Moral distress

2014 ◽  
Vol 22 (1) ◽  
pp. 131-152 ◽  
Author(s):  
Joan McCarthy ◽  
Chris Gastmans
Keyword(s):  
Moral Agency ◽  
Quantitative Research ◽  
Moral Distress ◽  
Empirical Literature ◽  
Professional Lives ◽  
Healthcare Provision ◽  
Original Definition ◽  
Structural Inequities ◽  
Academic Search ◽  
Different Sources

Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: We found that like the empirical literature, most authors in this review draw on Jameton’s original definition and describe moral distress in psychological–emotional–physiological terms. They also agree that moral distress is linked to the presence of some kind of constraint on nurses’ moral agency, and that it is best understood as a two-staged process that can intensify over time. There is also consensus that moral distress has an important normative meaning, although different views concerning the normative meaning of moral distress are expressed. Finally, the authors generally agree that moral distress arises from a number of different sources and that it (mostly) affects negatively on nurses’ personal and professional lives and, ultimately, harms patients. However, despite this consensus, many authors take issue with the way in which moral distress is conceptualized and operationalized. Moreover, while some worry that identifying nurses as a group of health professionals whose voices are ignored or marginalized might disempower nurses and encourage them to avoid their moral responsibilities, others take situations involving moral distress as indicative of more fundamental, structural inequities at the heart of contemporary healthcare provision. Conclusion: We conclude that research on moral distress in nursing is timely and important because it highlights the specifically moral labour of nurses. However, we suggest that significant concerns about the conceptual fuzziness and operationalization of moral distress also flag the need to proceed with caution.

scholarly journals Conceptualising Work-Related Moral Suffering—Exploring and Refining the Concept of Moral Distress in the Context of Social Work

2019 ◽  
Vol 50 (3) ◽  
pp. 741-757 ◽  
Author(s):  
Maija Mänttäri-van der Kuip
Keyword(s):  
Social Work ◽  
Moral Agency ◽  
Moral Distress ◽  
Empirical Literature ◽  
Front Line ◽  
Complex Dynamic ◽  
Work Related ◽  
Conceptual Clarity ◽  
Valid Instrument ◽  
Nursing Literature

Abstract In the nursing literature, work-related suffering due to restricted moral agency is commonly considered under the concept of moral distress. This concept has resonated strongly amongst nursing scholars since the 1980s and has recently gained ground amongst social work scholars as well. However, the research on moral distress suffers from inadequate conceptual clarity; this has led to multiple and disparate ways of empirically studying the phenomenon. This article examines the conceptualisations of moral distress applied in the nursing and social work literature and identifies and discusses the challenges and potential problems related to them. The article sheds light on the complex, dynamic and relative nature of the phenomenon, which has not been sufficiently acknowledged in the existing empirical literature. Despite its complexities and defects, as highlighted in this article, the concept of moral distress can serve as an important tool for understanding and analysing experiences of moral suffering in front line social work. However, defining this experience in all its complexity and devising a valid instrument to measure it remain a major challenge.

scholarly journals Moral distress: Ethically appropriate actions

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
E Maeckelberghe
Keyword(s):  
Moral Agency ◽  
Moral Distress ◽  
Original Description ◽  
Moral Integrity ◽  
Moral Question ◽  
The Right ◽  
The Given ◽  
Psychological Dimensions ◽  
Original Concept ◽  
Ethical Situation

Abstract Andrew Jameton in 1984 coined the concept of moral distress as: “knowing what to do in an ethical situation, but not being allowed to do it” This original description presupposes that the right moral act can be identified and precludes situations of doubt and uncertainty. The 1984 definition emphasizes barriers that make it impossible for someone to do what they ought to do. Whereas Jameton in a revision in 2013 of his original concept emphasized reduction of the psychological dimensions, Peter& Liaschenko stress the element of moral agency. Moral distress then is a threat to the moral integrity of the professional. This requires three-step ananlysis: first, what is the moral question?; two, what are morally adeguate answers to this question?; three, what ethically appropriate actions are under pressure in the given situation? This will be illustrated with examples from the COVID-19 pandemic.

scholarly journals Health system resilience: a literature review of empirical research

2020 ◽  
Vol 35 (8) ◽  
pp. 1084-1109
Author(s):  
Louise Biddle ◽  
Katharina Wahedi ◽  
Kayvan Bozorgmehr
Keyword(s):  
Health System ◽  
Mixed Methods Research ◽  
Quantitative Research ◽  
Empirical Studies ◽  
Disease Outbreaks ◽  
Building Blocks ◽  
Theoretical Work ◽  
Empirical Literature ◽  
Quantitative And Qualitative Research ◽  
System Resilience

