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Scandinavian Journal of Caring Sciences Dec 2021This literature study describes caring science research on human dignity in different clinical practice. We already know a good deal about human dignity in nursing care... (Review)
Review
BACKGROUND
This literature study describes caring science research on human dignity in different clinical practice. We already know a good deal about human dignity in nursing care but how do patients, nurses, healthcare professionals and next of kin experience human dignity in clinical practice?
AIM
To summarise studies on human dignity to gain a deeper understanding of how it can be achieved in caring science research and to gain a broader understanding of the differences and similarities across caring contexts. The aim was also to gain a broader understanding of the differences and similarities of human dignity across different clinical practice.
METHOD
The literature review re-analysed 28 empirical studies on human dignity are experienced from acute, psychiatric, elderly and rehabilitation care. The data analysis strategy was conducted in a systematic and critical way and consisted of a five-step method.
RESULT
Maintaining dignity was described when caregivers had the time and the will to see and listen to patient and had the courage to see what they did not want to see, allowing their inner powers to act with the purpose of doing good. In elderly care, it was important that elderly persons are involved as members of society and experience respect, confidence, security and charity. Indignity was described when caregivers did not allow patients to have their will and when they had unethical attitudes, ignoring patients and creating powerlessness. The feeling of being abandoned and not being taken seriously are also described in elderly care.
CONCLUSION
Findings show how caregivers fulfil their ethical responsibility by seeing, listening and being a part of the time and place. The will to do good includes the courage to preserve dignity and human value rests on being created as a human being. More research is needed about ethical and moral responsibility in clinical practice.
Topics: Aged; Humans; Nursing Care; Personhood; Qualitative Research; Respect
PubMed: 33104271
DOI: 10.1111/scs.12922 -
Archives of Disease in Childhood Aug 2016To review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care... (Review)
Review
OBJECTIVE
To review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs).
DESIGN
Pubmed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus were searched using the terms neonat*, infant*, pediatric*, prematur* or preterm AND (moral distress OR moral responsibility OR moral dilemma OR conscience OR ethical confrontation) AND intensive care.
RESULTS
13 studies on moral distress published between January 1985 and March 2015 met our inclusion criteria. Fewer than half of those studies (6) were multidisciplinary, with a predominance of nursing staff responses across all studies. The most common themes identified were overly 'burdensome' and disproportionate use of technology perceived not to be in a patient's best interest, and powerlessness to act. Concepts of moral distress are expressed differently within nursing and medical literature. In nursing literature, nurses are often portrayed as victims, with physicians seen as the perpetrators instigating 'aggressive care'. Within medical literature moral distress is described in terms of dilemmas or ethical confrontations.
CONCLUSIONS
Moral distress affects the care of patients in the NICU and PICU. Empirical data on multidisciplinary populations remain sparse, with inconsistent definitions and predominantly small sample sizes limiting generalisability of studies. Longitudinal data reflecting the views of all stakeholders, including parents, are required.
Topics: Attitude to Death; Humans; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Medical Staff, Hospital; Morals; Nurses, Pediatric; Occupational Diseases; Stress, Psychological
PubMed: 26801075
DOI: 10.1136/archdischild-2015-309410 -
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 -
The Cochrane Database of Systematic... Jul 2017Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often...
BACKGROUND
Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine.
OBJECTIVES
The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income).
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 June 2017) and reference lists of retrieved studies.
