The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States

Beck, Jimmy; Falco, Carla; O'Hara, Kimberly; Bassett, Hannah K.; Randall, Cameron L.; Cruz, Stephanie; Hanson, Janice L.; Dean, Wendy; Senturia, Kirsten

doi:10.1080/10401334.2022.2056740

Cited by 13 publications

(19 citation statements)

References 41 publications

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“…The means of an individual unit to impact workforce deployment and healthcare delivery system may be limited to its organization's resources and policies. Therefore, organizational and system-level actions may be needed to mitigate moral distress 10,31 and to ensure safe staffing levels, adequate workloads and continuity of care.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Agarwal et al 38 found that the quantity of work (being excessive and inefficient) and content of work (being clerical and incongruous with education) contributed to low professional fulfillment and burnout. Beck et al 39 reinforced that the collection of endless metrics and burdensome use of EHRs contributed to MI and distress. In addition, clinicians experience moral distress from the administrative burden of the EHR, resulting from less time spent with patients and the complexity of each encounter.…”

Section: Task-oriented Versus Patient-oriented Carementioning

confidence: 99%

“…39 Beck et al describe clinicians struggling with autonomy when management dictates decisionmaking hierarchy and which actions are valued instead of those caring for patients. 39 Beck et al also found that decisions made without clinician influence siphoned necessary resources away from patient care. 39 Whether at the bedside or in outpatient settings, algorithmic care is often devoid of critical thinking and individualizing decisions for patient care.…”

Section: Lack Of Autonomy and Decision-makingmentioning

confidence: 99%

“…39 Beck et al also found that decisions made without clinician influence siphoned necessary resources away from patient care. 39 Whether at the bedside or in outpatient settings, algorithmic care is often devoid of critical thinking and individualizing decisions for patient care. Algorithmic care can contribute to MI by indiscriminately and aggressively providing treatment.…”

Section: Lack Of Autonomy and Decision-makingmentioning

confidence: 99%

“…Healthcare workers in the United States can suffer moral distress when the healthcare system's medical norm is to do as much as possible to and for a patient when inaction might be more appropriate. 39 These moral stressors and PMIEs include when further testing does not change medical management, inaction is the patient's preference, or action will cause more harm than good.…”

Section: Lack Of Autonomy and Decision-makingmentioning

confidence: 99%

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Examining moral injury in clinical practice: A narrative literature review

et al. 2023

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Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs.

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