A Closer Look at Health Care Providers' Moral Distress Regarding the Withdrawal of Artificial Nutrition and Hydration

2016 ◽  
Vol 7 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Kari Esbensen
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
Artificial Nutrition ◽  
Care Providers ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration

Knowledge, Attitudes, and Beliefs of Physicians and Other Health Care Providers Regarding Artificial Nutrition and Hydration at the End of Life

2018 ◽  
Vol 31 (7) ◽  
pp. 1121-1133 ◽  
Author(s):  
Roschelle Heuberger ◽  
Helen Wong
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Artificial Nutrition ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Advanced Dementia ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Eol Care

Objective: Despite the growing evidence against artificial nutrition and hydration (ANH) use among patients with advanced dementia, little is known about the perspectives of the health care team. This study examined the knowledge, attitudes, and beliefs of physicians and other health care providers regarding the use of ANH at the end of life (EOL). Methods: A cross-sectional survey explored the provision of EOL care using a hypothetical case scenario of a patient with advanced dementia and dysphagia. Questionnaire items were analyzed using parametric and nonparametric approaches. Results: In this sample of 323 respondents, statistical significance was found between physicians and other health care providers’ views on ANH and its related beneficial effects or health outcomes in EOL care. Discussion: Results indicate knowledge deficits in physicians and other health care professionals and highlight the need for comprehensive continuing education programs on EOL topics. Conclusion: Differences in knowledge, attitudes and beliefs regarding ANH in EOL among healthcare providers were observed and education regarding evidence based clinical guidelines are necessary.

scholarly journals Voluntary Refusal of Foods and Fluids: A Comparative Survey Across Health Disciplines (P12-044-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Roschelle Heuberger ◽  
Jessie Zenchak ◽  
Cody Stankowicz
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Human Subjects ◽  
Artificial Nutrition ◽  
Technological Advancement ◽  
Care Providers ◽  
Geriatric Population ◽  
Cross Sectional ◽  
Artificial Nutrition And Hydration ◽  
Animal Populations

Abstract Objectives To compare differences in attitudes, beliefs and knowledge of Voluntary Refusal of Foods and Fluids among disciplines and health care providers. This project is of a comparative nature in keeping with One Health paradigms, and the first of its kind. Methods A cross-sectional, incentivized, email survey of human health care providers, veterinary personnel, professional caregivers and lay persons. Questionnaire development through sequential focus groups of experts in palliative care was validated, piloted and revised accordingly. Data was acquired through Qualtrics, and analyzed with Nvivo and SPSS. Descriptives, correlations and regressions were employed, along with other non-parametric methods for analyses. The research was approved by IRB and Human Subjects Committees at the primary institution where the research was conducted. Results The demographics significantly correlated with parameters of Voluntary Refusal of Foods and Fluids (VRFF) were religiosity, education and profession. Interestingly, geographic locale, method of Artificial Nutrition and Hydration (ANH), and “patient wishes” were not influential. There was a lack of uniformity in decision-making. Age was inversely related to institution of ANH in VRFF (P < 0.001). Veterinary personnel showed far greater fiscal conservancy for treatment of VRFF (P < 0.01), and were more willing to try ANH with poor prognoses (P < 0.05) versus human healthcare providers. Caregivers were far more likely to oppose intervention in patients with VRFF (P < .0.01). Conclusions Etiology leading to VRFF was most important, as was experience with health care, death, ethics and technological advancement. Limitations include inability to show causality with cross sectional data. Further research on end of life decisions is required in light of the burgeoning geriatric population worldwide among both the human and companion animal populations. It is of great importance to conduct cross disciplinary research when an area of study is in its infancy, as is the case with VRFF. Funding Sources The project was funded through a foundation grant from Bridges to a Cure.

