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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 -
Journal of Occupational and... Jul 2023We investigated the impacts of workload, resources, organizational satisfaction, and psychological safety on changes in physician burnout and moral distress among...
BACKGROUND
We investigated the impacts of workload, resources, organizational satisfaction, and psychological safety on changes in physician burnout and moral distress among physicians during the early pandemic.
METHODS
We obtained national administrative and survey data on burnout, moral distress, organizational satisfaction, psychological safety, COVID-19 burden, and state-level restrictions for 11,877-14,246 Veterans Health Administration (VA) physicians from 2019 and 2020. We regressed the changes in burnout and moral distress on the changes in reasonable workload, appropriate job resources, organizational satisfaction, and psychological safety, controlling for COVID-19 burden and restrictions, and individual and medical center characteristics.
RESULTS
Burnout and moral distress were not related to COVID-19 cases or restrictions but were reduced by improvements in workload, organizational satisfaction, and psychological safety.
CONCLUSIONS
Health systems should be conscious of factors that can harm or improve physician well-being, especially in the context of external stressors.
Topics: Humans; COVID-19; Pandemics; Veterans Health; Burnout, Psychological; Burnout, Professional; Physicians; Surveys and Questionnaires; Job Satisfaction; Morals
PubMed: 37043388
DOI: 10.1097/JOM.0000000000002861 -
BMJ Open May 2024To explore and compare physicians' reported moral distress in 2004 and 2021 and identify factors that could be related to these responses.
OBJECTIVES
To explore and compare physicians' reported moral distress in 2004 and 2021 and identify factors that could be related to these responses.
DESIGN
Longitudinal survey.
SETTING
Data were gathered from the Norwegian Physician Panel Study, a representative sample of Norwegian physicians, conducted in 2004 and 2021.
PARTICIPANTS
1499 physicians in 2004 and 2316 physicians in 2021.
MAIN OUTCOME MEASURES
The same survey instrument was used to measure change in moral distress from 2004 to 2021. Logistic regression analyses examined the role of gender, age and place of work.
RESULTS
Response rates were 67% (1004/1499) in 2004 and 71% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased as 68.3% reported this 'somewhat' or 'very morally distressing' in 2004 compared with 75.1% in 2021. Moral distress also increased concerning that patients who 'cry the loudest' get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients and acting against one's conscience. Women reported higher moral distress than men at both time points, and there were significant gender differences for six statements in 2021 and one in 2004. Age and workplace influenced reported moral distress, though not consistently for all statements.
CONCLUSION
In 2004 and 2021 physicians' moral distress related to scarcity of time or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one's conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.
Topics: Humans; Norway; Male; Female; Longitudinal Studies; Physicians; Middle Aged; Adult; Surveys and Questionnaires; Morals; Attitude of Health Personnel; Psychological Distress; Stress, Psychological; Aged; Logistic Models; Sex Factors
PubMed: 38803245
DOI: 10.1136/bmjopen-2023-080380 -
Revista Da Escola de Enfermagem Da U S P 2023To assess the intensity and frequency of moral distress in mental health nurses in Brazil.
OBJECTIVE
To assess the intensity and frequency of moral distress in mental health nurses in Brazil.
METHOD
Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used.
RESULTS
Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts.
CONCLUSION
The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.
Topics: Humans; Mental Health; Brazil; Cross-Sectional Studies; Morals; Nurses
PubMed: 37695606
DOI: 10.1590/1980-220X-REEUSP-2023-0122en -
Nursing Ethics Feb 2024In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic...
In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents' health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the continuation of the practice of shielding as a moral failure. This is affirmed and specified in four dimensions: and (in MacIntyre's sense). is discussed in the context of prudent versus proportionate choices. As to , it will be shown that the continued practice of shielding no longer met the requirements of an (inherently moral) practice, as external goods such as security thinking and structural deficiencies prevented the pursuit of internal goods focusing on residents' interests and welfare, which in many places has led to a loss of trust in these facilities. This specification of moral failure also allows a novel perspective on moral distress, which can be understood as the expression of the psychological impact of moral failure on moral agents. Conclusions are formulated about how pandemic events can be understood as character challenges for healthcare professionals within residential care, aimed at preserving the internal goods of residential care even under difficult circumstances, which is understood as a manifestation of moral resilience. Finally, the importance of moral and civic education of healthcare students is emphasized to facilitate students' early identification as trusted members of a profession and a caring society, in order to reduce experiences of moral failure or improve the way to deal with it effectively.
