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Nursing Inquiry Mar 2016The two aims of the paper were to systematically review and critique social science and linguistic text analyses of nursing records in order to inform future research in... (Review)
Review
The two aims of the paper were to systematically review and critique social science and linguistic text analyses of nursing records in order to inform future research in this emerging area of research. Systematic searches in reference databases and in citation indexes identified 12 articles that included analyses of the social and linguistic features of records and recording. Two reviewers extracted data using established criteria for the evaluation of qualitative research papers. A common characteristic of nursing records was the economical use of language with local meanings that conveyed little information to the uninitiated reader. Records were dominated by technocratic-medical discourse focused on patients' bodies, and they depicted only very limited aspects of nursing practice. Nurses made moral evaluations in their categorisation of patients, which reflected detailed surveillance of patients' disturbing behaviour. The text analysis methods were rarely transparent in the articles, which could suggest research quality problems. For most articles, the significance of the findings was substantiated more by theoretical readings of the institutional settings than by the analysis of textual data. More probing empirical research of nurses' records and a wider range of theoretical perspectives has the potential to expose the situated meanings of nursing work in healthcare organisations.
Topics: Documentation; Humans; Linguistics; Morals; Nurse's Role; Nursing Methodology Research; Nursing Records; Qualitative Research; Social Sciences
PubMed: 26109278
DOI: 10.1111/nin.12106 -
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 -
BMJ Supportive & Palliative Care Sep 2019Palliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to...
OBJECTIVES
Palliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care.
METHODS
A literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms 'moral distress' AND 'palliative care'. The review process has followed the international PRISMA statement guidelines.
RESULTS
The initial search identified 248 papers and 10 of them were considered eligible. Four main areas were identified: (1) personal factors, (2) patients and caregivers, (3) colleagues and superiors and (4) environment and organisation. Managing emotions of self and others, witnessing sufferance and disability, caring for highly demanding patients and caregivers, as well as poor communication were identified as distressing. Moreover, the relationship with colleagues and superiors, and organisational constraints often led to actions which contravened personal values invoking moral distress. The authors also summarised some supportive and preventive recommendations including self-empowerment, communication improvement, management of emotions and specific educational programmes for palliative care providers. A holistic model of moral distress in adult palliative care (integrating emotional, cognitive, behavioural and organisational factors) was also proposed.
CONCLUSIONS
Cognisance of risk and protective factors associated with the moral distress phenomenon may help reframe palliative healthcare systems, enabling effective and tailored actions that safeguard the well-being of providers, and consequently enhance patient care.
Topics: Adult; Caregivers; Communication; Delivery of Health Care; Emotions; Empathy; Female; Health Personnel; Humans; Male; Morals; Occupational Stress; Palliative Care
PubMed: 30636204
DOI: 10.1136/bmjspcare-2018-001674 -
PloS One 2017Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully... (Review)
Review
BACKGROUND
Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments' measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations.
METHODS
A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990-2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument's usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee's criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments.
RESULTS
After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar's instrument for nursing students, Nurse Practitioners' Roles and Competencies Scale, and Perceived Faculty Competency Inventory.
CONCLUSION
Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.
Topics: Attitude of Health Personnel; Health Status; Humans; Professionalism
PubMed: 28498838
DOI: 10.1371/journal.pone.0177321 -
Preventive Medicine Oct 2014Self-determination theory is used as a framework for examining the relation between motivation and physical activity. The purpose of this review was to systematically... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Self-determination theory is used as a framework for examining the relation between motivation and physical activity. The purpose of this review was to systematically review studies that assessed the association between self-determined motivation and physical activity levels in children and adolescents.
METHOD
We searched electronic databases in April 2013. Included studies assessed the relation between motivation (as outlined in self-determination theory) and physical activity in children and adolescents.
