Moral Distress: Using Mindfulness-Based Stress Reduction Interventions to Decrease Nurse Perceptions of Distress

Vaclavik, Elizabeth Ann; Staffileno, Beth A.; Carlson, Elizabeth

doi:10.1188/18.cjon.326-332

Cited by 33 publications

(33 citation statements)

References 20 publications

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“…24 Social work-led reflective debriefing, mindfulness-based stress reduction, moral empowerment programs, and supportive ethical climate are also associated with lower moral distress among critical care nurses. [25][26][27] Physician trainees have reported that being notified of and discussing patient deaths and participating in death rounds helped them cope with moral distress. 22 Austin et al propose an interdisciplinary approach to education of nurses and other clinicians that encourages better understanding of others' experiences of moral distress.…”

Section: Discussionmentioning

confidence: 99%

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Bender

Andrilla

Sharma

et al. 2019

Am J Hosp Palliat Care

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Context: Providing nonbeneficial care at the end of life and delays in initiating comfort care have been associated with provider and nurse moral distress. Objective: Evaluate provider and nurse moral distress when using a comfort care order set and attitudes about timing of initiating comfort care for hospitalized patients. Methods: Cross-sectional survey of providers (physicians, nurse practitioners, and physician assistants) and nurses at 2 large academic hospitals in 2015. Providers and nurses were surveyed about their experiences providing comfort care in an inpatient setting. Results: Two hundred five nurse and 124 provider surveys were analyzed. A greater proportion of nurses compared to providers reported experiencing moral distress “some, most, or all of the time” when using the comfort care order set (40.5% and 19.4%, respectively, P = .002). Over 60% of nurses and providers reported comfort care was generally started too late in a patient’s course, with physician trainees (81.4%), as well as providers (80.9%) and nurses (84.0%) < 5 years from graduating professional school most likely to report that comfort care is generally started too late. Conclusions: The majority of providers and nurses reported that comfort care was started too late in a patient’s course. Nurses experienced higher levels of moral distress than providers when caring for patients using a comfort care order set. Further research is needed to determine what is driving this moral distress in order to tailor interventions for nurses and providers.

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Section: Discussionmentioning

confidence: 99%

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Bender

Andrilla

Sharma

et al. 2019

Am J Hosp Palliat Care

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“…Being able to make sense of the harshness of work may therefore be considered a protective factor to keep vocation alive and feel gratified, including in lack of (explicit) gratitude [58][59][60]. Personal balance and a solid philosophy of life are considered protective factors among nurses and medical doctors [61][62][63], including at the stage of education [64]. One interviewee reported how passion helped him to make sense of job challenges daily, to the extent of accepting and being aware of the physical consequences.…”

Section: External Pressure Vs Individual Balancementioning

confidence: 99%

“…This is confirmed by many contributions in literature. Primary care physicians receive fewer claims when their patients feel listened to [69]; nurses can accept more easily aggressive behaviors from patients when they are non-intentional [56], suspending the dichotomy between good and wrong, which is a factual example of the so-called "mindfulness" [62]; relatives can accept more easily the worsening of their beloved's health conditions when they are aware that it is not related to negligence from operators [70]; when the operators are aware of the patients' suffering, the latter may release part of their frustration [71]; sharing one's frustration with colleagues is a convenient release-valve [72,73].…”

Section: Sharing Daily Vs Accumulating Frustrationmentioning

confidence: 99%

Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

et al. 2021

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Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences.

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“…Auch die schriftliche Reflexion eigener klinischer Erfahrungen kann zur Identifikation von MoS beitragen [26,29]. Achtsamkeitstraining hat darüber hinaus das Potenzial, sich positiv auf die Wahrnehmung von MoS auszuwirken [41].…”

Section: A) Hilfe Zur Selbsthilfeunclassified

Moralischer Stress bei Medizinstudierenden und ärztlichen Berufseinsteigenden: Forschungsdesiderate im Rahmen der COVID-19-Pandemie

Kuehlmeyer

Kühn

Knochel

et al. 2020

Bundesgesundheitsbl

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Zusammenfassung Hintergrund Die COVID-19-Pandemie stellt Menschen, die in der medizinischen Versorgung arbeiten, vor besondere Herausforderungen. Ein Teil der Medizinstudierenden und ärztlichen Berufseinsteigenden, die in dieser Zeit in Einrichtungen der Gesundheitsversorgung ihre Mitarbeit beginnen, wird mit außergewöhnlichen moralischen Herausforderungen konfrontiert. Einige verfügen noch nicht über ausreichend Bewältigungsmöglichkeiten, um adäquat mit diesen Herausforderungen umzugehen. Dies kann zu sogenanntem moralischen Stress (MoS; Englisch: „moral distress“, MoD) führen. Dauerhafte oder intensive Belastung durch MoS kann gravierende Folgen haben. Geeignete Unterstützungsangebote haben das Potenzial, den Umgang mit MoS zu verbessern. Ziel Der Beitrag hat das Ziel, einen Überblick über den Stand der Forschung zu MoS von Medizinstudierenden und ärztlichen Berufseinsteigenden zu geben, um Lehrende mit Aus- und Weiterbildungsverantwortung und Ärzt*innen in Leitungspositionen für die Problematik zu sensibilisieren. Hauptteil In diesem Beitrag werden das wissenschaftliche Konzept MoS, bekannte Auslöser sowie Präventions- und Interventionsmöglichkeiten vorgestellt. Dazu wird das Thema Bezug nehmend auf die Veränderungen in der Patientenversorgung im Kontext der COVID-19-Pandemie analysiert und es werden Forschungsdesiderate aufgezeigt. Fazit Der Beitrag verdeutlicht die Notwendigkeit eines deutschsprachigen, interdisziplinären Diskurses über MoS bei Medizinstudierenden und Berufseinsteigenden.

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Moral Distress: Using Mindfulness-Based Stress Reduction Interventions to Decrease Nurse Perceptions of Distress

Cited by 33 publications

References 20 publications

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

Moralischer Stress bei Medizinstudierenden und ärztlichen Berufseinsteigenden: Forschungsdesiderate im Rahmen der COVID-19-Pandemie

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