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Clinical Psychology & Psychotherapy Jan 2022Despite a burgeoning of research on moral injury in the past decade, existing reviews have not explored the breadth of consequences and the multitude of pathways through... (Review)
Review
Despite a burgeoning of research on moral injury in the past decade, existing reviews have not explored the breadth of consequences and the multitude of pathways through which moral injury and potentially morally injurious experiences (PMIEs) influence mental and behavioural health outcomes. This study aimed to identify associations between moral injury on mental and behavioural health. Literature searches of psychological and medical databases were conducted through April 2020. Eligible studies measured moral injury or PMIEs, and health outcomes (e.g., depression, substance use and suicidality). Fifty-seven publications representing 49 separate samples were included. Studies examined the impact of moral injury on post-traumatic stress disorder (PTSD) (n = 43); depression (n = 32); anxiety (n = 15); suicide (n = 15); substance use (n = 14); and 'other' health outcomes, including pain, burnout, sleep disturbance and treatment-seeking behaviours (n = 11). The majority of studies found significant positive associations between moral injury-related constructs, mental health and behavioural health outcomes; however, the majority were also cross-sectional and focused on military samples. Proposed mediators included lack of social support, negative cognitions and meaning-making. Moderators included self-compassion, pre-deployment mental health education and mindfulness. Moral injury is associated with a variety of negative health outcomes. Research is needed to determine the mechanisms by which moral injury may influence these outcomes over time.
Topics: Cross-Sectional Studies; Humans; Mental Health; Military Personnel; Stress Disorders, Post-Traumatic; Suicide
PubMed: 33931926
DOI: 10.1002/cpp.2607 -
Children (Basel, Switzerland) Oct 2021In recent years, the development of social and moral emotions (often associated to pro-social behaviors) has become the subject of increased research interest. However,... (Review)
Review
In recent years, the development of social and moral emotions (often associated to pro-social behaviors) has become the subject of increased research interest. However, the relation between these emotions and attachment is less studied. The present systematic literature review (PROSPERO: CRD42021247210) was designed to synthesize current empirical contributions that explore the link between attachment and the development of moral emotions (e.g., empathy, sympathy, altruism, and guilt) during childhood and adolescence. Article exclusion criteria included: studies with participants not living in natural contexts (e.g., institutionalized); studies on mental illness; qualitative research; research that does not reliably evaluate attachment or moral emotions; research on intervention programs; and non-peer-reviewed articles. Only 10 studies were found eligible. Results highlight a present focus on empathy and guilt and gaps regarding sympathy and altruism. The mediator role and positive effect of emotion regulation was noted. Significant positive correlations between attachment security and guilt, shame and forgiveness were emphasized. Limitations of the eligible studies included: representativeness of the participants; causality of the results; and the validity and significance of the instruments (e.g., lack of results reported by various parties involved). The present review aims to contribute to the understanding of an empathic, healthy development, in contrast to the alienation and bullying affecting the youth's emotional, relational and academic lives.
PubMed: 34682180
DOI: 10.3390/children8100915 -
Current Opinion in Psychology Oct 2022What types of honesty interventions have been tested and to what extent? We conducted a systematic literature review of single-element intervention studies designed to... (Review)
Review
What types of honesty interventions have been tested and to what extent? We conducted a systematic literature review of single-element intervention studies designed to curtail individual-level dishonesty and classified the obtained interventions in a taxonomy that encompasses three frameworks: nudging, economic, and internal-reward. We find moral reminders that we classify as educative nudges as well as external commitments (pledges, oaths, honor codes) and priming that we classify under the internal-reward framework to be the most frequently studied interventions, whereas architectural nudges (defaults, sludge) have hardly been developed. Most importantly, we identify two areas for improvement essential for our collective ability to successfully translate and scale honesty interventions: a more thorough examination of the interventions' underlying psychological processes and precise description of the experimental designs.
Topics: Deception; Humans; Morals; Reward; Sewage
PubMed: 35921754
DOI: 10.1016/j.copsyc.2022.101410 -
Medicine, Health Care, and Philosophy Sep 2022To present the ethical issues, moral arguments, and reasons found in the ethical literature on organoid models. (Review)
Review
OBJECTIVE
To present the ethical issues, moral arguments, and reasons found in the ethical literature on organoid models.
DESIGN
In this systematic review of reasons in ethical literature, we selected sources based on predefined criteria: (1) The publication mentions moral reasons or arguments directly relating to the creation and/or use of organoid models in biomedical research; (2) These moral reasons and arguments are significantly addressed, not as mere passing mentions, or comprise a large portion of the body of work; (3) The publication is peer-reviewed and published in an academic article, book, national-level report, working paper, or Ph.D. thesis; (4) The publications collected are in English.
ANALYSIS
Each article was read in-depth for identifiable moral reasons, arguments, and concerns. These were then inductively classified and synthesized to create broader categories of reasons, and eventually an overarching conceptual scheme was created.