SELECTION CRITERIA
All published and unpublished randomised controlled trials, cluster-randomised trials comparing continuous support during labour with usual care. Quasi-randomised and cross-over designs were not eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We sought additional information from the trial authors. The quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS
We included a total of 27 trials, and 26 trials involving 15,858 women provided usable outcome data for analysis. These trials were conducted in 17 different countries: 13 trials were conducted in high-income settings; 13 trials in middle-income settings; and no studies in low-income settings. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (average RR 1.08, 95% confidence interval (CI) 1.04 to 1.12; 21 trials, 14,369 women; low-quality evidence) and less likely to report negative ratings of or feelings about their childbirth experience (average RR 0.69, 95% CI 0.59 to 0.79; 11 trials, 11,133 women; low-quality evidence) and to use any intrapartum analgesia (average RR 0.90, 95% CI 0.84 to 0.96; 15 trials, 12,433 women). In addition, their labours were shorter (MD -0.69 hours, 95% CI -1.04 to -0.34; 13 trials, 5429 women; low-quality evidence), they were less likely to have a caesarean birth (average RR 0.75, 95% CI 0.64 to 0.88; 24 trials, 15,347 women; low-quality evidence) or instrumental vaginal birth (RR 0.90, 95% CI 0.85 to 0.96; 19 trials, 14,118 women), regional analgesia (average RR 0.93, 95% CI 0.88 to 0.99; 9 trials, 11,444 women), or a baby with a low five-minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Data from two trials for postpartum depression were not combined due to differences in women, hospitals and care providers included; both trials found fewer women developed depressive symptomatology if they had been supported in birth, although this may have been a chance result in one of the studies (low-quality evidence). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, such as admission to special care nursery (average RR 0.97, 95% CI 0.76 to 1.25; 7 trials, 8897 women; low-quality evidence), and exclusive or any breastfeeding at any time point (average RR 1.05, 95% CI 0.96 to 1.16; 4 trials, 5584 women; low-quality evidence).Subgroup analyses suggested that continuous support was most effective at reducing caesarean birth, when the provider was present in a doula role, and in settings in which epidural analgesia was not routinely available. Continuous labour support in settings where women were not permitted to have companions of their choosing with them in labour, was associated with greater likelihood of spontaneous vaginal birth and lower likelihood of a caesarean birth. Subgroup analysis of trials conducted in high-income compared with trials in middle-income countries suggests that continuous labour support offers similar benefits to women and babies for most outcomes, with the exception of caesarean birth, where studies from middle-income countries showed a larger reduction in caesarean birth. No conclusions could be drawn about low-income settings, electronic fetal monitoring, the timing of onset of continuous support or model of support.Risk of bias varied in included studies: no study clearly blinded women and personnel; only one study sufficiently blinded outcome assessors. All other domains were of varying degrees of risk of bias. The quality of evidence was downgraded for lack of blinding in studies and other limitations in study designs, inconsistency, or imprecision of effect estimates.
AUTHORS' CONCLUSIONS
Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.
Topics: Cesarean Section; Delivery, Obstetric; Doulas; Female; Humans; Labor, Obstetric; Personal Autonomy; Pregnancy; Pregnancy Outcome; Professional-Patient Relations
PubMed: 28681500
DOI: 10.1002/14651858.CD003766.pub6 -
International Journal of Palliative... Dec 2016To reflect on the definition of compassion and analyse the concepts encompassed by the term. (Review)
Review
AIM
To reflect on the definition of compassion and analyse the concepts encompassed by the term.
BACKGROUND
A large number of authors have defined compassion, with certain nuances that differ from case to case. This raises the need for specificity in the definition of the term.
DATA SOURCES
First, a systematic search was conducted of scientific databases. Second, a selection of experts were consulted and a request made to them for specific articles. Third, the snowball method was used.
DESIGN
The keywords used in the literature search were 'compassion' and 'empathy', a MeSH term given for compassion. There are terms, such as self-compassion, compassion meditation, compassion fatigue and mindfulness, which, owing to their specific nature, were not included, because this study deals with the general aspects of compassion.
RESULTS
The systematic search found 104 articles, of which 6 articles were selected after applying the inclusion and exclusion criteria. The eight experts provided a total of 14 references, of which seven articles met the inclusion criteria. Finally, 15 references were identified with the snowball method (n=28).
CONCLUSIONS
Compassion originates as an empathic response to suffering, as a rational process which pursues patients' wellbeing, through specific, ethical actions directed at finding a solution to their suffering. We therefore define the term compassion to mean the sensitivity shown in order to understand another person's suffering, combined with a willingness to help and to promote the wellbeing of that person, in order to find a solution to their situation. This should be a duty in healthcare professionals' daily work.
