Re-defining moral distress: A systematic review and critical re-appraisal of the argument-based bioethics literature

2019 ◽  
Vol 14 (4) ◽  
pp. 195-210
Author(s):  
Christine Sanderson ◽  
Linda Sheahan ◽  
Slavica Kochovska ◽  
Tim Luckett ◽  
Deborah Parker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Moral Distress ◽  
Large Body ◽  
Institutional Constraints ◽  
Multiple Perspectives ◽  
Course Of Action ◽  
Local Practices ◽  
Conceptual Problems ◽  
The Right

The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. We found that moral distress is most frequently framed around individual experiences of distress in relation to local practices and constraints, and understood in terms of power relations and workplace hierarchies. This understanding is directly derived from, and often still seen as specific to, nursing. Frequently the perspective of the morally distressed individual is privileged. Understandings of moral distress have evolved towards an ‘occupational health approach’, with the assumption that moral distress should be measured and prevented. Counter-perspectives were identified, highlighting conceptual problems. Based on our review, we propose a redefinition of moral distress: ‘Ethical unease or disquiet resulting from a situation where a clinician believes they have contributed to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values’. This definition is specific enough for research use, anchored in clinicians’ professional responsibilities and concerns about harms to patients, framed relationally rather than hierarchically, and amenable to multiple perspectives on any given morally distressing situation.

Free Speech, Civility, and Censorship in Education

2016 ◽  
Author(s):  
Josh Corngold
Keyword(s):  
Free Speech ◽  
Educational Institutions ◽  
Multiple Perspectives ◽  
Forthcoming Article ◽  
Student Speech ◽  
Academic Mission ◽  
Course Of Action ◽  
Legitimate Target ◽  
The Right ◽  
Complex Subject

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Education. Please check back later for the full article. Besides being protected by the First Amendment, the right of students and faculty to express divergent opinions—even discomfiting opinions—is central to the academic mission of schools, colleges, and universities. Two familiar Millian arguments underscore this point. First, the dynamic clash of contrary ideas offers the best prospect we have of arriving at the “whole truth” about any complex subject. Second, unless it is subject to periodic questioning and critique, any established and received bit of wisdom “will be held in the manner of a prejudice with little comprehension or feeling of its rational grounds.” These arguments notwithstanding, anyone who has ever spent time in classrooms knows that educators sometimes curtail student speech. Can such conduct be justified in educational institutions dedicated to free and open inquiry and the examination of multiple perspectives? In mundane cases, student speech is suppressed for the sake of minimizing disruptions and maintaining order and efficiency in the classroom—as when the teacher cuts off a particularly loquacious student in order to allow others to get a word in, or a tangent-prone student in order to keep the discussion on point and avoid protracted digressions, etc. Even the most ardent defender of free speech must concede that censorship, in such cases, is necessary for the effective functioning of the educational environment. A more complex and philosophically interesting set of cases involves educators who silence students for the sake of civility. Granted, when the speech in question involves personally targeted insults, gratuitous put-downs, and the like, the rationale for censorship seems unassailable. But what about speech that is strictly relevant to the topic under consideration, doesn’t descend to the level of direct, personal invective, and yet, nevertheless, denigrates members of some widely stigmatized group—e.g., a student’s declaration, during a discussion of the Supreme Court’s recent same-sex marriage ruling, that homosexuality is aberrant and a legitimate target of deterrent legislation? Is silencing this kind of utterance the appropriate course of action for educators? Or are the interests of all parties better served by permitting such views to be expressed and discussed openly in the classroom?

Nurses’ perceptions of and responses to morally distressing situations

2012 ◽  
Vol 19 (4) ◽  
pp. 488-500 ◽  
Author(s):  
Colleen Varcoe ◽  
Bernie Pauly ◽  
Jan Storch ◽  
Lorelei Newton ◽  
Kara Makaroff
Keyword(s):  
Ethical Climate ◽  
Moral Distress ◽  
System Level ◽  
Institutional Constraints ◽  
Limited Attention ◽  
Considerable Effort ◽  
Effect Change ◽  
Course Of Action ◽  
Nurses Perceptions ◽  
Conceptual Work

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change.

