Understanding ethical climate, moral distress, and burnout: a novel tool and a conceptual framework

Dzeng, Elizabeth; Curtis, J. Randall

doi:10.1136/bmjqs-2018-007905

Cited by 83 publications

(69 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a previous study, paediatric oncologists describe that they on a daily basis face difficult decisions that they prefer not to take by themselves [40]. The increased survival rate and the never-ending availability of non-standard treatment options in paediatric oncology has made the decisions even more difficult [3]. Furthermore, the practice of shared decision-making with the patients or proxy has been suggested to further increase the moral distress among physicians [41].…”

Section: Discussionmentioning

confidence: 99%

Important situations that capture moral distress in paediatric oncology

2020

View full text Add to dashboard Cite

Background: The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology. Methods: In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. Results: Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21.Conclusion: In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.

show abstract

Section: Discussionmentioning

confidence: 99%

Important situations that capture moral distress in paediatric oncology

2020

View full text Add to dashboard Cite

show abstract

“…The impact that this unique environment can have on healthcare professionals is being increasingly recognized [3][4][5]. Challenging ethical situations, exposure to high patient mortality and difficult daily workloads can lead to excessive stress for those caring for critically ill patients [3,6,7]. A growing body of literature suggests that this excessive stress and resultant moral distress can lead to burnout syndrome.…”

Section: Introductionmentioning

confidence: 99%

Burnout and Joy in the Profession of Critical Care Medicine

2020

View full text Add to dashboard Cite

show abstract

“…However, when the treatment is no longer beneficial for the patient, decisions to withdraw or withhold LST must be considered. 1,2 This decision-making process is complex and challenging. [3][4][5][6] A decision to withdraw or withhold LST is based on information about the patient´s medical prognosis regarding acute disease and any comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Swedish intensivists’ experiences and attitudes regarding end‐of‐life decisions

Syrous

Ågård

Redfors

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background To make end‐of‐life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists’ experiences and attitudes regarding the decision‐making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists’ experiences, beliefs and attitudes regarding decision‐making pertaining to EOL decisions. Second, we aimed to identify underlying factors that may contribute to variability in the decision‐making process. Method This is a descriptive, qualitative study. Semi‐structured interviews with nineteen intensivists from five different Swedish hospitals, with different ICU levels, were performed from 1 February 2017 to 31 May 2017. Results Intensivists strive to make end‐of‐life decisions that are well‐grounded, based on sufficient information. Consensus with the patient, family and other physicians is important. Concurrently, decisions that are made with scarce information or uncertain medical prognosis, decisions made during on‐call hours and without support from senior consultants cause concern for many intensivists. Underlying factors that contribute to the variability in decision‐making are lack of continuity among senior intensivists, lack of needed support during on‐call hours and disagreements with physicians from other specialties. There is also an individual variability primarily depending on the intensivist's personality. Conclusion Swedish intensivists’ wish to make end‐of‐life decisions based on sufficient information, medically certain prognosis and consensus with the patient, family, staff and other physicians. Swedish intensivists’ experience a variability in end‐of‐life decisions, which is generally accepted and not questioned.

show abstract

Understanding ethical climate, moral distress, and burnout: a novel tool and a conceptual framework

Cited by 83 publications

References 52 publications

Important situations that capture moral distress in paediatric oncology

Important situations that capture moral distress in paediatric oncology

Burnout and Joy in the Profession of Critical Care Medicine

Swedish intensivists’ experiences and attitudes regarding end‐of‐life decisions

Contact Info

Product

Resources

About