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General Hospital Psychiatry 2023Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to... (Review)
Review
IMPORTANCE
Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to 52% of patients exhibiting demoralization syndrome. Given established evidence linking demoralization in patients with cancer to physical symptom burden, quality of life, sleep disturbance, and suicidality, assessment and treatment of demoralization syndrome is critical for optimizing clinical and psychosocial outcomes.
OBSERVATIONS
The term "demoralization" is highly relevant to the care of patients with cancer facing life-limiting illnesses. Indeed, demoralization can be conceptualized as a feeling state characterized by the perception of being unable to cope with some pressing problems and/or of lack of adequate support from others. Despite a considerable overlap in symptoms, demoralization and depression should be regarded as distinct and independent clinical syndromes. Patients who are demoralized but not clinically depressed often describe a sense of subjective incompetence and do not report anhedonia (i.e., loss of interest and inability to enjoy things). Although the definition of demoralization is now included as a distinct syndrome in the International Classification of Diseases (ICD)-11, it has been neglected by the current U.S. official nosology in psychiatry, such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). As such, demoralization syndrome may be under- or misdiagnosed and treated ineffectively in the oncology setting, potentially prolonging suffering and influencing cancer outcomes.
CONCLUSIONS AND RELEVANCE
Optimization of methods to diagnose and assess demoralization syndrome is critical to underpin rigorous studies evaluating the efficacy of psychotherapeutic and pharmacological interventions for patients with cancer experiencing demoralization. Our review supports the use of specific diagnostic criteria for demoralization in cancer patients, introduces methodological considerations relevant to treatment studies, and presents a novel measurement approach to the assessment of demoralization severity with the Clinical Interview for Demoralization (CIDE).
Topics: Humans; Demoralization; Quality of Life; Neoplasms; Emotions; Suicidal Ideation
PubMed: 37950966
DOI: 10.1016/j.genhosppsych.2023.10.004 -
Nursing Ethics Aug 2023The unique role of the nurse ethicist in the clinical setting is one meant to enhance the ethical capacity of nurses, and front-line healthcare providers. As a nurse... (Review)
Review
The unique role of the nurse ethicist in the clinical setting is one meant to enhance the ethical capacity of nurses, and front-line healthcare providers. As a nurse ethicist, it is also my goal to enhance the ethical climate of each individual work area, patient care unit, and the broader institution by encouraging ethical conversations, navigating ethical dilemmas, and seeking creative solutions to minimize moral distress and burnout. To provide preventive ethics support and education, I began regularly visiting patient care areas for ethics rounds, which I affectionately named "E-walks" (for Ethics Walks). I will discuss and reflect upon the lessons that have emerged as three key components of "E-Walks": Recognition, Solidarity and Dialogue. These themes will speak to the unique presence and availability of a nurse ethicist as a valuable resource to front-line healthcare providers who face ethical dilemmas and morally concerning cases. I will go on to argue and demonstrate that my role as the nurse ethicist lies at the intersection of bioethics and the theoretical framework of the "ethic of care," which is focused on building, creating, and sustaining caring interprofessional relationships through the work of ethics, nursing, and education.
Topics: Humans; Ethics, Nursing; Ethicists; Bioethics; Burnout, Psychological; Stress, Psychological; Morals
PubMed: 37946386
DOI: 10.1177/09697330231160002 -
The Canadian Journal of Cardiology Mar 2024
Topics: Humans; Frailty; Transcatheter Aortic Valve Replacement; Morals; Decision Making
PubMed: 38042337
DOI: 10.1016/j.cjca.2023.11.035 -
The Journal of Applied Psychology Aug 2023To better understand the consequences of ethical voice in organizations, we have brought together multiple relevant literatures that focus on behaviors that fit our... (Review)
Review
To better understand the consequences of ethical voice in organizations, we have brought together multiple relevant literatures that focus on behaviors that fit our definition of ethical voice but have previously not been studied together, including internal reporting, social issue selling, ethical voice (in groups), moral objection, and confronting prejudice. Research across them has found both positive and negative responses to ethical voice. Further, emerging evidence suggests ambivalent attitudes and emotions toward ethical voice and voicers, hinting at more complex outcomes. However, a systematic understanding of when and why positive, negative, and more complex outcomes occur has remained elusive and is much needed. Building on empirical evidence, theory and research on ethical decision-making, self-enhancement/protection, and ambivalence, we offer an integrative theoretical framework to understand when and why ethical voice leads to targets'/observers' support for, undermining of, and inaction/disengagement from ethical voice and the voicer. We propose a morally motivated process, an instrumentally motivated process, and emotional ambivalence to explain these different responses. We also propose boundary conditions. We discuss our contributions and propose future directions for ethical voice research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Social Behavior; Emotions; Morals; Affect; Prejudice
PubMed: 36729504
DOI: 10.1037/apl0001075 -
Cambridge Quarterly of Healthcare... Apr 2024Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics...
Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey's proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce's views on feelings as emotional interpretants. Finally, the connection between Dewey's experimental ethics and democracy is outlined and compared to unfettered ethical progressivism.
Topics: Humans; Bioethics; Morals
PubMed: 37332165
DOI: 10.1017/S0963180123000282 -
Nursing Open Sep 2023To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and... (Review)
Review
AIM
To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and professional and career intentions.
DESIGN
Joanna Briggs Institute mixed-methods systematic review and thematic synthesis. Registered in Prospero (Redacted).
METHODS
Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.
RESULTS
Searches yielded 2343 hits. Seventy-seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well-being.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution to this systematic review.
Topics: Humans; Students, Nursing; North America; Morals; Job Satisfaction; Nurses
PubMed: 37458290
DOI: 10.1002/nop2.1913 -
Nursing Ethics Sep 2023Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the...
BACKGROUND
Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts.
RESEARCH AIM
To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic.
RESEARCH DESIGN
Qualitative analysis using a directed content methodology.
PARTICIPANTS AND RESEARCH CONTEXT
The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States.
ETHICAL CONSIDERATIONS
Participant privacy and data confidentiality were addressed.
FINDINGS
Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients.
DISCUSSION
This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice.
CONCLUSIONS
Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.
Topics: Humans; Ethics, Nursing; Pandemics; COVID-19; Morals; Uncertainty; Qualitative Research; Nurses
PubMed: 36971185
DOI: 10.1177/09697330221143150 -
Nursing Ethics Sep 2023During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under...
BACKGROUND
During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under severe pressure. During this time, bachelor's degree programs in nursing, physiotherapy and occupational therapy were disrupted, and students in their second year were displaced. Students experienced the continuous reorganisation of their traineeship as healthcare facilities adapted to a climate of uncertainty.
PURPOSE
The aim of this study was to investigate the degree of moral distress and the ethical issues most often encountered by physiotherapy, nursing and occupational therapy students enrolled in a traineeship during the first wave of the COVID-19 pandemic in southern Switzerland.
PARTICIPANTS AND RESEARCH CONTEXT
The sample consisted of 102 participants, and the response rate was 81.6%.
RESEARCH DESIGN
Based on a pragmatic approach, a mixed-method with a convergent design was adopted. Data were collected between 30 April 2020 and 14 May 2020, via a survey administered to all occupational therapy, physiotherapy and nursing students in their fourth semester.
ETHICAL CONSIDERATIONS
Given that no vulnerable persons were involved, the Ethics Committee of Southern Switzerland waived authorisation. However, all measures were put into place to protect participants by guaranteeing their anonymity and confidentiality.
RESULTS AND DISCUSSION
The data analysis showed that the main source for moral distress was 'poor teamwork' and that the moral issues encountered most often by students were related to the appropriateness of care and working conditions, with a clear reference to students' own safety and that of their loved ones; the other concerns reported included the loss of learning opportunities and the perceived lack of technical knowledge and skills.
CONCLUSIONS
This survey offers a faithful overview of physiotherapy, nursing and occupational therapy students' experience during the first pandemic wave. This study also identifies some key recommendations for healthcare professions' education.
Topics: Humans; Pandemics; Education, Nursing, Baccalaureate; Ethics, Nursing; Morals; Delivery of Health Care; Students, Nursing
PubMed: 36989456
DOI: 10.1177/09697330221146227 -
Cambridge Quarterly of Healthcare... Apr 2024This article presents a revised version of negative utilitarianism. Previous versions have relied on a hedonistic theory of value and stated that suffering should be...
This article presents a revised version of negative utilitarianism. Previous versions have relied on a hedonistic theory of value and stated that suffering should be minimized. The traditional rebuttal is that the doctrine in this form morally requires us to end all sentient life. To avoid this, a need-based theory of value is introduced. The frustration of the needs not to suffer and not to have one's autonomy dwarfed should, , be decreased. When decreasing the need frustration of some would increase the need frustration of others, the case is deferred and a fuller ethical analysis is conducted. The author's perceptions on murder, extinction, the right to die, antinatalism, veganism, and abortion are used to reach a reflective equilibrium. The new theory is then applied to consumerism, material growth, and power relations. The main finding is that the burden of proof should be on those who promote the
Topics: Humans; Moral Obligations; Ethical Analysis; Ethical Theory; Philosophy
PubMed: 36799026
DOI: 10.1017/S096318012300004X -
PloS One 2024At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action,...
OBJECTIVE
At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions.
METHODS
A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic.
RESULTS
Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients' care options, professionals' beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals' moral comfort. Patients' care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change.
CONCLUSION
This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals' disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals' beliefs, repercussions on professionals' wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.
Topics: Humans; Health Personnel; Morals; Social Workers; Qualitative Research; COVID-19; Psychological Distress; Stress, Psychological
PubMed: 38935754
DOI: 10.1371/journal.pone.0303013