Drivers of Moral Distress in Surgical Intensive Care Providers: A Mixed Methods Study

Bleicher, Josh; Place, Aubrey; Schoenhals, Sarah; Luppens, Carolyn L; Grudziak, Joanna; Lambert, Laura; McCrum, Marta L.

doi:10.1016/j.jss.2021.04.017

Cited by 14 publications

(25 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Total moral distress scores tend to be higher in studies based in the US (Epstein et al 2019, Bleicher et al 2021 than in Europe (Colville et al 2019, Donkers et al 2021. The total scores of the APNs in this study appear to be similar to those of healthcare professionals in other European studies, particularly among respondents working in secondary care.…”

Section: Discussionsupporting

confidence: 73%

Moral distress in advanced practice nurses during the COVID-19 pandemic

et al. 2022

View full text Add to dashboard Cite

Background Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic.Aim To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic.Method This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues.Findings A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All of the respondents expressed concerns about patients due to delayed care and about the mental well-being of their colleagues, particularly those who were redeployed to COVID-19 wards. ConclusionThe COVID-19 pandemic has caused moral and psychological distress for APNs. However, the type of distress and its direct causes varied among these practitioners. Tailored support is required to address moral distress and subsequently improve staff retention.

show abstract

Section: Discussionsupporting

confidence: 73%

Moral distress in advanced practice nurses during the COVID-19 pandemic

et al. 2022

View full text Add to dashboard Cite

show abstract

“…of moral distress. Most studies refer to Jameton's traditional definition of moral distress, where distress results from an individual's inability to pursue what is ethically right due to institutional or hierarchical constraints (7,8,(24)(25)(26)(27)(28)(29)(30)(31). One study adopted a definition of moral distress in-line with the BMA definition, indirectly defining moral distress to include Jameton's original definition while also capturing the distress caused by witnessing perceived moral wrongs (32).…”

Section: Discussionmentioning

confidence: 99%

“…In 19 articles, individual factors were considered in relation to their association with moral distress among surgeons (2)(3)(4)(5)(6)8,10,25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). In some instances, this was in connection to demographic characteristics such as gender (2,8,30,31), years in practice (2,29,(31)(32)(33)36), and the impact of being in a leadership or supervisory position (30).…”

Section: Individualmentioning

confidence: 99%

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

View full text Add to dashboard Cite

Background: There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist. Methods: We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies.A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis.Results: A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress. Conclusions:The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.

show abstract

“…Finally, perception of futile care was identified as an antecedent contributing to MD 2,20,26,27,32,36–40 . Medical futility (MF) involves provision of aggressive treatment when survival is unlikely 41 .…”

Section: Resultsmentioning

confidence: 99%

“…24 Finally, perception of futile care was identified as an antecedent contributing to MD. 2,20,26,27,32,[36][37][38][39][40] Medical futility (MF) involves provision of aggressive treatment when survival is unlikely. 41 Sources of MD stemmed from nurses' contribution in prolonging patient suffering 2,26,32,39,42,43 and providing/witnessing a medically futile cardiac resuscitation attempt.…”

Section: Antecedentsmentioning

confidence: 99%

Moral distress in critical care nursing practice: A concept analysis

2022

View full text Add to dashboard Cite

Aim To provide a critical analysis of the concept of moral distress (MD) in critical care (CC) nursing. Background Despite extensive inquiry pertaining to the legitimacy of MD within nursing discourse, some authors still question its relevancy to the profession. However, amid the global COVID‐19 pandemic, MD is generating a significant amount of discussion anew, warranting the further exploration of the concept within CC nursing to provide clarity and expand on the definition. Design Rodger's Evolutionary Concept Analysis method was used to guide this analysis. Methods Related terms, attributes, antecedents, and consequences of MD were identified using current literature. Results The results of this analysis demonstrate strong congruence between the attributes, antecedents, and negative consequences pertaining to MD. However, a new theme has emerged from this review of the contemporary literature, highlighting the potential unexpected positive outcomes perceived by nurses who experience MD, including the provision of better care, increased levels of empathy, and enhanced opportunities for ethical reflection.

show abstract

Drivers of Moral Distress in Surgical Intensive Care Providers: A Mixed Methods Study

Cited by 14 publications

References 30 publications

Moral distress in advanced practice nurses during the COVID-19 pandemic

Moral distress in advanced practice nurses during the COVID-19 pandemic

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Moral distress in critical care nursing practice: A concept analysis

Contact Info

Product

Resources

About