scholarly journals Moral injury in healthcare professionals: A scoping review and discussion

2021 ◽  
pp. 096973302096677
Author(s):  
Anto Čartolovni ◽  
Minna Stolt ◽  
P Anne Scott ◽  
Riitta Suhonen
Keyword(s):  
Moral Distress ◽  
Empirical Studies ◽  
Moral Injury ◽  
Existential Suffering ◽  
Moral Residue ◽  
Literature Searches ◽  
Scoping Literature Review ◽  
As Stress ◽  
Stress Of Conscience ◽  
Bear Witness

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.

Physician moral injury in the context of moral, ethical and legal codes

2021 ◽  
pp. medethics-2021-107225
Author(s):  
Philip Day ◽  
Jennifer Lawson ◽  
Sneha Mantri ◽  
Abhi Jain ◽  
David Rabago ◽  
...  
Keyword(s):  
Medical Practice ◽  
Moral Distress ◽  
Codes Of Ethics ◽  
Professional Associations ◽  
Moral Injury ◽  
Systematic Change ◽  
Ethical Codes ◽  
Validity Tests

After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything.The current research seeks to develop the construct of moral injury outside military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics.

The Role of Psilocybin-Assisted Psychotherapy to Support Patients With Cancer: A Critical Scoping Review of the Research

2021 ◽  
pp. 089801012110390
Author(s):  
Rebecca H. Lehto ◽  
Megan Miller ◽  
Jessica Sender
Keyword(s):  
Mental Health ◽  
Health Issues ◽  
Mushroom Species ◽  
Patients With Cancer ◽  
Existential Suffering ◽  
Vulnerable Patients ◽  
Scoping Literature Review ◽  
Life Threatening ◽  
Self Transcendence

Treatments for addressing psychiatric mental health issues in vulnerable patients with cancer are established. Yet, many patients persist with unrelenting psychological difficulties despite intervention. There is growing interest in the role of psilocybin-assisted psychotherapy for managing treatment-resistant mental health challenges in patients with cancer. Psilocybin is a naturally occurring compound derived from certain mushroom species that can induce entheogenic experiences or an altered state of consciousness. Reed's Self-Transcendence Theory provides a holistic lens to examine existential concerns and mental health in individuals who perceive their illness as potentially life threatening, such as those with cancer. This scoping literature review used Arksey and O’Malley's template to evaluate research examining psilocybin-assisted psychotherapy for patients with cancer. Eight articles met inclusion/exclusion criteria (four quantitative, two mixed methods, and two qualitative). Review findings indicated that the majority of patient experiences were positive, centering on themes of death acceptance, reflection, and broadened spirituality. Although psilocybin-assisted psychotherapy is in early stages of clinical testing, it thus shows promise for carefully screened patients with cancer who have persistent existential suffering. It will be critical for investigators to tailor this emerging intervention to select patients and for clinicians to be engaged in assessment of outcomes and efficacy.

scholarly journals Identifying approaches for synthesizing and summarizing information to support informed citizen deliberations in health policy: a scoping review

2019 ◽  
Vol 25 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Michael G Wilson ◽  
Aditya Nidumolu ◽  
Inna Berditchevskaia ◽  
Francois-Pierre Gauvin ◽  
Julia Abelson ◽  
...  
Keyword(s):  
Health Policy ◽  
Scoping Review ◽  
Empirical Studies ◽  
Grey Literature ◽  
Policy Issue ◽  
Optimal Strategies ◽  
Policy Issues ◽  
Stakeholder Perspectives ◽  
Literature Searches ◽  
Citizen Deliberation

Objective Public deliberations are an increasingly popular tool to engage citizens in the development of health policies and programmes. However, limited research has been conducted on how to best synthesize and summarize information on health policy issues for citizens. To begin to address this gap, our aim was to map the literature on the preparation of information to support informed citizen deliberations related to health policy issues. Methods We conducted a scoping review where two reviewers screened the results of electronic database searches, grey literature searches and hand searches of organizational websites to identify empirical studies, scholarly commentaries, and publicly available organizational documents focused on synthesizing and summarizing information to inform citizen deliberation about health policy issues. Two reviewers categorized each included document according to themes/topics of deliberation, purpose of deliberation and the form of deliberation, and developed a summary of the key findings related to synthesizing and summarizing information to support informed citizen deliberations. Results There was limited reporting about whether and how information was synthesized. Evidence was typically organized based on the source used (e.g. by comparing the views of stakeholders or experts) or according to the areas that policymakers need to consider when making decisions (e.g. benefits, harms, costs and stakeholder perspectives related to policy options). Information was presented primarily through written materials (e.g. briefs and brochures), audiovisual resources (e.g. videos or presentations from stakeholders), but some interactive presentation approaches were also identified (e.g. through interactive arts-based approaches). Conclusions The choice and framing of information to inform citizen deliberations about health policy can strongly influence their understanding of a policy issue, and has the potential to impact the discussions and recommendations that emerge from deliberations. Our review confirmed that there remains a dearth of literature describing methods of the preparation of information to inform citizen deliberations about health policy issues. This highlights the need for further exploration of optimal strategies for citizen-friendly approaches to synthesizing and summarizing information for deliberations.

