Moral Distress: What Are We Measuring?

Kolbe, Laura; Melo‐Martín, Inmaculada de

doi:10.1080/15265161.2022.2044544

Cited by 38 publications

(18 citation statements)

References 69 publications

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“…However, there is a certain consensus that “illegitimate constraints on individuals’ moral agency” constitute a hallmark of moral distress. Unfortunately, existing measurement tools cannot determine with certainty, whether the assessed subjective feeling of moral distress results from such an illegitimate constraint, and whether the distress experienced is correctly classified as moral (Kolbe and Melo-Martin 2022 ). Therefore, those tools do not allow a reliable normative judgment about the action(s) of a person.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, from a dialogical ethics point of view, subjective moral intuitions of stakeholders can be considered as relevant information and contribution to solving ethical issues (Abma et al 2009 ). Furthermore, considering the negative impact moral distress can have on mental health and job satisfaction of healthcare workers, subjectively experienced moral distress might be of relevance regardless of its cause or normative evaluation (Kolbe and de Melo Martin 2022 ).…”

Section: Discussionmentioning

confidence: 99%

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Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey

Sommerlatte

Lugnier

Schoffer

et al. 2023

J Cancer Res Clin Oncol

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Purpose There is evidence for mental burden and moral distress among healthcare workers during the pandemic. However, there is scarcity of analyses regarding possible correlations of mental burden and moral distress in this context. This study provides data to quantify mental burden and possible associations with moral distress among physicians and nurses working in oncology in Germany. Methods We conducted a cross-sectional online survey with physicians and nurses working in oncology in Germany between March and July 2021. Next to sociodemographic characteristics and working conditions, mental burden and moral distress were assessed using standardized instruments. Binary multivariate logistic regression using the enter method was performed in order to explore the relationship between mental burden and moral distress. Results 121 physicians and 125 nurses were included in the study. Prevalence of clinically relevant depressive symptoms, anxiety, somatic symptoms, burnout symptoms and moral distress was 19.2, 14.5, 12.7, 46.0 and 34.7% in physicians and 41.4, 24.0, 46.8, 46.6 and 60.0% in nurses respectively. Mental burden was significantly associated with moral distress, being female/diverse, younger age < 40 and increase in workload. Nurses who felt sufficiently protected from COVID-19 reported significantly less moral distress. Conclusion To improve pandemic resilience, there is a need to ensure safe working environment including psychosocial support. Further evidence on risk and protective factors for moral distress is needed to be able to develop and implement strategies to protect healthcare workers within and beyond the pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey

Sommerlatte

Lugnier

Schoffer

et al. 2023

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

show abstract

“…Another weakness is that the scope of this study is limited by its design, as the correlational nature of this study precludes causal inferences. Moreover, the MDS‐R itself has attracted criticism, despite its widespread popularity 37 . While Kolbe & de Melo‐Martin 37 argue that the instrument overestimates moral distress, it is important to bear in mind that even the opposite is possible.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the MDS‐R itself has attracted criticism, despite its widespread popularity 37 . While Kolbe & de Melo‐Martin 37 argue that the instrument overestimates moral distress, it is important to bear in mind that even the opposite is possible. Isolated situations generate only low MDS‐R scores due to the low frequencies, but they can nevertheless be extremely morally distressing when they do happen, and cause intention to leave or result in sick leave.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the MDS-R itself has attracted criticism, despite its widespread popularity. 37 39 The MMD-HP describes even situations not included in the MDS, for example, compromised care due to demands for excessive documentation, that was found to be the most frequent cause of moral distress among pediatric residents and hospitalists in a recent study. 40 However, to allow comparisons between study sites, the MDS-R was applied throughout the present study, after it had been modified for the target population.…”

Section: Study Limitationsmentioning

confidence: 99%

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Moral distress and ethical climate in pediatric oncology care impact healthcare professionals' intentions to leave

et al. 2023

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Objective To assess perceptions of ethical climate, experiences of moral distress, and intentions to leave among healthcare professionals in Nordic pediatric oncology care. Methods A cross‐sectional survey with registered nurses, physicians, and nursing assistants at 20 Nordic pediatric cancer centers. Data were collected by using translated versions of the Swedish Hospital Ethical Climate Survey‐Shortened and the Swedish Moral Distress Scale‐Revised. Descriptive analyses and non‐parametric tests were used to describe, summarize, and compare data. Results According to 543 healthcare professionals (response rate 58%), the ethical climate in Nordic pediatric oncology care was positive. Inadequate staffing levels, poor continuity and lack of time were the most common causes of moral distress. Registered nurses experienced significantly higher levels of moral distress compared to physicians and nursing assistants. About 6% of the respondents considered leaving due to moral distress. Typically, they assessed the ethical climate as less positive and reported higher levels of moral distress than those who had no intention to leave. Conclusions Organizational actions that ensure safe staffing levels and improve the continuity of care are needed to prevent moral distress and high staff turnover.

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Clinician Moral Distress: Toward an Ethics of Agent‐Regret

Kim,

Shelton,

Applewhite

2023

Hastings Center Report

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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.

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Moral Distress: What Are We Measuring?

Cited by 38 publications

References 69 publications

Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey

Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey

Moral distress and ethical climate in pediatric oncology care impact healthcare professionals' intentions to leave

Clinician Moral Distress: Toward an Ethics of Agent‐Regret

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