Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic

Ducharlet, Kathryn; Trivedi, Mayuri; Gelfand, Samantha L.; Liew, Hui; McMahon, Lawrence P.; Ashuntantang, Gloria; Brennan, Frank; Brown, Mark; Martin, Dominique

doi:10.1016/j.semnephrol.2021.05.006

Cited by 21 publications

(21 citation statements)

References 67 publications

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“…Some patients experienced loneliness and depressive symptoms, and caregivers described heightened anxiety and an increased desire for information from health care professionals 102 . Many patient and provider groups described ethical compromise and psychological distress, as they felt unable to provide or receive care at pre-pandemic levels 103 , 104 . Furthermore, patient and provider groups have described adversity, fear, abandonment, hope and resilience 105 – 108 .…”

Section: Psychosocial Aspects Of Covid-19mentioning

confidence: 99%

“…Moral distress in health care during the COVID-19 pandemic has been extensively described and may explain some of the negative psychological consequences described above 104 . Moral distress can occur when an individual perceives that they are unable to act according to their ethical values owing to external barriers 110 .…”

Section: Psychosocial Aspects Of Covid-19mentioning

confidence: 99%

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Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

et al. 2022

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The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.

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Section: Psychosocial Aspects Of Covid-19mentioning

confidence: 99%

Section: Psychosocial Aspects Of Covid-19mentioning

confidence: 99%

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

et al. 2022

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“…To ensure that the situations described and experienced by professionals do not have similar consequences in the future, they must learn to make ethically and morally charged decisions in a consensual manner amid great uncertainty. 40 Training in ethical conflicts and moral deliberation in teams is one of the key strategies needed to address day‐to‐day care and to handle future situations that are similar to the COVID‐19 pandemic. 5 Rushton et al found that building moral resilience, that is, the ability to maintain or restore personal integrity in the face of moral adversity, can be a valuable personal resource in response to moral and ethical conflicts.…”

Section: Discussionmentioning

confidence: 99%

Ethical conflicts among physicians and nurses during the COVID‐19 pandemic: A qualitative study

Muñoz‐Quiles

Fernández

Hernández‐Padilla

et al. 2022

Evaluation Clinical Practice

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Rationale, Aims and Objectives The healthcare system and professionals working in the sector have experienced a high caseload during the coronavirus disease 2019 (COVID‐19) pandemic. This has increased the potential for morally harmful events that violate professionals' moral codes and values. The aim of this study was to understand and explore experiences of new moral challenges emerging among physicians and nurses caring for individuals during the COVID‐19 pandemic. Method The consolidated criteria for reporting qualitative research (COREQ) checklist was used in this qualitative study based on Gadamer's phenomenology. Participants were selected using a convenience sampling method. Thirteen medicine and nursing graduates were interviewed in depth. The participants all worked on the frontline at the start of the COVID‐19 pandemic. Data were gathered in two basic healthcare districts in Spain, encompassing both primary care and hospital care. Results Four main themes emerged from the data analysis: (1) Betrayal of moral and ethical values as a key source of suffering; (2) Ethical and moral sense of failure accompanying loss of meaning; (3) Lack of confidence in performance; (4) Self‐demand and self‐punishment as personal condemnation among healthcare workers. Conclusions Health institutions must implement interventions for health professionals to help mitigate the consequences of experiencing complex ethical scenarios during the pandemic. In addition, they should promote training in moral and ethical deliberation and prepare them to make decisions of great ethical significance.

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“…The concept of moral distress has not been well studied in nephrology and even less in SSA [ 57 ]. A study among nurses who manage patients with chronic kidney disease in 2 major hospitals in Nigeria found that the burden of care, as measured by the Zarit Burden of Life Instrument, was highest for dialysis [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Bedside rationing and moral distress in nephrologists in sub- Saharan Africa

2022

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Background Kidney diseases constitute an important proportion of the non-communicable disease (NCD) burden in Sub-Saharan Africa (SSA), though prevention, diagnosis and treatment of kidney diseases are less prioritized in public health budgets than other high-burden NCDs. Dialysis is not considered cost-effective, and for those patients accessing the limited service available, high out-of-pocket expenses are common and few continue care over time. This study assessed challenges faced by nephrologists in SSA who manage patients needing dialysis. The specific focus was to investigate if and how physicians respond to bedside rationing situations. Methods A survey was conducted among a randomly selected group of nephrologists from SSA. The questionnaire was based on a previously validated survey instrument. A descriptive and narrative approach was used for analysis. Results Among 40 respondents, the majority saw patients weekly with acute kidney injury (AKI) or end-stage kidney failure (ESKF) in need of dialysis whom they could not dialyze. When dialysis was provided, clinical compromises were common, and 66% of nephrologists reported lack of basic diagnostics and medication and > 80% reported high out-of-pocket expenses for patients. Several patient-, disease- and institutional factors influenced who got access to dialysis. Patients’ financial constraints and poor chances of survival limited the likelihood of receiving dialysis (reported by 79 and 78% of nephrologists respectively), while a patient’s being the family bread-winner increased the likelihood (reported by 56%). Patient and institutional constraints resulted in most nephrologists (88%) frequently having to make difficult choices, sometimes having to choose between patients. Few reported existence of priority setting guidelines. Most nephrologists (74%) always, often or sometimes felt burdened by ethical dilemmas and worried about patients out of hospital hours. As a consequence, almost 46% of nephrologists reported frequently regretting their choice of profession and 26% had considered leaving the country. Conclusion Nephrologists in SSA face harsh priority setting at the bedside without available guidance. The moral distress is high. While publicly funded dialysis treatment might not be prioritized in essential health care packages on the path to universal health coverage, the suffering of the patients, families and the providers must be acknowledged and addressed to increase fairness in these decisions.

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Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic

Cited by 21 publications

References 67 publications

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

Ethical conflicts among physicians and nurses during the COVID‐19 pandemic: A qualitative study

Bedside rationing and moral distress in nephrologists in sub- Saharan Africa

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