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1.
Health Qual Life Outcomes ; 19(1): 120, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849571

RESUMO

OBJECTIVES: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). METHODS: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was conducted. RESULTS: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0-432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach's alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055-0.067]) and reliability (0.91 [95%CI, 0.89-0.92]) of the instrument. CONCLUSIONS: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.


Assuntos
Atenção à Saúde/ética , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Princípios Morais , Psicometria/normas , Inquéritos e Questionários/normas , Traduções , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Análise Fatorial , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , Estresse Psicológico
2.
J Clin Ethics ; 30(4): 314-317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851622

RESUMO

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one's under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.


Assuntos
Pessoal de Saúde/psicologia , Princípios Morais , Autonomia Pessoal , Profissionalismo/ética , Estresse Psicológico , Atitude do Pessoal de Saúde , Ética Profissional , Feminino , Humanos
3.
AJOB Empir Bioeth ; 10(2): 113-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31002584

RESUMO

BACKGROUND: As ongoing research explores the impact of moral distress on health care professionals (HCPs) and organizations and seeks to develop effective interventions, valid and reliable instruments to measure moral distress are needed. This article describes the development and testing of a revision of the widely used Moral Distress Scale-Revised (MDS-R) to measure moral distress. METHODS: We revised the MDS-R by evaluating the combined data from 22 previous studies, assessing 301 write-in items and 209 root causes identified through moral distress consultation, and reviewing 14 recent publications from various professions in which root causes were described. The revised 27-item scale, the Measure of Moral Distress for Healthcare Professionals (MMD-HP), is usable by all HCPs in adult and pediatric critical, acute, or long-term acute care settings. We then assessed the reliability of the MMD-HP and evaluated construct validity via hypothesis testing. The MMD-HP, Hospital Ethical Climate Survey (HECS), and a demographic survey were distributed electronically via Qualtrics to nurses, physicians, and other health care professionals at two academic medical centers over a 3-week period. RESULTS: In total, 653 surveys were included in the final analysis. The MMD-HP demonstrated good reliability. The four hypotheses were supported: (1) MMD-HP scores were higher for nurses (M 112.3, SD 73.2) than for physicians (M 96.3, SD 54.7, p = 0.023). (2) MMD-HP scores were higher for those considering leaving their position (M 168.4, SD 75.8) than for those not considering leaving (M 94.3, SD 61.2, p < 0.001). (3) The MMD-HP was negatively correlated with the HECS (r = -0.55, p < 0.001). (4) An exploratory factor analysis revealed a four-factor structure, reflective of patient, unit, and system levels of moral distress. CONCLUSIONS: The MMD-HP represents the most currently understood causes of moral distress. Because the instrument behaves as would be predicted, we recommend that the MMD-HP replace the MDS-R.


Assuntos
Pessoal de Saúde/psicologia , Princípios Morais , Estresse Ocupacional , Inquéritos e Questionários , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Reprodutibilidade dos Testes
4.
Am J Nurs ; 118(5): 50-59, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29698279

RESUMO

: This article presents the discussion that occurred during a policy dialogue on aid in dying (AID) presented at the American Academy of Nursing's annual conference in October 2016. Panelists explored the arguments for and against the growing state expansion of AID legislation, and the role for nurses in assisting patients who request AID. Recommendations are offered and four expert commentaries respond to the points raised.


Assuntos
Papel do Profissional de Enfermagem , Defesa do Paciente , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal/normas , American Nurses' Association , Congressos como Assunto , Humanos , Autonomia Profissional , Estados Unidos
6.
HEC Forum ; 29(2): 127-143, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28070806

RESUMO

Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the "presenting problem" may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution's ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral distress.


Assuntos
Atitude do Pessoal de Saúde , Atenção à Saúde/ética , Princípios Morais , Estresse Psicológico/etiologia , Ética Médica , Humanos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta
7.
Am J Bioeth ; 16(12): 15-17, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27901420
8.
Hastings Cent Rep ; 46 Suppl 1: S22-7, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27649915

RESUMO

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called "moral spaces," reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings.


