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International Journal of Environmental... Jul 2022The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing... (Review)
Review
The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing moral distress, which is associated with poor work ability. The causes and consequences of moral distress among eldercare workers remain undiscovered. This scoping review investigates the existing studies of causes and consequences of moral distress among eldercare workers. Additionally, it seeks evidence of interventions designed to mitigate moral distress in eldercare workers. Fourteen studies were included in the final review. Most of the included studies were qualitative, aiming to increase understanding of morally challenging situations in eldercare. We also found quantitative studies with cross-sectional designs and small sample sizes. Thus, no reliable evidence of causal effects between moral distress and worker wellbeing in eldercare was found. We found no interventions undertaken to resolve moral distress among eldercare workers, either. More research is needed on the causes and consequences of moral distress and on interventions to mitigate moral distress among eldercare workers. This is of utmost importance to increase the attractiveness of eldercare as a workplace and to improve eldercare workers' ability to work and sustain long working careers.
Topics: Cross-Sectional Studies; Humans; Morals; Surveys and Questionnaires; Workplace
PubMed: 35954662
DOI: 10.3390/ijerph19159303 -
International Journal of Environmental... May 2022Using e-cigarettes for smoking cessation is a controversial topic among health experts. Evidence suggests that vaping might have been moralized among the general public....
Using e-cigarettes for smoking cessation is a controversial topic among health experts. Evidence suggests that vaping might have been moralized among the general public. Despite the detrimental consequences of moralizing health behaviors on social cohesion and health, some argue for using moralization strategically to prevent and combat vaping. We aim to add to the body of literature showing the dangers of moralization in health by proposing a person-centered approach to the moralization of anti-vaping attitudes. Our cross-sectional survey explores the moralization of anti-vaping attitudes and its predictors on a convenience sample of 348 Romanian never-vapers, before the final vote to severely restrict vaping. By fitting a hierarchical regression model on our data, we found support for a unique contribution of negative prototypes (β = 0.13) and opinions of vapers (β = 0.08) in predicting moralization, with significant contributions of piggybacking on moralized self-control, on moralized attitudes toward smoking and on sanctity/degradation, disgust, anger, harm to children, and gender. Together, these variables explained 56% of the variance of the moralization of anti-vaping attitudes. Our findings add to our knowledge of motivated moralization and advise against using moralization in health, suggesting that people may weaponize it to legitimize group dislike.
Topics: Attitude; Child; Cross-Sectional Studies; Electronic Nicotine Delivery Systems; Humans; Smokers; Vaping
PubMed: 35565020
DOI: 10.3390/ijerph19095628 -
Nursing Philosophy : An International... Jul 2022Person-centred care is founded on ethics as a basis for organizing care. In spite of healthcare systems claiming that they have implemented person-centred care, patients... (Review)
Review
Person-centred care is founded on ethics as a basis for organizing care. In spite of healthcare systems claiming that they have implemented person-centred care, patients report less satisfaction with care. These contrasting results require clarification of how to practice person-centred ethics using Paul Ricoeur's 'Little ethics', summarized as: 'aiming for the good life, with and for others in just institutions'. In this ethic Kantian morality is at once subordinate and complementary to Aristotelian ethics because the ethical goal needs to be critically assessed and passed through the examination of the norm in each care situation. This paper presents examples that describes a person-centred care practice that balance a critical review of care activities based on a conviction of aiming for patients' wellbeing. In contrast to patients' experiences of person-centred care in real life, research projects have shown that if the clinical performers comprehend and apply the practice of person-centred ethics, patients report positive outcomes. The implementation of person-centred care therefore demands that stakeholders and managers enables and requires that healthcare staff study ethics in the same way as studying for example pharmacology is required when handling patients' medicines.
Topics: Delivery of Health Care; Humans; Moral Obligations; Morals; Palliative Care; Patient-Centered Care
PubMed: 35213781
DOI: 10.1111/nup.12382 -
Does thinking make it so?-what to make of the empirical evidence on moral distress amongst surgeons.Annals of Palliative Medicine Sep 2023
Topics: Humans; Morals; Stress, Psychological; Surgeons
PubMed: 37431224
DOI: 10.21037/apm-23-343 -
Health (London, England : 1997) Jan 2022Drawing on interview and online ethnographic data from a study of suicide on the railways, this paper describes the ways in which many of the concepts, assumptions and...