RESULTS
Forty-six studies (n=15,984 participants) met the inclusion criteria. Meta-analysis indicated that overall levels of self-determined motivation had a weak to moderate, positive associations with physical activity (ρ=.21 to .31). Autonomous forms of motivation (i.e., intrinsic motivation and identified regulation) had moderate, positive associations with physical activity (ρ=.27 to .38), whereas controlled forms of motivation (i.e., introjection and external regulation) had weak, negative associations with physical activity (ρ=-.03 to -.17). Amotivation had a weak, negative association with physical activity (ρ=-.11 to -.21).
CONCLUSIONS
Evidence provides some support for self-determination theory tenets. However, there was substantial heterogeneity in most associations and many studies had methodological shortcomings.
Topics: Adolescent; Child; Child, Preschool; Exercise; Humans; Male; Motivation; Personal Autonomy; Psychological Theory; Surveys and Questionnaires
PubMed: 25073077
DOI: 10.1016/j.ypmed.2014.07.033 -
Pediatric Blood & Cancer Sep 2022Nonprofit organizations (NPOs) play critical roles as funding sources, research partners, and disseminators of drug developments in pediatric cancer. Yet the literature... (Review)
Review
Nonprofit organizations (NPOs) play critical roles as funding sources, research partners, and disseminators of drug developments in pediatric cancer. Yet the literature provides limited guidance about ethical best practices when NPOs make trial funding decisions in this space. We conducted a systematic review of the literature indexed in PubMed and Web of Science to identify the ethical, legal, and social responsibilities of NPOs to four key stakeholder groups in funding pediatric cancer trials: (i) patients/families, (ii) researchers, (iii) industry sponsors, and (iv) donors. We applied the lifecycle framework for patient engagement in drug research and development proposed by Geissler and colleagues to analyze themes related to NPOs' responsibilities across 54 articles that met our inclusion criteria. Emergent themes included transparency surrounding conflicts of interest, the rigor of scientific review, and communication with patients/communities about trial progress. Our research identified critical gaps in best practices for negotiating research partnerships, managing competing research priorities, and pursuing alternative financing models including venture philanthropy. Results from our review informed a set of best practices to guide NPOs in making trial funding decisions that align with stakeholder values and interests.
Topics: Child; Humans; Neoplasms; Organizations, Nonprofit; Social Responsibility
PubMed: 35713116
DOI: 10.1002/pbc.29854 -
Journal of Pain and Symptom Management Jan 2022Caring for dying neonates is distressing for healthcare professionals (HCP)s. Yet, the extent of these effects is poorly understood, compromising support of HCPs. To... (Review)
Review
CONTEXT
Caring for dying neonates is distressing for healthcare professionals (HCP)s. Yet, the extent of these effects is poorly understood, compromising support of HCPs. To better understand and support HCPs, a systematic scoping review (SSR) of prevailing data is proposed.
OBJECTIVES
In mapping prevailing data on the impact of caring for dying neonates on HCPs, an SSR proffers new insights on changes to their beliefs, values, coping, actions, relationships and self-concepts of personhood.
METHODS
Krishna's Systematic Evidenced Based Approach (SEBA) supports a robust, reproducible review whilst its constructivist approach and relativist lens effectively contends with diverse data sources, facilitating a holistic study.
RESULTS
A total of 9826 abstracts were reviewed and 69 articles were included. Thematic and content analysis were used simultanously. The four categories drawn from the Ring Theory of Personhood (RToP) complements the four themes identified: Emotional and Physical Difficulties, Coping Mechanisms, Conflict and Recommendations.
CONCLUSION
In highlighting significant longitudinal effects upon all aspects of their lives, this SSR in SEBA reveals a critical need for timely, appropriate and personalized support. We recommend adapting the RToP as an assessment tool to identify and evaluate the needs of these HCPs. It may also be used to structure a holistic support mechanism. Future studies are required to validate its use and appraise other aspects of support available for HCPs.
Topics: Health Personnel; Humans; Infant, Newborn; Nurses; Personhood; Physicians; Self Concept
PubMed: 34271142
DOI: 10.1016/j.jpainsymman.2021.07.002 -
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 -
Journal of Educational Evaluation For... 2016This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students' motivation to engage in academic... (Review)
Review
PURPOSE
This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students' motivation to engage in academic activities based on the self-determination theory's perspective.
