Moral distress in rehabilitation professionals: results from a hospital ethics survey.

OBJECTIVE: Moral distress in the rehabilitation setting was examined in a follow-up survey. The survey had 3 goals: (1) to systematically and anonymously gather data about the ethical issues that employees struggle with in their daily work; (2) to raise the visibility of the hospital-based ethics program and resources available to employees; and (3) to prioritize and focus the direction of the program's educational seminars, quality improvement projects, and ethics consultation. DESIGN: Online survey of employees. SETTING: Urban rehabilitation system of care. PARTICIPANTS: The survey was open to all employees; 207 completed the survey. INTERVENTIONS: N/A MAIN OUTCOME MEASUREMENTS: N/A CONCLUSIONS: Three broad categories of moral distress were identified: institutional ethics, professional practice, and clinical decision-making. Institutional ethics issues related to the health care environment, such as health care reimbursement pressures and corporate culture. Professional practice issues involved codes of behavior and concepts of professionalism, including patient confidentiality/privacy. Clinical decision-making included such practical dilemmas as conflicts around goal-setting, discharge planning, and assessment of decision-making capacity. An anonymous survey of staff members allowed the hospital ethics program to identify sources of moral distress and prioritize strategies to address them.

Ashley X.

The recent case of Ashley X has sparked much recent public debate and controversy, and raises critical questions for physiatrists and rehabilitation professionals. The case came to light when Gunther and Diekema published an article in the October 2006 issue of Archives of Pediatric and Adolescent Medicine describing a novel growth attenuation treatment for Ashley X, a 6-yr-old girl with developmental disabilities. Her parents also published a blog about Ashley, with detailed explanations for their rationale in choosing this treatment on behalf of Ashley which involved beliefs about her future and quality of life. Ashley's parents refer to the series of interventions as the Ashley Treatment in their blog, and this phrase has also been adopted by the popular press and others who have commented on the case. In this article we present an analysis of the Ashley X treatment and use a disability ethics approach to examine the perspectives of various stakeholders involved, including Ashley and other girls with extensive disabilities, parents, physicians, and bioethics committees. We conclude with critical questions for physiatrists and other disability specialists who are in a unique position to examine medical controversies involving people with disabilities.

Feeding tubes: three perspectives.

Percutaneous endoscopic gastrostomy tubes, or PEG tubes, look innocuous enough-narrow, plastic, pliable tubes, that when inserted into the stomach protrude approximately 3 to 5 inches and can be attached to a bag of liquid food. How can something so seemingly straightforward create so much controversy and evoke such intense emotion? It seems that part of the answer lies in the fact that nobody sees the same thing when they look at a feeding tube. This article will present three different views of gastrostomy tubes and challenge practitioners to think beyond traditional models.

Ethics, family caregivers, and stroke.

Even though stroke caregivers provide valuable care to loved ones, often sacrificing their own life goals and sometimes their health, they are frequently viewed by stroke professionals as irritants or problems. Medical training and medical bioethics literature focus almost exclusively on the physician-patient relationship, which leaves family members with uncertain standing. A family-centered approach allows providers to acknowledge and respect caregivers' needs without sacrificing patients' interests or authority.

Assessment of the needs of the young stroke survivor.

As part of program planning efforts by the RIC Stroke Team, convenience samples of 100 young (<60 years old) stroke survivors and 65 referring physicians were surveyed to determine the unique needs ofthis patient group. The correlation between survivors' and physicians' rankings of programs/activities value was not significant. Survivors ranked exercise/fitness, education/information, individual counseling, stress management, and recreation/social programs as the five most valuable programs. Physicians ranked education/ information, individual counseling, sexual, vocational, and family adjustment programs as the five most valuable. Other comparisons and program planning implications are analyzed and discussed.