Assuntos
Comissão de Ética , Ética Institucional , Princípios Morais , Eticistas , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Liderança , Qualidade da Assistência à Saúde , Estados Unidos
9.
J Crit Care ; 31(1): 178-82, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26596697

RESUMO

PURPOSE: To determine which demographic characteristics are associated with moral distress in intensive care unit (ICU) professionals. METHODS: We distributed a self-administered, validated survey to measure moral distress to all clinical personnel in 13 ICUs in British Columbia, Canada. Each respondent to the survey also reported their age, sex, and years of experience in the ICU where they were working. We used multivariate, hierarchical regression to analyze relationships between demographic characteristics and moral distress scores, and to analyze the relationship between moral distress and tendency to leave the workplace. RESULTS: Response rates to the surveys were the following: nurses--428/870 (49%); other health professionals (not nurses or physicians)--211/452 (47%); physicians--30/68 (44%). Nurses and other health professionals had higher moral distress scores than physicians. Highest ranked items associated with moral distress were related to cost constraints and end-of-life controversies. Multivariate analyses showed that age is inversely associated with moral distress, but only in other health professionals (rate ratio [95% confidence interval]: -7.3 [-13.4, -1.2]); years of experience is directly associated with moral distress, but only in nurses (rate ratio (95% confidence interval):10.8 [2.6, 18.9]). The moral distress score is directly related to the tendency to leave the ICU job, in both the past and present, but only for nurses and other non-physician health professionals. CONCLUSION: Moral distress is higher in ICU nurses and other non-physician professionals than in physicians, is lower with older age for other non-physician professionals but greater with more years of experience in nurses, and is associated with tendency to leave the job.


Assuntos
Atenção à Saúde/ética , Unidades de Terapia Intensiva/estatística & dados numéricos , Corpo Clínico Hospitalar/psicologia , Princípios Morais , Adulto , Fatores Etários , Atitude do Pessoal de Saúde , Colúmbia Britânica , Feminino , Humanos , Satisfação no Emprego , Masculino , Corpo Clínico Hospitalar/ética , Pessoa de Meia-Idade , Análise Multivariada , Estresse Psicológico , Inquéritos e Questionários
10.
Hastings Cent Rep ; 45(3): 33-40, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25944207

RESUMO

Courage is indispensable. Telling caregivers they must be courageous in difficult circumstances is sometimes a back-handed endorsement of oppression, however.


Assuntos
Coragem , Teoria Ética , Ética Institucional , Relações Enfermeiro-Paciente/ética , Cultura Organizacional , Relações Médico-Paciente/ética , Estresse Psicológico/etiologia , Virtudes , Formação de Conceito , Empatia , Ética Médica , Ética em Enfermagem , Humanos , Obrigações Morais , Moral , Negociação
11.
J Nurs Scholarsh ; 47(2): 117-25, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25440758

RESUMO

PURPOSE: Moral distress is a phenomenon affecting many professionals across healthcare settings. Few studies have used a standard measure of moral distress to assess and compare differences among professions and settings. DESIGN: A descriptive, comparative design was used to study moral distress among all healthcare professionals and all settings at one large healthcare system in January 2011. METHODS: Data were gathered via a web-based survey of demographics, the Moral Distress Scale-Revised (MDS-R), and a shortened version of Olson's Hospital Ethical Climate Scale (HECS-S). FINDINGS: Five hundred ninety-two (592) clinicians completed usable surveys (22%). Moral distress was present in all professional groups. Nurses and other professionals involved in direct patient care had significantly higher moral distress than physicians (p = .001) and other indirect care professionals (p < .001). Moral distress was negatively correlated with ethical workplace climate (r = -0.516; p < .001). Watching patient care suffer due to lack of continuity and poor communication were the highest-ranked sources of moral distress for all professional groups, but the groups varied in other identified sources. Providers working in adult or intensive care unit (ICU) settings had higher levels of moral distress than did clinicians in pediatric or non-ICU settings (p < .001). Providers who left or considered leaving a position had significantly higher moral distress levels than those who never considered leaving (p < .001). Providers who had training in end-of-life care had higher average levels of moral distress than those without this training (p = .005). CONCLUSIONS: Although there may be differences in perspectives and experiences, moral distress is a common experience for clinicians, regardless of profession. CLINICAL RELEVANCE: Moral distress is associated with burnout and intention to leave a position. By understanding its root causes, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care, staff satisfaction, and retention.


Assuntos
Atitude do Pessoal de Saúde , Atenção à Saúde/ética , Corpo Clínico Hospitalar/psicologia , Princípios Morais , Estresse Psicológico/etiologia , Adolescente , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Assistência Terminal , Local de Trabalho/normas , Adulto Jovem
12.
J Nurs Care Qual ; 28(2): 153-61, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23222195

RESUMO

Medical errors are a substantial problem in health care. Understanding the effect of medical errors on health care providers as the "second victims" is necessary to maintain safe, quality patient care for the good of both patients and providers. We report an integrative literature review of the effect of medical errors on nurses. A model derived from the findings illustrates the concept of nurses' experience of medical errors. Specific recommendations for improving that experience are offered.