Topics: Attitude of Health Personnel; Delivery of Health Care; Empathy; Ethics, Clinical; Humans; Terminology as Topic
PubMed: 27992278
DOI: 10.12968/ijpn.2016.22.12.599 -
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 -
Journal of the National Medical... Oct 2019In spite of emphasis on patient-centered cares and promotion of their quality, shortcomings have been seen in health systems due to lack of compassion.
BACKGROUND
In spite of emphasis on patient-centered cares and promotion of their quality, shortcomings have been seen in health systems due to lack of compassion.
PURPOSE
The aim of the present study was to determine the definition, fields, facilitating and inhibiting factors of compassionate care in healthcare systems and the interventions designed to promote it.
METHODS
This study was conducted through narrative synthesis which is supposed to do systematic and synthesized review. Searching was done in English databases including Pub Med, CINAHL, Google Scholar, Web of Science, and Cochrane library, Ovid, Science Direct, WILEY by using keywords of Compassionate Care, Delivery of Health Care, Healthcare Systems, Compassion and Health Care Providers from 1987 to 2017.
RESULTS
Compassionate care has some dimensions including ethical, professional, effective communication, human, spiritual/religious and getting involve with patients. Facilitating and inhibiting factors consisted of the nurse's personal characteristics, patients' behavior and organizational factors included workload, role model, and value of compassionate care in healthcare systems. Educational interventions such as providing feedback and reorienting have been mostly used to improve the compassionate care.
CONCLUSIONS
Although compassionate care has been known as the main element of improving services quality in health care system, it has been studied restrictively from the viewpoints of the patients and all personnel in healthcare systems. The improvement of compassionate care through education cannot remove completely the gap between theory and practice, because it seems that clinical environment and organizational values of healthcare system are the largest facilitating and inhibiting factors for filling this gap. Therefore, it is necessary to take measures for promoting organizational culture.
Topics: Attitude of Health Personnel; Communication; Delivery of Health Care; Empathy; Humanism; Humans; Organizational Culture; Patient-Centered Care; Professionalism; Quality Improvement; Spirituality; Workload
PubMed: 31060872
DOI: 10.1016/j.jnma.2019.04.002 -
International Journal of Nursing Studies Dec 2018Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different...
BACKGROUND
Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values.
OBJECTIVE
To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.
DESIGN, DATA SOURCES AND METHODS
A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.
RESULTS
Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.
CONCLUSIONS
Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.
Topics: Ethics, Nursing; Health Priorities; Humans; Morals; Nursing Care; Qualitative Research
PubMed: 30179768
DOI: 10.1016/j.ijnurstu.2018.08.006 -
The British Journal of Psychiatry : the... Jun 2018Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder (PTSD), depression, etc.).AimsWe aimed to assess the effect of moral injury on mental health outcomes.
METHOD
We conducted a systematic review and meta-analysis to assess the association between work-related PMIEs and mental health disorders. Studies were independently assessed for methodological quality and potential moderator variables, including participant age, gender and PMIE factors, were also examined.
RESULTS
Thirteen studies were included, representing 6373 participants. PMIEs accounted for 9.4% of the variance in PTSD, 5.2% of the variance in depression and 2.0% of the variance in suicidality. PMIEs were associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant. Moderator analyses indicated that methodological factors (e.g. PMIE measurement tool), demographic characteristics and PMIE variables (e.g. military v. non-military context) did not affect the association between a PMIE and mental health outcomes.
CONCLUSIONS
Most studies examined occupational PMIEs in military samples and additional studies investigating the effect of PMIEs on civilians are needed. Given the limited number of high-quality studies available, only tentative conclusions about the association between exposure to PMIEs and mental health disorders can be made.Declaration of interestNone.
Topics: Depressive Disorder; Humans; Military Personnel; Morals; Occupational Diseases; Stress Disorders, Post-Traumatic; Suicide
PubMed: 29786495
DOI: 10.1192/bjp.2018.55