Truth Telling as an Element of Culturally Competent Care at End of Life

2016 ◽  
Vol 28 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Margaret L. Rising
Keyword(s):  
Health Care ◽  
Latin American ◽  
Health Care Providers ◽  
Moral Distress ◽  
The United States ◽  
Biomedical Ethics ◽  
Cultural Humility ◽  
Care Providers ◽  
Truth Telling ◽  
Intercultural Interactions

Purpose: Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm. Design: Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility. Implications for Practice: By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness.

scholarly journals Stress, Resilience and Moral Distress among Health Care Providers During COVID-19 Pandemic

Esculapio ◽  
2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ahmed Latif ◽  
◽  
Sobia Yaqub ◽  
Qudsia Anwar Dar ◽  
Umer Sultan Awan ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
High Stress ◽  
Care Providers ◽  
Online Questionnaire ◽  
Stress Resilience ◽  
Stress Scale ◽  
Distress Score ◽  
The Mean

Objective: This study aims to determine level of stress, resilience and moral distress among health care providers during covid-19 pandemic. Methods: This is a cross-sectional study performed using an online questionnaire. Data was collected from Health Care Providers, working in various tertiary care hospitals of Lahore, using an online questionnaire. Perceived stress scale (PSS), Connor-Davidson Resilience Scale (CD-RISC 10) and Moral Distress Thermometer were used to determine level of stress, resilience and moral stress respectively among the HCPs. Scores on the PSS can range from 0 to 40 with scores of 0-13, 14-26 and 27-40 being considered as low, moderate and high stress respectively. The Moral Distress Thermometer has scores ranging from 0-10 with value of ≥4 considered high. Data was analyzed using SPSS version.23.Descriptive variables were reported as means and frequencies. Intergroup analysis was done using Chi square test with p<0.05 taken as significant. Results: A total of 278 (n=278) HCPs participated in study. According to the PSS (Perceived Stress Scale) scores, 5.03% (14) reported low, 86.69% (241) moderate and 8.27% (23) high stress levels. The mean stress score is 21.56+/-4.32. Providing patient care (mean = 2.28+/-1.15 SD) and transmitting infection to others (mean = 3.02+/-1.10 SD) were deemed major causes of stress. The mean CD-RISC score was 23.14+/-7.81 SD. Only 10.8% (30) had a score of ≥ 32. The mean Moral Distress score was 4.2+/-2.98 SD, with 53.2% (149) participants reporting high Moral distress (score ≥4). Conclusion: The high level of stress among HCPs during COVID-19 pandemic highlights the need of urgent measures to overcome this psychological issue which if left un-addressed can affect performance of HCPs. Key Words: Stress, Resilience, HCPs How to cite: Latif A., Yaqub S., Dar A.Q., Awan S.U., Farhat Hina., Khokhar A.M., Stress, Resilience and Moral Distress among Health care Providers during COVID-19 pandemic. Esculapio 2021;17 (01):79-82

The ethics of interprofessional collaboration

2013 ◽  
Vol 20 (4) ◽  
pp. 426-435 ◽  
Author(s):  
Joyce Engel ◽  
Dawn Prentice
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
Ethical Issues ◽  
Interprofessional Collaboration ◽  
Care Providers ◽  
Quality Health Care ◽  
Health Care Outcomes ◽  
Quality Health ◽  
Interprofessional Competencies

Interprofessional collaboration has become accepted as an important component in today’s health care and has been guided by concerns with patient safety, quality health-care outcomes, and economics. It is widely accepted that interprofessional collaboration improves patient outcomes through enhanced communication among health-care providers and increased accessibility to services. Although there is a paucity of research that provides confirmatory evidence, interprofessional competencies continue to be incorporated into the curricula of health-care students. This article examines the ethics of interprofessional collaboration and ethical issues that arise from the mainstream adoption of interprofessional competencies and the potential for moral distress in nursing.

Moral distress among health care workers in the intensive care unit; a systematic review and meta-analysis

2021 ◽  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Care Providers ◽  
Distress Scale