RESULTS
A total of twenty-three sources were included and analyzed out of an initial 266 collected sources. Five themes of ethical issues and arguments were found: Animal Experimentation; Clinical Applications and Experiments; Commercialization and Consent; Organoid Ontology and Moral Status; and Research Ethics and Research Integrity. These themes are then further broken down into sub-themes and topics. Given the extensive nature of the topics found, we will focus on describing the topics that comprised of more in-depth reasons and arguments rather than few, passing mentions or concerns.
CONCLUSIONS
The ethics of organoids requires further deliberation in multiple areas, as much of the discussions are not presented as in-depth arguments. Such sentiments are also echoed throughout the organoid ethics literature.
Topics: Animal Experimentation; Animals; Dissent and Disputes; Ethics, Research; Humans; Organoids
PubMed: 35532849
DOI: 10.1007/s11019-022-10082-3 -
Philosophy, Ethics, and Humanities in... Nov 2022Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Moral distress is one of the most important problems that nurses face in their care of patients. Various studies have reported the frequency and severity of moral distress in nurses. However, to date, a comprehensive study that shows the results of these research across the world was not found, therefore due to the importance of this issue, its role in the health of nurses and patients, and the lack of general statistics about it worldwide, the present study was conducted to determine the frequency and severity of moral distress in nurses through a systematic review and meta-analysis.
METHODS
In this review study, searching national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Embase, ScienceDirect, Scopus, CINHAL, PubMed, and Web of Science (WoS) between 2005 and February 2020 were extracted. The random-effects model was used for analysis, and the heterogeneity of studies with the I index was investigated. Data were analyzed using Comprehensive Meta-Analysis (Version 2).
RESULTS
The frequency of moral distress in 9 articles with a sample size of 1576 persons was 1.7 ± 0.5 from (0-4), in 13 articles with a sample size of 1870 persons, 3.07 ± 0.1 from (0-5), in 6 articles with a sample size of 1316 persons, 3.2 ± 0.29 from (0-6), in 18 articles with a sample size of 1959 persons, 4.6 ± 0.518 from (1-7) and in 35 articles with a sample size of 3718 persons, 81.1 ± 4.6 from (216-30), and the severity of moral distress in 4 articles with a sample size of 1116 persons, 1.7 ± 0.37 from (0-4), in 5 articles with a sample size of 1282 persons, 2.6 ± 0.28 from (0-5), in 5 articles with a sample size of 944 persons, 3.9 ± 0.63 from (0-6) and in 8 articles with a sample size of 901 persons was 82.3 ± 5.4 (0-216).
CONCLUSION
The results of this study showed that the frequency and severity of moral distress in nurses are high and are a serious problem in nurses. Therefore, policymakers in this field should consider its role in the health of nurses and patients.
Topics: Humans; Morals
PubMed: 36348378
DOI: 10.1186/s13010-022-00126-0 -
Cancer NursingWeighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses.
OBJECTIVE
This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics.
METHODS
We conducted a systematic search of 7 electronic databases (2000-2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis.
RESULTS
Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care.
CONCLUSION
Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress.
IMPLICATIONS FOR PRACTICE
Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.
Topics: Humans; Stress, Psychological; Oncology Nursing; Cross-Sectional Studies; Burnout, Professional; Neoplasms; Morals; Surveys and Questionnaires
PubMed: 35283474
DOI: 10.1097/NCC.0000000000001075 -
Journal of Behavioral Addictions Dec 2021In recent years, increasing attention has been given to the relationship between compulsive sexual behavior (CSB), religiosity, and spirituality. This review summarizes... (Review)
Review
BACKGROUND AND AIMS
In recent years, increasing attention has been given to the relationship between compulsive sexual behavior (CSB), religiosity, and spirituality. This review summarizes research examining the relationship CSB has with religiosity and spirituality, clarifying how these constructs inform the assessment and treatment of this syndrome.
METHODS
The present paper reviews research published through August 1, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Only studies providing quantitative analyses were included.
RESULTS
This review identified 46 articles, subsuming 59 studies, analyzing the relationship between CSB and religiosity or spirituality. Most studies used cross-sectional designs with samples primarily composed of heterosexual White men and women. Generally, the studies found small to moderate positive relationships between religiosity and CSB. Studies considering the mediating or moderating role of moral incongruence identified stronger, indirect relationships between religiosity and problematic pornography use (PPU), a manifestation of CSB. Few studies examined the association between spirituality and CSB, but those that did either reported negative relationships between indicators of spiritual well-being and CSB or positive relationships between CSB and aspects of spiritual struggles.
DISCUSSION AND CONCLUSIONS
Although research examining CSB and religiosity has flourished, such growth is hampered by cross-sectional samples lacking in diversity. Moral incongruence assists in explaining the relationship between religiosity and PPU, but future research should consider other manifestations of CSB beyond PPU. Attention should also be given to examining other religiosity and spirituality constructs and obtaining more diverse samples in research on CSB, religiosity, and spirituality.