Assuntos
Atitude do Pessoal de Saúde , Esgotamento Profissional/psicologia , Erros de Medicação/psicologia , Recursos Humanos de Enfermagem/psicologia , Recursos Humanos de Enfermagem/normas , Humanos , Erros de Medicação/prevenção & controle , Segurança do Paciente
13.
HEC Forum ; 24(1): 39-49, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22476738

RESUMO

Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. Corley et al. (2001) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007; Schwenzer and Wang 2006). Other scholars have proposed variations on Jameton's core definition (Sporrong et al. 2006, 2007), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006), ethics stress (Raines 2000), and stress of conscience (Glasberg et al. 2006). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered.


Assuntos
Ética Clínica , Pessoal de Saúde/psicologia , Obrigações Morais , Estresse Psicológico/etiologia , Inquéritos e Questionários , Pesquisa Empírica , Ética em Enfermagem , Humanos , Recursos Humanos de Enfermagem/ética , Recursos Humanos de Enfermagem/psicologia , Pesquisa Qualitativa , Estresse Psicológico/prevenção & controle , Estados Unidos
15.
Virtual Mentor ; 12(1): 6-11, 2010 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-23140776
16.
Account Res ; 16(2): 78-105, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19353387

RESUMO

Most U.S. clinical trials are funded by industry. Opportunities exist for sponsors to influence research in ways that jeopardize research objectivity. The purpose of this study was to survey U.S. medical school faculty to assess financial arrangements between investigators and industry to learn about investigators' first hand knowledge of the effects of industry sponsorship on research. Here we show first-hand knowledge that compromises occurred in: research participants' well-being (9%), research initiatives (35%), publication of results (28%), interpretation of research data (25%), and scientific advancement (20%) because of industry support. Financial relationships with industry were prevalent and considered important to conducting respondents' research.


Assuntos
Pesquisa Biomédica/economia , Conflito de Interesses/economia , Ética em Pesquisa , Indústrias , Apoio à Pesquisa como Assunto/ética , Adulto , Pesquisa Biomédica/ética , Pesquisa Biomédica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Apoio à Pesquisa como Assunto/economia , Apoio à Pesquisa como Assunto/normas , Inquéritos e Questionários , Estados Unidos
18.
Crit Care Med ; 35(2): 422-9, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17205001

RESUMO

OBJECTIVE: To explore registered nurses' and attending physicians' perspectives on caring for dying patients in intensive care units (ICUs), with particular attention to the relationships among moral distress, ethical climate, physician/nurse collaboration, and satisfaction with quality of care. DESIGN: Descriptive pilot study using a survey design. SETTING: Fourteen ICUs in two institutions in different regions of Virginia. SUBJECTS: Twenty-nine attending physicians who admitted patients to the ICUs and 196 registered nurses engaged in direct patient care. INTERVENTIONS: Survey questionnaire. MEASUREMENTS AND MAIN RESULTS: At the first site, registered nurses reported lower collaboration (p<.001), higher moral distress (p<.001), a more negative ethical environment (p<.001), and less satisfaction with quality of care (p=.005) than did attending physicians. The highest moral distress situations for both registered nurses and physicians involved those situations in which caregivers felt pressured to continue unwarranted aggressive treatment. Nurses perceived distressing situations occurring more frequently than did physicians. At the second site, 45% of the registered nurses surveyed reported having left or considered leaving a position because of moral distress. For physicians, collaboration related to satisfaction with quality of care (p<.001) and ethical environment (p=.004); for nurses, collaboration was related to satisfaction (p<.001) and ethical climate (p<.001) at both sites and negatively related to moral distress at site 2 (p=.05). Overall, registered nurses with higher moral distress scores had lower satisfaction with quality of care (p<.001), lower perception of ethical environment (p<.001), and lower perception of collaboration (p<.001). CONCLUSIONS: Registered nurses experienced more moral distress and lower collaboration than physicians, they perceived their ethical environment as more negative, and they were less satisfied with the quality of care provided on their units than were physicians. Provider assessments of quality of care were strongly related to perception of collaboration. Improving the ethical climate in ICUs through explicit discussions of moral distress, recognition of differences in nurse/physician values, and improving collaboration may mitigate frustration arising from differences in perspective.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Morte , Comportamento Cooperativo , Morte , Unidades de Terapia Intensiva/ética , Enfermeiras e Enfermeiros , Doenças Profissionais , Relações Médico-Enfermeiro , Médicos , Estresse Psicológico , Inquéritos e Questionários , Adulto , Humanos , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Projetos Piloto , Estresse Psicológico/epidemiologia
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