METHODS
A search was conducted across databases (MEDLINE, CINHAL, EMBASE, PsycINFO, and ERIC databases), hand-search of relevant journals, grey literature, and published research profile of key authors. Quantitative and qualitative studies were included if they reported research in health professions education focused on determinants, mediators, and/or outcomes of motivation from the self-determination and if meeting the quality criteria.
RESULTS
A total of 17 studies met the inclusion and quality criteria. Articles retrieved came from diverse locations and mainly from medical education and to a lesser extent from psychology and dental education. Intrapersonal (gender and personality traits) and interpersonal determinants (academic conditions and lifestyle, qualitative method of selection, feedback, and an autonomy supportive learning climate) have been reported to have a positive influence on students' motivation to engage in academic activities. No studies were found that tested mediation effects between determinants and students' motivation. In turn, students' self-determined motivation has been found to be positively associated with different cognitive, affective, and behavioural outcomes.
CONCLUSION
This study has found that generally, motivation could be enhanced by changes in the educational environment and by an early detection of students' characteristics. Doing so may support future health practitioners' self-determined motivation and positively influence how they process information and their emotions and how they approach their learning activities.
Topics: Education, Dental; Education, Medical; Health Occupations; Humans; Learning; Motivation; Personal Autonomy; Personality; Psychology; Social Environment; Students, Dental; Students, Medical
PubMed: 27134006
DOI: 10.3352/jeehp.2016.13.19 -
PloS One 2016To systematically review the evidence on the knowledge, beliefs, and attitudes of patients and the general public towards the interactions of physicians with the... (Meta-Analysis)
Meta-Analysis Review
Knowledge, Beliefs and Attitudes of Patients and the General Public towards the Interactions of Physicians with the Pharmaceutical and the Device Industry: A Systematic Review.
OBJECTIVE
To systematically review the evidence on the knowledge, beliefs, and attitudes of patients and the general public towards the interactions of physicians with the pharmaceutical and the device industry.
METHODS
We included quantitative and qualitative studies addressing any type of interactions between physicians and the industry. We searched MEDLINE and EMBASE in August 2015. Two reviewers independently completed data selection, data extraction and assessment of methodological features. We summarized the findings narratively stratified by type of interaction, outcome and country.
RESULTS
Of the 11,902 identified citations, 20 studies met the eligibility criteria. Many studies failed to meet safeguards for protecting from bias. In studies focusing on physicians and the pharmaceutical industry, the percentages of participants reporting awareness was higher for office-use gifts relative to personal gifts. Also, participants were more accepting of educational and office-use gifts compared to personal gifts. The findings were heterogeneous for the perceived effects of physician-industry interactions on prescribing behavior, quality and cost of care. Generally, participants supported physicians' disclosure of interactions through easy-to-read printed documents and verbally. In studies focusing on surgeons and device manufacturers, the majority of patients felt their care would improve or not be affected if surgeons interacted with the device industry. Also, they felt surgeons would make the best choices for their health, regardless of financial relationship with the industry. Participants generally supported regulation of surgeon-industry interactions, preferably through professional rather than governmental bodies.
CONCLUSION
The awareness of participants was low for physicians' receipt of personal gifts. Participants also reported greater acceptability and fewer perceived influence for office-use gifts compared to personal gifts. Overall, there appears to be lower awareness, less concern and more acceptance of surgeon-device industry interactions relative to physician-pharmaceutical industry interactions. We discuss the implications of the findings at the patient, provider, organizational, and systems level.
Topics: Conflict of Interest; Drug Industry; Female; Gift Giving; Health Knowledge, Attitudes, Practice; Humans; Interprofessional Relations; Male; Physicians; Practice Patterns, Physicians'; Public Opinion; Surgeons
PubMed: 27556929
DOI: 10.1371/journal.pone.0160540