Drawing on interview and online ethnographic data from a study of suicide on the railways, this paper describes the ways in which many of the concepts, assumptions and practices of mainstream suicide prevention are challenged in the accounts of those who are planning, or have enacted, a suicide attempt. We reflect on the ethical dilemmas which can arise for researchers (and practitioners) when lived experience accounts diverge - theoretically, morally and in terms of practical implications - from present-day expert ones. In online, 'pro-choice' suicide discussions, people describe beliefs, attitudes, ways of thinking and acting which stand in contrast to existing professional and clinical descriptions of suicide and suicidal behaviour. Most obviously, there is often a rejection of 'pro-life' positions, which are framed as ideological, oppressive and naïve. For researchers engaging in online ethnography of 'pro-choice' spaces, dilemmas can arise in relation to the representation of perspectives which fundamentally challenge not only prevailing norms within suicide research and prevention practice but socio-cultural norms more widely. Similar issues can arise when considering how best to represent research participants when their accounts diverge from accepted 'expert' knowledge and beliefs. In-depth qualitative interviews with those who have thought about or attempted to take their own life indicate that existing theories and models of suicide which start from assumptions of deficit and pathology underestimate the extent to which suicide, as the end result of an often-complex series of actions, requires a person to engage in logistical processes of planning, decision-making, imagination and adaptation. The accounts described here, gathered using two different methodological approaches, highlight the ethical issues which can surface when there are competing claims to (expert) knowledge, as well as differences in beliefs, attitudes and moral stance towards life and death. We argue that researchers need to reflect on their own ethical-moral position in relation to suicide, and on the practical consequences of their privileging of some voices at the expense of other, less well represented, ones.
Topics: Humans; Morals; Suicide, Attempted
PubMed: 34541907
DOI: 10.1177/13634593211046843 -
Nature Communications Oct 2021Judgments of whether an action is morally wrong depend on who is involved and the nature of their relationship. But how, when, and why social relationships shape moral...
Judgments of whether an action is morally wrong depend on who is involved and the nature of their relationship. But how, when, and why social relationships shape moral judgments is not well understood. We provide evidence to address these questions, measuring cooperative expectations and moral wrongness judgments in the context of common social relationships such as romantic partners, housemates, and siblings. In a pre-registered study of 423 U.S. participants nationally representative for age, race, and gender, we show that people normatively expect different relationships to serve cooperative functions of care, hierarchy, reciprocity, and mating to varying degrees. In a second pre-registered study of 1,320 U.S. participants, these relationship-specific cooperative expectations (i.e., relational norms) enable highly precise out-of-sample predictions about the perceived moral wrongness of actions in the context of particular relationships. In this work, we show that this 'relational norms' model better predicts patterns of moral wrongness judgments across relationships than alternative models based on genetic relatedness, social closeness, or interdependence, demonstrating how the perceived morality of actions depends not only on the actions themselves, but also on the relational context in which those actions occur.
Topics: Humans; Interpersonal Relations; Judgment; Morals; Social Perception
PubMed: 34599174
DOI: 10.1038/s41467-021-26067-4 -
BMJ Open Quality Jul 2021Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds...
INTRODUCTION
Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being.
METHODS
An audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care.
RESULTS
The majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020).
CONCLUSIONS AND IMPLICATIONS
This report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.
Topics: Fatigue; Hospital Design and Construction; Humans; Medical Staff, Hospital; Morale; Patient Safety; Quality Improvement; Shift Work Schedule; Sleep; State Medicine; Surveys and Questionnaires; United Kingdom
PubMed: 34301729
DOI: 10.1136/bmjoq-2021-001403 -
The Behavioral and Brain Sciences Apr 2020Morality has two key features: (1) moral judgments are not solely determined by what your group thinks, and (2) moral judgments are often applied to members of other...
Morality has two key features: (1) moral judgments are not solely determined by what your group thinks, and (2) moral judgments are often applied to members of other groups as well as your own group. Cooperative motives do not explain how young children reject unfairness, and assert moral obligations, both inside and outside their groups. Resistance and experience with conflicts, alongside cooperation, is key to the emergence and development of moral obligation.
Topics: Child; Child, Preschool; Humans; Judgment; Moral Obligations; Morals
PubMed: 32349809
DOI: 10.1017/S0140525X19002401 -
Cognitive Science Aug 2020The claim that common sense regards free will and moral responsibility as compatible with determinism has played a central role in both analytic and experimental...
The claim that common sense regards free will and moral responsibility as compatible with determinism has played a central role in both analytic and experimental philosophy. In this paper, we show that evidence in favor of this "natural compatibilism" is undermined by the role that indeterministic metaphysical views play in how people construe deterministic scenarios. To demonstrate this, we re-examine two classic studies that have been used to support natural compatibilism. We find that although people give apparently compatibilist responses, this is largely explained by the fact that people import an indeterministic metaphysics into deterministic scenarios when making judgments about freedom and responsibility. We conclude that judgments based on these scenarios are not reliable evidence for natural compatibilism.
Topics: Humans; Judgment; Metaphysics; Morals; Personal Autonomy; Philosophy
PubMed: 33145820
DOI: 10.1111/cogs.12873 -
BMC Public Health Mar 2022As 'disease detectives' and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive...
BACKGROUND
As 'disease detectives' and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress.
RESULTS
Among 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it "frequently" or "almost always." Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress "frequently" or "almost always" than those in higher-income countries (33.0% vs 9.1%, P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%).
CONCLUSIONS
Field epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in association with these challenges. These findings indicate an unmet need among field epidemiologists for support in navigating ethical challenges, as well as for resources to address the human and professional consequences of moral distress.
Topics: Epidemiologists; Humans; Morals; Stress, Psychological; Surveys and Questionnaires
PubMed: 35296269
DOI: 10.1186/s12889-022-12950-2