Moral distress in veterinarians

2019 ◽  
Vol 185 (20) ◽  
pp. 631-631 ◽  
Author(s):  
Alejandra I Arbe Montoya ◽  
Susan Hazel ◽  
Susan M Matthew ◽  
Michelle L McArthur
Keyword(s):  
Healthcare Professionals ◽  
Moral Distress ◽  
Mental Health Problems ◽  
Psychological State ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Limited Data ◽  
Medical Field ◽  
Modifying Factors ◽  
Distress Scale

Moral distress is a psychological state of anguish that has been widely studied in healthcare professionals. Experiencing moral distress can lead to problems including avoidance of patients and increased staff turnover. Moral distress in veterinarians has not yet been explored to the extent seen in the human medical field, and there is limited data regarding moral distress in veterinarians. However, it is expected to be prevalent in these professionals. So far, it has been reported that veterinarians commonly experience moral conflict, ethical challenges and ethical dilemmas during their career. These conflicts in association with other modifying factors such as personality traits can lead to the experience of moral distress. In a profession with known levels of occupational stress and reported mental health problems, exploring the area of moral distress and its effects on the professional wellbeing of veterinarians is important. Further studies such as developing a moral distress scale to measure this issue are needed in order to evaluate the incidence of this problem in veterinary professionals. Furthermore, assessing a possible relationship between moral distress, mental illness and attrition in veterinarians would be useful in developing intervention strategies to minimise the experience of moral distress and its associated negative consequences in veterinarians.

scholarly journals Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039463
Author(s):  
Ramin Asgary ◽  
Katharine Lawrence
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Moral Distress ◽  
Unintended Consequences ◽  
Aid Effectiveness ◽  
International Agency ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Humanitarian Operations

IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.

scholarly journals Analytical study of care quality and moral distress in clinical situations and patient care

2019 ◽  
Vol 6 (4) ◽  
pp. 327-334
Author(s):  
Masoumeh Hasanlo ◽  
Arezo Azarm ◽  
Parvaneh Asadi ◽  
Kourosh Amini ◽  
Hossein Ebrahimi ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Analytical Study ◽  
Moral Distress ◽  
Professional Competence ◽  
Care Quality ◽  
Nursing Profession ◽  
Ethical Challenges ◽  
Significant Difference ◽  
Distress Scale

Abstract Objective Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality. Methods In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13. Results Investigating moral distress domains (ignoring patient, decision-making power, and professional competence) and care quality domains (psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain (P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical (bodily), and communication domains of care quality. Conclusions Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decision-making domains, improve the professional competence, and pay attention to patients.

Moral distress in paediatric oncology: Contributing factors and group differences

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2351-2363 ◽  
Author(s):  
Pernilla Pergert ◽  
Cecilia Bartholdson ◽  
Klas Blomgren ◽  
Margareta af Sandeberg
Keyword(s):  
Healthcare Professionals ◽  
Moral Distress ◽  
Ethical Issues ◽  
Paediatric Oncology ◽  
National Study ◽  
Ethical Review ◽  
Contributing Factors ◽  
High Turnover ◽  
Scale Scores ◽  
Distress Scale

Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care.

Development and evaluation of a moral distress scale

2001 ◽  
Vol 33 (2) ◽  
pp. 250-256 ◽  
Author(s):  
Mary C. Corley ◽  
R. K. Elswick ◽  
Martha Gorman ◽  
Theresa Clor
Keyword(s):  
Moral Distress ◽  
Distress Scale

scholarly journals Ethical considerations at the end-of-life care

2021 ◽  
Vol 9 ◽  
pp. 205031212110009
Author(s):  
Melahat Akdeniz ◽  
Bülent Yardımcı ◽  
Ethem Kavukcu
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Healthcare Professionals ◽  
Ethical Decision Making ◽  
Biomedical Ethics ◽  
Artificial Nutrition ◽  
Life Care ◽  
Ethical Challenges ◽  
Physician Assisted Suicide

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

Moral distress in undergraduate nursing students

2019 ◽  
Vol 26 (7-8) ◽  
pp. 2325-2339 ◽  
Author(s):  
Simoní Saraiva Bordignon ◽  
Valéria Lerch Lunardi ◽  
Edison Luiz Devos Barlem ◽  
Graziele de Lima Dalmolin ◽  
Rosemary Silva da Silveira ◽  
...  
Keyword(s):  
Nursing Students ◽  
Undergraduate Students ◽  
Moral Distress ◽  
Intensity Level ◽  
Linear Regression Models ◽  
Design Data ◽  
Cross Sectional ◽  
Undergraduate Nursing Students ◽  
Undergraduate Nursing ◽  
Distress Scale

Background: Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints. Objectives: To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil. Method: Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil answering the scale. The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models. Ethical considerations: Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande. Findings: The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000). Conclusion: The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician.

Researching moral distress among New Zealand nurses

2014 ◽  
Vol 22 (1) ◽  
pp. 117-130 ◽  
Author(s):  
Martin Woods ◽  
Vivien Rodgers ◽  
Andy Towers ◽  
Steven La Grow
Keyword(s):  
New Zealand ◽  
Nurse Educators ◽  
Moral Distress ◽  
Response Rate ◽  
Ethical Considerations ◽  
Optimal Care ◽  
Adequate Response ◽  
Human Ethics ◽  
Distress Scale ◽  
Service Managers

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

Ethical challenges when using coercion in mental healthcare: A systematic literature review

2016 ◽  
Vol 25 (1) ◽  
pp. 92-110 ◽  
Author(s):  
Marit Helene Hem ◽  
Elisabeth Gjerberg ◽  
Tonje Lossius Husum ◽  
Reidar Pedersen
Keyword(s):  
Patient Autonomy ◽  
Moral Distress ◽  
Mental Healthcare ◽  
Healthcare Personnel ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Best Interest ◽  
Ethical Considerations ◽  
Search Terms ◽  
Healthcare It

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress.

Gender and the experience of moral distress in critical care nurses

2014 ◽  
Vol 22 (1) ◽  
pp. 32-42 ◽  
Author(s):  
Christopher B O’Connell
Keyword(s):  
Gender Differences ◽  
Critical Care ◽  
Gender Difference ◽  
Intent To Leave ◽  
Moral Distress ◽  
Psychological Symptoms ◽  
Research Question ◽  
Critical Care Nurses ◽  
Underrepresented Groups ◽  
Distress Scale

Background: Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether. Research question: Do significant gender differences exist in the moral distress scores of critical care nurses? Research design: This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores. Participants and research context: Participants ( n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale–Revised online over a 5-day period in July 2013. Ethical considerations: Institutional review board review approved the study, and accessing and completing the survey implied informed consent. Findings: The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low. Discussion: The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress. Conclusion: Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups.

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