Abstract The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. While substantial effort has gone into the conceptualization of health system resilience, there has been no review of how the concept has been operationalized in empirical studies. We conducted an empirical review in three databases using systematic methods. Findings were synthesized using descriptive quantitative analysis and by mapping aims, findings, underlying concepts and measurement approaches according to the resilience definition by Blanchet et al. We identified 71 empirical studies on health system resilience from 2008 to 2019, with an increase in literature in recent years (62% of studies published since 2017). Most studies addressed a specific crisis or challenge (82%), most notably infectious disease outbreaks (20%), natural disasters (15%) and climate change (11%). A large proportion of studies focused on service delivery (48%), while other health system building blocks were side-lined. The studies differed in terms of their disciplinary tradition and conceptual background, which was reflected in the variety of concepts and measurement approaches used. Despite extensive theoretical work on the domains which constitute health system resilience, we found that most of the empirical literature only addressed particular aspects related to absorptive and adaptive capacities, with legitimacy of institutions and transformative resilience seldom addressed. Qualitative and mixed methods research captured a broader range of resilience domains than quantitative research. The review shows that the way in which resilience is currently applied in the empirical literature does not match its theoretical foundations. In order to do justice to the complexities of the resilience concept, knowledge from both quantitative and qualitative research traditions should be integrated in a comprehensive assessment framework. Only then will the theoretical ‘resilience idea’ be able to prove its usefulness for the research community.

scholarly journals Improvements In Audit Report Lag And Reporting Timeliness: A Non-Event For Technology Advances

2011 ◽  
Vol 1 (2) ◽  
Author(s):  
David F. Bean ◽  
Richard A. Bernardi
Keyword(s):  
Financial Reporting ◽  
Research Study ◽  
Empirical Literature ◽  
Professional Lives ◽  
Audit Report ◽  
Font Size ◽  
Technological Advances ◽  
Reporting Delays ◽  
Arthur Andersen ◽  
Reporting Delay

<p class="MsoNormal" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-size: 10pt; mso-bidi-font-style: italic; mso-bidi-font-size: 12.0pt;"><span style="font-family: Times New Roman;">Technological advances have transformed the professional lives of all accountants.<span style="mso-spacerun: yes;">&nbsp; </span>Consequential expectations would include improvements in the timing of the audit report and the reporting of financial information.<span style="mso-spacerun: yes;">&nbsp; </span>There is a presumption in the empirical literature that audit report lag is a primary cause of financial reporting delay.<span style="mso-spacerun: yes;">&nbsp; </span>This empirical research study finds little or no change in the audit report lag and timeliness of reporting during the period 1996 to 2001.<span style="mso-spacerun: yes;">&nbsp; </span>Audit report lag appears to play a questionable role, if any, in financial reporting delays and other factors such as inertia and interest may be the major impediments to timely reporting.<span style="mso-spacerun: yes;">&nbsp; </span>Finally, given the financial atmosphere after the Enron-Arthur Andersen debacle, our research finds no difference among auditing firms for the variables examined.<span style="mso-spacerun: yes;">&nbsp; </span>While this could be interpreted in a positive manner, it could also indicate that all Big-5 firms potentially have similar problems.</span></span></p>

scholarly journals Corruption Perception Indices: A Comparative Analysis

2001 ◽  
Vol 40 (4II) ◽  
pp. 813-830 ◽  
Author(s):  
Naved Ahmad
Keyword(s):  
Comparative Analysis ◽  
Case Studies ◽  
Survey Data ◽  
Empirical Literature ◽  
Large Sample ◽  
Depth Analysis ◽  
Corruption Perception ◽  
Different Sources

The empirical literature on corruption has used data on corruption from three different sources: (i) investigative reports, (ii) newspapers, and (iii) surveys or questionnaire-based data. Some studies on corruption are based on case studies and newspaper reports. Studies by Wedeman (1997); Wade (1982) and Alam (1996) fall in this category. While these studies have presented an in-depth analysis of corruption, they do not examine a large sample of countries. Moreover, the investigative reports require detective work and sometimes connections with people in high echelons in order to expose corruption. Unlike investigative reports, access to survey data on corruption enables researchers to study corruption for a large sample of countries, but at the same time, raises questions about their subjectivity.1 However, the subjectivity of these indices is often justified on the ground that corruption is illegal in nature, and hard to measure directly.

scholarly journals Sustainable Transformation of Consumer Behavior—Vector Modeling in Determining the Decision to Choose a Medical Service in the Context of COVID-19

2021 ◽  
Vol 13 (23) ◽  
pp. 13025
Author(s):  
Raluca-Giorgiana (Popa) Chivu ◽  
Ionuț-Claudiu Popa ◽  
Adrian Mociu ◽  
Petre-Sorin Savin ◽  
Robert-Ionuț Popa ◽  
...  
Keyword(s):  
Consumer Behavior ◽  
Health Services ◽  
Quantitative Research ◽  
Behavioral Model ◽  
Point Of View ◽  
Medical Services ◽  
Small Samples ◽  
Healthcare Provision ◽  
Protection Measures ◽  
The Individual

