identity ( = 0.34); (f) emotions and affective relative deprivation ( = 0.35); (g) moral conviction and threat to moral ( = 0.29); and (h) disagreement with system justification belief ( = -0.26). Participation in successful CB and SMs provokes positive changes in emotions, social identity and social relationships, values and beliefs, and empowerment, as well as negative effects such as depression, stress, burnout, and disempowerment related to the failures of SMs.
CONCLUSION
Studies confirm the importance of explanatory factors for SMs, with data from various cultural regions. There is a lack of systematic studies of CB as well as meta-analyses and more culturally diverse studies of the effects of participation in them.
PubMed: 37151317
DOI: 10.3389/fpsyg.2023.1096877 -
Nursing Ethics Feb 2017Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles,... (Review)
Review
BACKGROUND
Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles, and concepts) to understand surrogates' day-to-day experiences in end-of-life care planning for incapacitated adults.
OBJECTIVES AND METHODS
This qualitative systematic review was conducted to identify the types of ethical frameworks used to address surrogates' experiences in end-of-life care planning for incapacitated adults as well as the most common themes or patterns found in surrogate decision-making research.
FINDINGS
Seven research papers explicitly identified ethical theories, principles, or concepts, such as autonomy, substituted judgment, and best interest standards as guidelines for the research. Surrogate decision making themes included the responsibilities and goals of being a surrogate, factors influencing surrogates' decision making, outcomes for surrogates, and an overarching theme of "wanting to do the right thing" for their loved one and/or themselves.
DISCUSSION
Understanding the complexity of surrogates' experiences of end-of-life care planning is beyond the scope of conventional ethical frameworks.
CONCLUSION
Ethical frameworks that address individuality and contextual variations related to decision making may more appropriately guide surrogate decision-making research that explores surrogates' end-of-life care planning experiences.
Topics: Decision Making; Ethics, Nursing; Family; Humans; Terminal Care
PubMed: 27005954
DOI: 10.1177/0969733016638145 -
BMJ Open Mar 2016To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs). (Review)
Review
OBJECTIVE
To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs).
DESIGN
Systematic review and thematic synthesis.
DATA SOURCES
Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists.
STUDY SELECTION
We included 22 articles, reporting on 18 studies, involving 646 participants.
INCLUSION CRITERIA
peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants' perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH.
DATA EXTRACTION
1 of 3 authors extracted data with checking by a second.
DATA SYNTHESIS
A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities.
CONCLUSIONS
This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs.
TRIAL REGISTRATION NUMBER
CRD42014014115.
Topics: Housing; Humans; Motivation; Qualitative Research; Smoke-Free Policy; Smoking; Tobacco Smoke Pollution; Vulnerable Populations
PubMed: 26988351
DOI: 10.1136/bmjopen-2015-010260 -
BMC Medical Education Jan 2021Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks... (Review)
Review
BACKGROUND
Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks (hereafter "tools") provide useful foundations for integrating new knowledge and skills into existing professional practice and education. We conducted this scoping review to identify tools used for teaching cybercivility in health professions education.
METHODS
Using Arksey and O'Malley's scoping review framework, we searched six biomedical and educational databases and three grey literature databases for articles available in English published between January 1, 2000 and March 31, 2020. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we screened and extracted relevant data, and reported the results of the search.
RESULTS
The search resulted in 2272 articles, with 8 articles included in this review after inclusion criteria were applied. Four articles (50%) were peer-reviewed journal papers while the other 4 (50%) were dissertations. Eleven unique tools were identified by this review: (1) Transpersonal Caring Theory, (2) Theory of Workplace Incivility, (3) Conceptualization of Incivility, (4) Media Ecology Theory, (5) Principlism, (6) Salmon's Five Stage Model of Online Learning, (7) Learner-Centered Educational Theory, (8) Gallant and Drinan's 4-Stage Model of Institutionalization of Academic Integrity, (9) Theory of Planned Behavior, (10) Communication Privacy Management Theory, and (11) Moral Development Theory. Based on the tools analyzed in our scoping review, we determined three features of cybercivility pedagogy to which the tools provided a guide: (1) behavioral manifestations, (2) academic integrity, and (3) digital professionalism.
CONCLUSIONS
The reviewed tools provide a pedagogical foundation and guidance for teaching various properties of cybercivility. Future studies should be expanded to include a broader literature body and non-English literature to provide the global perspective and global skills needed by a diverse population of learners.
Topics: Communication; Delivery of Health Care; Health Occupations; Professionalism; Thinking
PubMed: 33516204
DOI: 10.1186/s12909-021-02507-z