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Nursing Ethics Aug 2021Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing...
BACKGROUND
Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff.
RESEARCH QUESTION
The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events.
RESEARCH DESIGN
A hermeneutic-phenomenological qualitative study was performed.
PARTICIPANTS AND RESEARCH CONTEXT
Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim.
ETHICAL CONSIDERATIONS
Ethical approval was obtained from the Institutional Review Hospital Board.
FINDINGS
Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured.
DISCUSSION
In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events.
CONCLUSION
Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.
Topics: Adaptation, Psychological; Humans; Morals; Nurses; Qualitative Research; Stress, Psychological; Terminal Care
PubMed: 33267730
DOI: 10.1177/0969733020964859 -
Oncology Nursing Forum Nov 2020To (a) compare the domains of distress between patients who were distressed and patients who were not distressed and (b) examine the relationship between the National...
OBJECTIVES
To (a) compare the domains of distress between patients who were distressed and patients who were not distressed and (b) examine the relationship between the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients (DT-PL) and the Hospital Anxiety and Depression Scale (HADS) in individuals with advanced lung cancer.
SAMPLE & SETTING
Individuals with advanced lung cancer receiving chemotherapy were recruited from a comprehensive cancer center in the southeastern United States.
METHODS & VARIABLES
A cross-sectional, descriptive, exploratory design was used. Individuals with lung cancer completed the DT-PL and the HADS. Data were analyzed using descriptive statistics, t tests, and chi-square analysis.
RESULTS
Significant differences were found between the nondistressed group and the clinically distressed group in three domains of distress.
IMPLICATIONS FOR NURSING
Distress in individuals with advanced lung cancer goes beyond psychological stressors and includes family problems and physical problems.
Topics: Anxiety; Cross-Sectional Studies; Depression; Humans; Lung Neoplasms; Psychometrics; Stress, Psychological; Surveys and Questionnaires
PubMed: 33063781
DOI: 10.1188/20.ONF.732-738 -
International Journal of Environmental... Jan 2021There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about...
There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener-15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11-16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi's continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R = 0.53) and T1 RHS score accounted for the majority of variance ( = 0.64, < 0.001), with post-migration stress accounting for markedly less (β = 0.19, = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).
Topics: Bhutan; Humans; Mass Screening; Refugees
PubMed: 33573131
DOI: 10.3390/ijerph18031238 -
The Hastings Center Report Nov 2023Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain...
Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably. But these emotions are distinct, and they are not all equally fitting in the same circumstances. This indicates a problematic ambiguity in the moral distress concept that obscures its distinctiveness, its relevant circumstances, and how individual clinicians and the medical community should practically respond to it. We argue that, in a range of situations that are said to be morally distressing, the characteristic emotion can be well-understood in terms of what Bernard Williams calls "agent-regret." We show what can thereby be gained in terms of a less ambiguous concept and a more adequate ethical response to this distinctive and complex clinician experience.
Topics: Humans; Stress, Psychological; Emotions; Morals
PubMed: 38131494
DOI: 10.1002/hast.1544 -
Psycho-oncology Apr 2020Psychosocial distress is common in cancer patients and survivors and encompasses a broad range of concerns and psychological symptoms. The aim of the current study was...
OBJECTIVES
Psychosocial distress is common in cancer patients and survivors and encompasses a broad range of concerns and psychological symptoms. The aim of the current study was to identify subgroups of respondents who experience a specific constellation of distress symptoms.
METHODS
This study uses data from a large data base (n = 21 680) of cancer patients from diverse settings who provided data in the Questionnaire on Distress in Cancer Patients-Short Form (QSC-R10). Cluster analysis was applied to identify subgroups with a distinct constellation of distress symptoms.
RESULTS
The results showed five distinct clusters: minimally distressed patients (46.6% of the sample), highly distressed patients (12.7%), mainly physically distressed patients (15.2%), mainly psychologically distressed patients (15.6%), and mainly socially distressed patients (9.9%). These groups differed with regard to age, sex, cancer site, treatment setting, and disease progression.
CONCLUSION
The results revealed large heterogeneity in the experience of distress. Distress clusters were associated with socio-demographic and clinical variables. These associations might aid a clinician to tailor interventions and to address specific types of distress.
Topics: Adult; Cancer Survivors; Female; Humans; Male; Middle Aged; Neoplasms; Psychological Distress; Risk
PubMed: 31876011
DOI: 10.1002/pon.5321 -
Sensors (Basel, Switzerland) Nov 2022A comprehensive representation of the road pavement state of health is of great interest. In recent years, automated data collection and processing technology has been...
A comprehensive representation of the road pavement state of health is of great interest. In recent years, automated data collection and processing technology has been used for pavement inspection. In this paper, a new signal on graph (SoG) model of road pavement distresses is presented with the aim of improving automatic pavement distress detection systems. A novel nonlinear Bayesian estimator in recovering distress metrics is also derived. The performance of the methodology was evaluated on a large dataset of pavement distress values collected in field tests conducted in Kazakhstan. The application of the proposed methodology is effective in recovering acquisition errors, improving road failure detection. Moreover, the output of the Bayesian estimator can be used to identify sections where the measurement acquired by the 3D laser technology is unreliable. Therefore, the presented model could be used to schedule road section maintenance in a better way.
