Navigating the Liminal State Between Life and Death: Clinician Moral Distress and Uncertainty Regarding New Life-Sustaining Technologies

Dzeng, Elizabeth

doi:10.1080/15265161.2016.1265172

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Some included articles adopt Jameton’s definition, which assumes the physician has knowledge of the right course of action but is unable to follow through with that course of action 1 2 32 34 85–164…”

Section: Resultsmentioning

confidence: 99%

“…In answering its primary and secondary research questions, this SSR in SEBA suggests that physicians’ concepts of MD extends beyond Jameton’s notion of ‘(A) the psychological distress of; (B) being in a situation in which one is constrained from acting and (C) on what one knows to be right ’ 1 2 6–10 32 34 85–118 120–123 125–164. Indeed this SSR in SEBA reveals that physicians also include contextual, practice, environmental, cultural, community and institutional factors, resource limitations and allocations, quality of care and ethical dilemmas2 33 108 117 118 125 132 138 143 148 180 186 and personal factors including feelings of powerlessness and ‘attacks’ on their integrity,89 99 106 113 personal values,116 professional codes172 and existential beliefs105 139 166 171 as situational constructs that shape their personal constructs within their rings of personhood 3 38.…”

Section: Discussionmentioning

confidence: 99%

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Systematic scoping review on moral distress among physicians

et al. 2022

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BackgroundConcepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.MethodsA systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.ResultsA total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.ConclusionsInitial reviews suggest that MD involves conflicts within a physician’s personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician’s personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician’s MD and preventing burn-out.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic scoping review on moral distress among physicians

et al. 2022

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“…Associated systemic forces include a lack of time and decision-making heuristics that favor treating individual organ systems as they fail rather than a more holistic approach. The allure of new technologies in combination with patients’ fear of death results in ever-escalating interventions where the goal of person-centeredness is forgotten for the sake of longevity 33,38,39 .…”

Section: Discussionmentioning

confidence: 99%

Homing in on the Social: System-Level Influences on Overly Aggressive Treatments at the End of Life

Dzeng

Dohan

Curtis

et al. 2018

Journal of Pain and Symptom Management

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“…troubling trends and to build the needed capacity within the profession to address ethical challenges and meet the needs of complex clinical patient care. [33][34][35]…”

Section: E3mentioning

confidence: 99%

Mindful Ethical Practice and Resilience Academy: Equipping Nurses to Address Ethical Challenges

Rushton

Reller²,

Skarupski

et al. 2021

American Journal of Critical Care

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Background Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care. Objectives To examine the impact of a longitudinal, experiential educational curriculum to enhance nurses’ skills in mindfulness, resilience, confidence, and competence to confront ethical challenges in clinical practice. Methods A prospective repeated-measures study was conducted before and after a curricular intervention at 2 hospitals in a large academic medical system. Intervention participants (192) and comparison participants (223) completed study instruments to assess the objectives. Results Mindfulness, ethical confidence, ethical competence, work engagement, and resilience increased significantly after the intervention. Resilience and mindfulness were positively correlated with moral competence and work engagement. As resilience and mindfulness improved, turnover intentions and burnout (emotional exhaustion and depersonalization) decreased. After the intervention, nurses reported significantly improved symptoms of depression and anger. The intervention was effective for intensive care unit and non–intensive care unit nurses (exception: emotional exhaustion) and for nurses with different years of experience (exception: turnover intentions). Conclusions Use of experiential discovery learning practices and high-fidelity simulation seems feasible and effective for enhancing nurses’ skills in addressing moral adversity in clinical practice by cultivating the components of moral resilience, which contributes to a healthy work environment, improved retention, and enhanced patient care.

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Navigating the Liminal State Between Life and Death: Clinician Moral Distress and Uncertainty Regarding New Life-Sustaining Technologies

Cited by 6 publications

References 10 publications

Systematic scoping review on moral distress among physicians

Systematic scoping review on moral distress among physicians

Homing in on the Social: System-Level Influences on Overly Aggressive Treatments at the End of Life

Mindful Ethical Practice and Resilience Academy: Equipping Nurses to Address Ethical Challenges

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