scholarly journals Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

2019 ◽  
Vol 10 (2) ◽  
pp. 136-144 ◽  
Author(s):  
Paulo Rodrigues ◽  
Johan Menten ◽  
Chris Gastmans
Keyword(s):  
Systematic Review ◽  
Empirical Studies ◽  
Sufficient Conditions ◽  
Clinical Intervention ◽  
Palliative Sedation ◽  
Related Factors ◽  
Existential Suffering ◽  
Synthesis Methodology ◽  
Meta Analyses ◽  
Necessary And Sufficient

BackgroundPalliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians’ perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention.AimTo gain deeper insight into physicians’ perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.DesignSystematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology.Data sourcesSeven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians’ perceptions of PS-ES.ResultsThe search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians’ perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified.ConclusionsTo date, there is still no consensus on physicians’ perceptions of PS-ES. Further research is necessary to understand factors that influence physicians’ perceptions and philosophical-ethical presuppositions underlying this perceptions.

Organizational ethics: A literature review

2011 ◽  
Vol 18 (3) ◽  
pp. 285-303 ◽  
Author(s):  
Riitta Suhonen ◽  
Minna Stolt ◽  
Heli Virtanen ◽  
Helena Leino-Kilpi
Keyword(s):  
Literature Review ◽  
Moral Distress ◽  
Empirical Studies ◽  
Organizational Ethics ◽  
Ethical Challenges ◽  
Healthcare Organizations ◽  
Cross Sectional ◽  
Ethical Climates ◽  
Conceptual Clarity ◽  
Large Research

The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.

Midwifery students’ reactions to ethical dilemmas encountered in outpatient clinics

2020 ◽  
Vol 27 (7) ◽  
pp. 1542-1555
Author(s):  
Serap Ejder Apay ◽  
Ayşe Gürol ◽  
Elif Yağmur Gür ◽  
Sarah Church
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Professional Ethics ◽  
Ethics Education ◽  
Moral Distress ◽  
Ethical Dilemmas ◽  
Empirical Studies ◽  
Intrauterine Device ◽  
Health Science ◽  
Written Information

Background: Midwives are required to make ethical decisions with the support of respective codes of professional ethics which provide a framework for decision making in clinical practice. While each midwife should be ethically aware and sensitive to the ever-changing issues within reproduction, few empirical studies have examined the views of student midwives in relation to reproductive ethical dilemmas. Objective: The aim of this study was to explore midwifery students’ reactions to a number of ethical dilemmas relating to women’s experiences of reproductive decision making. Design: A series of focus groups were conducted with midwifery students who were asked to discuss five culturally significant scenarios including issues of knowledge acquisition regarding methods of family planning, removal or insertion of an intrauterine device, and abortion. Setting: A University in Turkey was the setting for this study. Participants: Purposeful sampling was adopted which resulted in five focus groups with a total of 57 midwifery students. Ethical considerations: The study was reviewed and granted formal ethical approval by an ethical committee at the Faculty of Health Science in Atatürk University. The head of the Faculty of Health Science approved the investigation. The participants received both oral and written information about the study and they gave their consent. Results: Five themes were identified from the analysis of the focus group data related to all five scenarios. These themes were ‘the right to information’, ‘choice and protection’, ‘parental rights and welfare of the women’, ‘make a decision’ and ‘women rights and sexual abuse’. Conclusion: This study has shown that while students respected women’s choice, they also expressed great ambivalence in some situations when personal values conflict with dominant societal beliefs and professional ethics. A focus on ethics education to include human rights is suggested as a means to enable students to explore their own social-value judgements, and as a means to limit the possible development of ethical confusion and moral distress.

Evidence-Based Human Factors Guidelines for PowerPoint Presentations

2011 ◽  
Vol 19 (3) ◽  
pp. 4-8 ◽  
Author(s):  
Francis T. Durso ◽  
Vlad L. Pop ◽  
John S. Burnett ◽  
Eric J. Stearman
Keyword(s):  
Human Factors ◽  
Empirical Studies ◽  
Choosing Wisely ◽  
Evidence Based ◽  
Bear Witness

For decades, the vehicle of choice for idea transfer has been Microsoft’s PowerPoint. PowerPoint gives the orator a plethora of options in the design of a presentation. Choosing configurations for the most effective presentation can prove daunting, and even professional presentations bear witness to the difficulty of choosing wisely. Guidelines based on a collection of basic human factors/ergonomics principles and a few empirical studies are presented for effective PowerPoint presentations.

When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates

2016 ◽  
Vol 22 (1) ◽  
pp. 51-67 ◽  
Author(s):  
Giulia Lamiani ◽  
Lidia Borghi ◽  
Piergiorgio Argentero
Keyword(s):  
Ethical Climate ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Psychological Empowerment ◽  
Empirical Studies ◽  
Psychological Characteristics ◽  
Job Retention ◽  
Preventive Interventions ◽  
The Right ◽  
Do The Right Thing

Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians’ wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.

scholarly journals Ethical Dilemmas, Moral Distress, and the Risk of Moral Injury

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Colleen M. Farrell ◽  
Bradley J. Hayward
Keyword(s):  
Moral Distress ◽  
Ethical Dilemmas ◽  
Moral Injury
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