Moral distress in medicine: An ethical analysis

Kherbache, Alexandra; Mertens, Evelyne; Denier, Yvonne

doi:10.1177/13591053211014586

Cited by 34 publications

(30 citation statements)

References 82 publications

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“…O'Neal et al ( 17 ) found 66.5% of surveyed HCPs felt moral distress related to conflicts between institutional constraints and what they believed was right during the pandemic. Similar moral dilemmas have been suggested for physicians who may be experiencing tensions between physicians' fidelity to best medical practices, their Hippocratic Oath, and managing scarce resources ( 18 ). Factors and experiences which have been found to cause moral distress during COVID-19 include uncertainty and lack of knowledge, fear of exposure, intra-professional tensions and miscommunications, policies that prevent or impede care, practicing within crisis standards of care, new roles/tasks and broken routines, and dealing with medical resource scarcity ( 19 , 20 ).…”

Section: Introductionmentioning

confidence: 65%

Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic

et al. 2022

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Introduction:In the context of the global pandemic of the SARS-CoV-2 coronavirus (COVID-19), healthcare providers (HCPs) have experienced difficult moral and ethical dilemmas. Research is highlighting the importance of moral injury (MI)–a trauma syndrome related to transgressing personal morals and values–in understanding the psychological harm and occupational impairment experienced by HCPs. To date, MI treatments have largely been developed for military personnel and veterans and rely on in-person one-on-one psychotherapy.Purpose:This project aims to explore the feasibility and acceptability of an evidence-informed online Acceptance and Commitment Therapy-based group therapy for MI in HCPs called “Accepting Moral Pain and Suffering for Healthcare Providers” (AMPS-HCP).Method:This feasibility and acceptability study included three separate phases with the first two phases focused on the development of the psychotherapeutic intervention and the third phase focused on the evaluation of the psychotherapeutic intervention. Eight participants (including registered nurses, practical nurses and respiratory therapists) completed seven 90-min sessions in an online group format. The focus of these sessions included ACT and MI psychoeducation and experientials. Qualitative semi-structured interview data was thematically analyzed while demographic and quantitative self-reported outcome data underwent descriptive analysis and non-parametric testing.Results:Results show that the intervention was highly feasible and acceptable to healthcare providers who worked on the frontline during COVID-19. Feasibility (referrals, eligibility, retention, participation engagement) was strong (8 out of 10 participants; 80% vs. desired >70% eligibility) and overall, 80% of participants completed 71% of the intervention. Data further supported the applicability and acceptability of the intervention. Preliminary data suggests that AMPS-HCP may supports HCPs to address MI.Discussion:This study is the first to report on the development and evaluation of an online MI group intervention for registered nurses, registered practical nurses, and respiratory therapists working during COVID-19. Results showed the use of both the online and group components of the intervention were acceptable and feasible during the third wave of COVID-19.

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Section: Introductionmentioning

confidence: 65%

Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic

et al. 2022

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“…It is argued that the primary goal in addressing moral distress is to address the moral or ethical issues that cause the distress ( 18 ). In the healthcare sector, ethics training has been shown to help reduce moral distress ( 12 ). In the veterinary sector, understanding and application of ethics is identified as a key day-1 competency by the World Organisation for Animal Health (OIE) ( 19 ), and accrediting bodies including the Royal College of Veterinary Surgeons (UK) ( 20 ), the European Association of Establishments for Veterinary Education (Europe) ( 21 ), and the North American Veterinary Medical Education Consortium ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, Millar argued that “beyond early career training, there is also an increasing need to support the development of a broader set of ethical reflection skills within the veterinary profession that goes beyond just raising awareness and knowledge acquisition” ( 26 ). Organizational support is critical in facilitating positive coping strategies ( 12 ). Organizational support includes creating a culture of ethical reflection and discussion, stimulating open dialogue among colleagues and with patients, and investing in medical ethics education for staff.…”

Section: Introductionmentioning

confidence: 99%

“…Moral distress is defined as "the experience of psychological distress that results from engaging in, or failing to prevent, decisions or behaviors that transgress, or come to transgress, personally held moral or ethical beliefs" (9). Among healthcare workers, moral distress has been correlated with low psychological empowerment and autonomy, low workplace satisfaction and engagement, poor ethical climate and collaboration, high turnover and career attrition (10)(11)(12). Moral distress among healthcare workers is also correlated with reduced quality of care, including reduced patient safety and reduced treatment efficacy (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

“…Among healthcare workers, moral distress has been correlated with low psychological empowerment and autonomy, low workplace satisfaction and engagement, poor ethical climate and collaboration, high turnover and career attrition (10)(11)(12). Moral distress among healthcare workers is also correlated with reduced quality of care, including reduced patient safety and reduced treatment efficacy (12)(13)(14). Where clinicians are distressed and/or inadequately supported, their capacity to provide care in a timely, competent and compassionate manner is diminished (15).…”

Section: Introductionmentioning

confidence: 99%

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“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

2022

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Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female (n = 70, 81%). Most were veterinarians (n = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) (n = 18, 21%), veterinary nurses or animal health technicians (n = 10, 12%) and veterinary students (n = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32–52, n = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.

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Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

Gibson,

Brennan,

Oxtoby

et al. 2023

Veterinary Record

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BackgroundUnderstanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing.MethodsA qualitative exploration of UK veterinary practitioners’ experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique.ResultsQuestions surrounding acceptable boundaries of care, decision‐making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events.LimitationsThe qualitative nature of this study limits the generalisability of the findings.ConclusionsEthical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.

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Moral distress in medicine: An ethical analysis

Cited by 34 publications

References 82 publications

Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic

Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

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