Background: The effect of moral distress among healthcare providers is significant on disease morbidity, especially within the intensive care unit (ICU). In this systematic review and meta-analysis, we aimed to gather all evidence regarding moral distress frequency and severity/intensity among ICU health care providers. Methods: We conducted a systematic search to gather all relevant studies from six databases, followed by a manual search of references. Fourteen studies consisting of 5905 participants were included in the final moral distress scale analyses. Results: Overall, there was moderate moral distress severity/intensity among all participants (Mean = 27.79; 95% confidence interval (CI) = 7.40–64.18). On further stratification of the results according to countries, Canada (Mean = 91.99; 95% CI = 80.10–105.65) and USA (Mean = 52.54; 95% CI = 44.78–61.64) showed the highest distress scores, followed by Iran (Mean = 21.20; 95% CI = 7.21–62.30) and Italy (Mean = 3.42; 95% CI = 3.15–3.72). Studies conducted in high income-earning countries reported more severity/intensity (Mean = 22.65; 95% CI = 6.58–78.02) compared to those in the upper-middle income-earning ones (Mean = 18.89; 95% CI = 2.80–127.34). There was significant heterogeneity among the included studies, which could not be explained by the difference in scales, country of the participants, or the female proportion. Moreover, there was a moderate frequency of moral distress (Mean = 46.83; 95% CI = 8.34–262.87), which was found to be much higher (Mean = 87.94; 95% CI = 83.55–92.57), in performing analysis. Conclusion: Moral distress is a major problem in the ICU setting, in terms of both severity/intensity and frequency. Future large-scale studies are required, through a unified framework, to develop appropriate interventions to address ICU-related moral distress.

scholarly journals Ethical and Social Issues for Health Care Providers in the Intensive Care Unit during the Early Stages of the COVID-19 Pandemic in Japan: a Questionnaire Survey

2021 ◽  
Author(s):  
Yusuke Seino ◽  
Yayoi Aizawa ◽  
Atsushi Kogetsu ◽  
Kazuto Kato
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Medical Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
Social Issues ◽  
Free Text ◽  
Care Providers

AbstractThis questionnaire-based observational study was conducted in July 2020 with the aim of understanding the ethical and social issues faced by health care providers (HCPs) registered with the Japanese Society of Intensive Care Medicine in intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic. There were 200 questionnaire respondents, and we analyzed the responses of 189 members who had been involved in COVID-19 treatment in ICUs. The ethical and social issues that HCPs recognized during the pandemic were difficulties in the decision-making process with patients’ families, limitations of life-sustaining treatment, lack of palliative care, and inadequate mental support for patients’ families and HCPs. Regarding decision-making on issues of clinical ethics during the pandemic, more than half of the respondents thought they had failed to provide sufficient palliative care to patients and responded that they experienced moral distress. The free-text responses on moral distress revealed issues such as unusual treatment and care, restricted visits, challenging situations for HCPs, and psychological burden. Additionally, 38.1% of respondents experienced episodes of social prejudice or discrimination and 4.7% experienced a shortage of medical resources. Our study result shows that the moral distress of HCPs was caused by difficulties in patient-centered decision-making and insufficient medical care to patients and their families. These were caused mainly by a lack of communication due to the stronger implementation of infection control measures. We believe that it is important to address ethical and social issues during a pandemic in order to provide appropriate medical care and prevent burnout among HCPs.

scholarly journals Moral distress in health care professionals

2017 ◽  
Vol 86 (2) ◽  
pp. 32-34
Author(s):  
Ann Marie Corrado ◽  
Monica L Molinaro
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Moral Distress ◽  
Professional Judgment ◽  
Care Providers ◽  
Course Of Action ◽  
Systemic Factors ◽  
To Come ◽  
The Right

Thousands of health care providers currently live and practice in Canada,1 and each day these providers are presented with new situations from their patients and clients. Many of these situations require much contemplation, and often both personal and professional judgment is used to come to a conclusion. In many cases, the decision-making process becomes difficult due to personal and professional beliefs, as well as institutional and legal requirements placed upon the health care provider. This phenomenon, known as moral distress, is “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action”.2 This work provides a brief introduction to the topic of moral distress, the systemic factors that can lead to the development of moral distress, how it manifests in health care providers, and coping mechanisms used by health care providers to manage their moral distress.

Nurses' Moral Sensitivity and Hospital Ethical Climate: a Literature Review

2008 ◽  
Vol 15 (3) ◽  
pp. 304-321 ◽  
Author(s):  
Jessica Schluter ◽  
Sarah Winch ◽  
Kerri Holzhauser ◽  
Amanda Henderson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Ethical Climate ◽  
Moral Distress ◽  
Ethical Dilemmas ◽  
Quality Care ◽  
Empirical Literature ◽  
Care Providers ◽  
Nurse Turnover ◽  
Review Question

Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement.

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