Topics: Bayes Theorem; Benchmarking; Data Collection; Technology
PubMed: 36501885
DOI: 10.3390/s22239183 -
Canadian Journal of Surgery. Journal... May 2020Physician health is of increasing concern in health care systems. The purpose of this study was to determine the prevalence of distress among orthopedic surgeons and...
BACKGROUND
Physician health is of increasing concern in health care systems. The purpose of this study was to determine the prevalence of distress among orthopedic surgeons and trainees and to identify factors associated with distress.
METHODS
Voluntary, anonymous online surveys were sent to attending orthopedic surgeons and orthopedic trainees across Canada. The survey for attending surgeons used the Expanded Physician Well-Being Index, and the survey for trainees used the Resident/Fellow Well-Being Index. Demographic information was also collected. To look for predictors of physician distress, we evaluated the relationship between respondents' classification as "distressed" and "not distressed" against demographic factors.
RESULTS
In total, 1138 attending orthopedic surgeons and 493 orthopedic trainees were invited to complete the survey. The survey response rate was 31.2% for attending orthopedic surgeons and 24.3% for orthopedic trainees. Overall, 55.4% of attending surgeons and 40.0% of trainees screened positive for distress. Among both attending surgeons and trainees, having dependents was not a risk factor for distress, nor was gender. Practice location was not a risk factor for distress among attending surgeons. Attending surgeons who were classified as distressed had spent significantly fewer years in practice (median 11 yr) than those who were classified as "not distressed" (median 16 yr) (p = 0.004).
CONCLUSION
We found a higher rate of distress among orthopedic surgeons than has been previously reported. The distress rate among orthopedic trainees in this population is similar to that reported in other international publications, although self-reported rates of burnout were higher. The findings from this study may indicate a need for continuing research to determine intrinsic and extrinsic risk factors for distress among orthopedic surgeons and trainees and for the evaluation of prescriptive, evidence-based initiatives to address this crisis.
Topics: Burnout, Professional; Canada; Humans; Internship and Residency; Orthopedic Procedures; Orthopedic Surgeons; Orthopedics; Risk Factors; Self Report
PubMed: 32356949
DOI: 10.1503/cjs.004319 -
Sensors (Basel, Switzerland) Apr 2024The attributes of diversity and concealment pose formidable challenges in the accurate detection and efficacious management of distresses within subgrade structures. The... (Review)
Review
The attributes of diversity and concealment pose formidable challenges in the accurate detection and efficacious management of distresses within subgrade structures. The onset of subgrade distresses may precipitate structural degradation, thereby amplifying the frequency of traffic incidents and instigating economic ramifications. Accurate and timely detection of subgrade distresses is essential for maintaining and repairing road sections with existing distresses. This helps to prolong the service life of road infrastructure and reduce financial burden. In recent years, the advent of numerous novel technologies and methodologies has propelled significant advancements in subgrade distress detection. Therefore, this review delineates a concentrated examination of subgrade distress detection, methodically consolidating and presenting various techniques while dissecting their respective merits and constraints. By furnishing comprehensive guidance on subgrade distress detection, this review facilitates the expedient identification and targeted treatment of subgrade distresses, thereby fortifying safety and enhancing durability. The pivotal role of this review in bolstering the construction and operational facets of transportation infrastructure is underscored.
PubMed: 38732931
DOI: 10.3390/s24092825 -
Journal of Research in Nursing : JRN Nov 2022Moral distress has been studied widely in nursing but not in developing economies.
BACKGROUND
Moral distress has been studied widely in nursing but not in developing economies.
AIM
To investigate how moral distress is experienced by nurses working in neonatal intensive care and paediatric wards in Northern Ghana and to determine support measures offered by nurse managers.
METHOD
Qualitative descriptive method. Forty nurses and fourteen nurse managers working with children in four hospitals in Northern Ghana were interviewed. Thematic data analysis was carried out.
RESULTS
Six themes were identified: nurses experience morally distressing situations due to a variety of causes; the impact of morally distressing situations on nurses; coping mechanisms of nurses who experienced morally distressing situations; recommendations made by the nurses to reduce the incidence of moral distress; inadequate support measures available to nurse managers and nurse managers experience moral distress too.
CONCLUSION
The causes of moral distress in developed and developing economies are similar. The frequency and intensity of moral distress is high in Northern Ghana. Consistent with other studies conducted in Africa, nurses and nurse managers relied on their religious faith as a form of resilience. No support measures are available to nurse managers to support nurses who experience moral distress.
PubMed: 36338924
DOI: 10.1177/17449871221122022 -
BMJ Open Aug 2022To explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19...
OBJECTIVE
To explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic.
DESIGN
Cross-sectional survey in late 2020, employing quantitative and qualitative analyses.
SETTING
Safety net practices in 20 US states.
PARTICIPANTS
2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes.
MEASURES
Ordinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress.
RESULTS
Weighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported 'mild' or 'uncomfortable' levels and 26.8% characterised their moral distress as 'distressing', 'intense' or 'worst possible'. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress.
CONCLUSIONS
During the pandemic's first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study's clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians' moral distress from witnessing inequities and other injustices for their patients and communities.
Topics: COVID-19; Cross-Sectional Studies; Humans; Morals; Pandemics; Surveys and Questionnaires
PubMed: 36008061
DOI: 10.1136/bmjopen-2022-061369