Topics: Humans; Pandemics; COVID-19; Morals; Health Personnel; Nursing Homes
PubMed: 37294658
DOI: 10.1177/09697330231174532 -
Journal of Public Health (Oxford,... Aug 2023There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature,...
BACKGROUND
There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature, frequency, severity and duration of the problem in the public health professional workforce.
METHODS
Between 14 December 2021 and 23 February 2022, Faculty of Public Health (FPH) members were surveyed about their experiences of moral distress before and during the pandemic.
RESULTS
In total, 629 FPH members responded, of which, 405 (64%; 95% confidence interval [95%CI] = 61-68%) reported one or more experience of moral distress associated with their own action (or inaction), and 163 (26%; 95%CI = 23-29%) reported experiencing moral distress associated with a colleague's or organization's action (or inaction) since the start of the pandemic. The majority reported moral distress being more frequent during the pandemic and that the effects endured for over a week. In total, 56 respondents (9% of total sample, 14% of those with moral distress), reported moral injury severe enough to require time off work and/or therapeutic help.
CONCLUSIONS
Moral distress and injury are significant problems in the UK public health professional workforce, exacerbated by the COVID-19 pandemic. There is urgent need to understand the causes and potential options for its prevention, amelioration and care.
Topics: Humans; COVID-19; Pandemics; Public Health; Workforce; Morals
PubMed: 36866402
DOI: 10.1093/pubmed/fdad010 -
Medical Education Online Dec 2023Humanistic education aims to promote educated people's practical and conscious activities to enhance their humanity, cultivate ideal personalities, and realize personal... (Review)
Review
Humanistic education aims to promote educated people's practical and conscious activities to enhance their humanity, cultivate ideal personalities, and realize personal and social values, to develop a humanistic spirit. The advancement of higher education in China has led to the proposal to strengthen scientific and humanistic education integration. Medicine is between science and humanities, shouldering the important task of training senior medical personnel, the quality of medical students will affect the quality of future medical and health work; thus, medical students must explore and practice humanistic education. Promoting and practicing volunteerism is a specific act of constructing spiritual civilization in the whole society, and it is also considered beneficial for improving citizens' sense of responsibility and dedication. Medical students' practice of volunteerism and help in society is a precise manifestation of humanistic care. This review summarizes medical students' exploration and practice of humanistic education in volunteering.
Topics: Humans; Students, Medical; Humanities; Humanism; Education, Medical; Curriculum
PubMed: 36840966
DOI: 10.1080/10872981.2023.2182691 -
Nursing Ethics 2023Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress.
BACKGROUND
Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress.
OBJECTIVE
This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany.
RESEARCH DESIGN
A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic regressions, and Rasch analyses were performed.
PARTICIPANTS AND RESEARCH CONTEXT
The invitation to participate was sent to every German home-care service ( = 16,608).
ETHICAL CONSIDERATIONS
The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health.
RESULTS
A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence.
CONCLUSIONS
To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector.
Topics: Humans; Cross-Sectional Studies; Stress, Psychological; Job Satisfaction; Surveys and Questionnaires; Morals; Attitude of Health Personnel; Nurses
PubMed: 37308448
DOI: 10.1177/09697330231164761 -
Current Psychiatry Reports Jun 2024Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology,... (Review)
Review
PURPOSE OF REVIEW
Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions.
RECENT FINDINGS
We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.
Topics: Humans; Personhood; Respect; Psychotherapy
PubMed: 38809393
DOI: 10.1007/s11920-024-01506-3 -
Science and Engineering Ethics Sep 2023There is an ongoing debate about genetic engineering (GE) in food production. Supporters argue that it makes crops more resilient to stresses, such as drought or pests,...
There is an ongoing debate about genetic engineering (GE) in food production. Supporters argue that it makes crops more resilient to stresses, such as drought or pests, and should be considered by researchers as a technology to address issues of global food security, whereas opponents put forward that GE crops serve only the economic interests of transnational agrifood-firms and have not yet delivered on their promises to address food shortage and nutrient supply. To address discourse failure regarding the GE debate, research needs to understand better what drives the divergent positions and which moral attitudes fuel the mental models of GE supporters and opponents. Hence, this study investigates moral attitudes regarding GE opposition and support in Germany. Results show that GE opponents are significantly more absolutist than supporters and significantly less likely to hold outcome-based views. Furthermore, GE opponents are more willing to donate for preventing GE admission than supporters are willing to donate for promoting GE admission. Our results shed light on why the divide between opponents and supporters in the German GE debate could remain stark and stable for so long.
Topics: Morals; Crops, Agricultural; Germany; Nutrients; Genetic Engineering
PubMed: 37672172
DOI: 10.1007/s11948-023-00454-0