Topics: Compulsive Behavior; Cross-Sectional Studies; Female; Humans; Male; Paraphilic Disorders; Sexual Behavior; Spirituality
PubMed: 34971357
DOI: 10.1556/2006.2021.00084 -
Nursing Ethics 2023Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured... (Review)
Review
Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.
Topics: Humans; Pandemics; Nursing Care; Leadership; Qualitative Research; Morals
PubMed: 37845832
DOI: 10.1177/09697330231191279 -
International Nursing Review Dec 2022To summarize the findings from literature regarding the prevalence of plagiarism and its various types, knowledge, and attitudes of students toward plagiarism, factors... (Meta-Analysis)
Meta-Analysis Review
AIM
To summarize the findings from literature regarding the prevalence of plagiarism and its various types, knowledge, and attitudes of students toward plagiarism, factors associated with plagiarism, and the applied interventions to decrease the incidence of plagiarism.
BACKGROUND
Plagiarism is a major form of academic dishonesty practiced by students at all educational levels.
INTRODUCTION
Academic dishonesty was defined as any unauthorized help that adds to students' formal academic performance. These dishonest behaviors can be categorized as falsifying information, hiding errors, collaborating with colleagues when not allowed, and plagiarism.
METHODS
Systematic search of databases was conducted in September 2021 to identify studies that discussed plagiarism in nursing studies. We included 31 studies in this systematic review and meta-analysis, with a total of 9,175 nursing students. The analysis was conducted using RevMan software.
RESULTS
Plagiarism was the most frequent academic misconduct among nursing students (practiced by 55.3%). Paraphrasing without referencing was the most practiced form (39.53%), while submitting others' work without acknowledgment was the least one (9.61%). Most students were aware of the concept of plagiarism (80.8%) and had positive ethical attitudes toward it (88.26%). Plagiarism was negatively associated with age, parenting, and completing semester credits. However, it was positively correlated with average grades and liberal educators. Plagiarism was a significant predictor of clinical misconduct.
DISCUSSION
A gap in the students' knowledge and skills were noticed. These gaps may be contributing to the high occurrence of plagiaristic acts, besides the unethical attitudes.
CONCLUSION
Plagiarism is a serious academic misconduct practice that can be associated with subsequent clinical misconduct. There is a need to fill the knowledge and skills gap, and to set effective policies.
IMPLICATION FOR NURSING AND HEALTH POLICY
In their attempts to eliminate plagiarism, nurse educators are encouraged to provide effective educational training and practical tasks, in order to fill the gaps in knowledge and skills. Additionally, implementing clear and effective punishment policies would prevent intentional plagiaristic acts. This would aid in introducing qualified nurses accountable for the health of patients.
Topics: Humans; Plagiarism; Students, Nursing; Faculty, Nursing; Morals
PubMed: 35397177
DOI: 10.1111/inr.12755 -
Critical Care Medicine Sep 2020To provide a concise review of data and literature pertaining to the etiologies of conflict in the ICU, as well as current approaches to conflict management.
OBJECTIVES
To provide a concise review of data and literature pertaining to the etiologies of conflict in the ICU, as well as current approaches to conflict management.
DATA SOURCES
Detailed search strategy using PubMed and OVID Medline for English language articles describing conflict in the ICU as well as prevention and management strategies.
STUDY SELECTION
Descriptive and interventional studies addressing conflict, bioethics, clinical ethics consultation, palliative care medicine, conflict management, and conflict mediation in critical care.
DATA EXTRACTION
Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for critical care practice and training.
DATA SYNTHESIS
Conflict frequently erupts in the ICU between patients and families and care teams, as well as within and between care teams. Conflict engenders a host of untoward consequences for patients, families, clinicians, and facilities rendering abrogating conflict a key priority for all. Conflict etiologies are diverse but understood in terms of a framework of triggers. Identifying and de-escalating conflict before it become intractable is a preferred approach. Approaches to conflict management include utilizing clinical ethics consultation, and palliative care medicine clinicians. Conflict Management is a new technique that all ICU clinicians may use to identify and manage conflict. Entrenched conflict appears to benefit from Bioethics Mediation, an approach that uses a neutral, unaligned mediator to guide parties to a mutually acceptable resolution.
CONCLUSIONS
Conflict commonly occurs in the ICU around difficult and complex decision-making. Patients, families, clinicians, and institutions suffer undesirable consequences resulting from conflict, establishing conflict prevention and resolution as key priorities. A variety of approaches may successfully identify, manage, and prevent conflict including techniques that are utilizable by all team members in support of clinical excellence.
Topics: Critical Care; Dissent and Disputes; Ethics, Medical; Group Processes; Humans; Intensive Care Units; Negotiating; Palliative Care; Patient Care Team
PubMed: 32618689
DOI: 10.1097/CCM.0000000000004440