Consumer behavior has been a topic of interest since ancient times, from the point of view of both the socio-human sciences (psychology, sociology) and the economy; the consumer is seen as a producer of income. With the emergence and development of services in the economic sphere, the consumer has become the beneficiary of those services, with the same role of generating revenue and profits for suppliers. In the field of healthcare provision, the analysis of consumer behavior is a delicate subject because there are no standard behavioral models (not only due to the confidentiality of information that does not allow data to be obtained by researchers but also due to individual particularities regarding the need for health services). Moreover, in the context of COVID-19, the attitude of their beneficiaries toward health services has changed compared to what experts have recorded in the past, as pandemic restrictions and fear of the new virus have led to changes in behavior and people’s decisions regarding health services. For this study, quantitative research was conducted, complemented by a conceptual, behavioral model, on the satisfaction levels of health service beneficiaries in the context of COVID-19. In this research, numerous variables were analyzed regarding the protection measures implemented by medical institutions whose services have benefited from the perceived urgency. The research was conducted in Romania on a sample of 100 people from the southeast region, in order to observe to what extent the analyzed factors inform their decisions. According to government statistics, only 80% of Romania’s population uses medical services. Given the sample size, the PLS-SEM method of analysis was used, which, according to the recommendations identified in the literature, is the most appropriate technique for small samples due to the individual method of analyzing the links between variables, leading to significant results. Technological evolution and the digitization of some procedures within the medical services (such as making online appointments and online or telephone consultations) represents only one factor analyzed in the process of determining the satisfaction levels of the beneficiaries of health services in the context of the COVID-19 pandemic.

scholarly journals Correlation between Lecturers’ Professional Development Activities and their Competencies in Maldives Higher Education Institutes

2021 ◽  
Vol 20 (9) ◽  
pp. 18-37
Author(s):  
Zuha Aishath ◽  
Intan Marfarrina Omar ◽  
Waheeda Aishath
Keyword(s):  
Higher Education ◽  
Professional Development ◽  
Quantitative Research ◽  
Empirical Literature ◽  
Full Time ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Higher Education System

The quality of higher education (HE) is one of the key areas the higher education system of the Maldives focuses on to develop and expand the sector. Two of the factors that contribute to and influence the quality of HE are professional development (PD) and lecturers’ competency. However, in the context of Maldives, although efforts are made in the area of PD, little to no research has been conducted in this area. Hence, the purpose of this study is to examine the relationship between lecturer PD activities and their competencies in Maldives’ higher education institutes. A quantitative research design was adopted, which conducted a cross-sectional survey by administering a structured online questionnaire. A total of 171 lecturers participated, which included both full-time and part-time lecturers from two public and two private institutions. Data analysis revealed that there is a weak positive correlation between PD activities and lecturers’ competency; rs(129)=0.232, p=0.008. It is also possible that PD activities conducted do not cater for the needs of lecturers, and a culture where structured and individual PD activities are supported and encouraged is not efficiently established. In light of these findings, it is important to strengthen and expand the existing PD policies and focus on providing effective PD sessions on topics and areas that are most needed for lecturers, rather than on generic topics. This study contributes to the empirical literature on PD in the context of Maldives and to the overall development of the HE sector.

scholarly journals Enhancing Nurse Moral Agency: The Leadership Promise of Doctor of Nursing Practice Preparation

2018 ◽  
Vol 23 (1) ◽  
Author(s):  
Pamela Grace
Keyword(s):  
Transformational Learning ◽  
Moral Agency ◽  
Ethics Education ◽  
Nursing Practice ◽  
Moral Distress ◽  
Good Practice ◽  
Nurse Leaders ◽  
Best Interests ◽  
Doctor Of Nursing Practice ◽  
Ethical Content

An expansive and growing body of literature documents the problem of nurses’ moral distress when they are unable to carry out actions that they perceive to be in the best interests of patients. Further, nurse leaders and educators are not always well prepared to help nurses to develop moral agency. Moral agency is the ability to provide good care and overcome obstacles to good practice. One reason for the lack of preparation is that ethics education in academia, and in ongoing nurse education, has been inconsistent or has focused more on dilemmas than the ubiquitous everyday practice issues. The purpose of this article is to discuss goals of the nursing profession, contemporary challenges to good nursing practice, and leadership from those educated as Doctors of Nursing Practice (DNP). The author argues that the proliferation of (DNP) programs, focused as they are on leadership in practice settings, presents a unique opportunity to prepare nurse leaders who are, first and foremost, skilled and knowledgeable about the ethical content of everyday nursing practice. An ‘ethics matrix’ is described and proposed as an essential base for DNP education upon which all other knowledge is built, with specific discussion of types of leadership and the relationship of transformational learning to transformational leadership.

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