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.

scholarly journals L’infermiere e la percezione del Moral Distress nella cura del fine vita nel paziente dializzato

2022 ◽  
Vol 34 ◽  
pp. 10-13
Author(s):  
Elena Brioni ◽  
Nadia Pennacchio ◽  
Giulia Villa ◽  
Noemi Giannetta ◽  
Cristiano Magnaghi ◽  
...  
Keyword(s):  
End Of Life ◽  
Complex Disease ◽  
Nursing Practice ◽  
Moral Distress ◽  
Dialysis Patients ◽  
Emotional Challenges ◽  
Disease Trajectory ◽  
Course Of Action ◽  
The Right

The phenomenon of Moral Distress in nursing practice is described as a situation of suffering that arises when the nurse recognizes the ethically appropriate action to be taken and yet institutional impediments make it impossible for him to follow the right course of action. Dialysis patients often have a complex disease trajectory that sometimes involves professional and emotional challenges for staff, especially at the end of life. The objective of this review is to identify which strategies are useful for preserving emotional integrity and awareness in operational settings, for the benefit of both operators and patients.  

Moral distress: A concept clarification

2020 ◽  
Vol 27 (4) ◽  
pp. 1127-1146
Author(s):  
Sadie Deschenes ◽  
Michelle Gagnon ◽  
Tanya Park ◽  
Diane Kunyk
Keyword(s):  
Policy Development ◽  
Moral Distress ◽  
Large Body ◽  
Institutional Constraints ◽  
Internal Constraints ◽  
Nursing Literature ◽  
Antecedents And Consequences ◽  
Definition Of ◽  
The Individual ◽  
The Relationship

Background Over the past few decades, moral distress has been examined in the nursing literature. It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature. This lack of cohesion has led to complications for study of the phenomenon, along with its effects to nursing practice, education and targeted policy development. Objectives The aim of this analysis was to uncover unique definitions of moral distress as found in the nursing literature and to examine the relationship between these definitions. Research Design and Context Morse’s method of concept clarification was applied given the large body of literature which includes definitions, descriptions and measurements of the concept in research. The steps include (a) conducting a literature review; (b) analysing the literature; and (c) identifying, describing, comparing, and contrasting attributes, antecedents and consequences of each category. Findings Each of the 18 included studies described constraints in their definition of moral distress, whether implied or explicitly stated. External constraints are widely described as obstacles outside of the individual, whether institutional, systemic or situational, while internal constraints are located within the individuals themselves and are described as personal limitations, failings or weakness of will. Conclusion Upon reviewing these definitions, we determined that the term ‘internal constraints’ is problematic due to the emphasis of responsibility on the individual experiencing moral distress. We propose an alteration to ‘internal characteristics’ that will assume less responsibility of change from the individual to place a heavier onus on systemic and institutional constraints.

Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?

2009 ◽  
Vol 16 (6) ◽  
pp. 734-742 ◽  
Author(s):  
Mark Repenshek
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Moral Distress ◽  
Ethical Framework ◽  
Critical Examination ◽  
Course Of Action ◽  
Starting Point ◽  
The Right ◽  
End Of Life Decision ◽  
Life Decision

Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton’s 1984 book Nursing practice. The definition Jameton formulated reads ‘... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Unfortunately, it appears that, despite the frequent use of Jameton’s definition of moral distress, the definition itself remains uncritically examined. It seems as if the context of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing’s discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition’s normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing’s discomfort and as a starting point to recontextualize moral distress.

scholarly journals Sacrificing Oneself or Another: The Difference Between Prescriptive and Normative Judgments in Moral Evaluation

2020 ◽  
pp. 003329411989606
Author(s):  
Štěpán Bahník ◽  
Emir Efendic ◽  
Marek A. Vranka
Keyword(s):  
Moral Judgment ◽  
Moral Evaluation ◽  
Normative Judgment ◽  
Question Wording ◽  
Judgment Type ◽  
Course Of Action ◽  
The Difference ◽  
The Right ◽  
The Sacrifice ◽  
Normative Judgments

When asked whether to sacrifice oneself or another person to save others, one might think that people would consider sacrificing themselves rather than someone else as the right and appropriate course of action—thus showing an other-serving bias. So far however, most studies found instances of a self-serving bias—people say they would rather sacrifice others. In three experiments using trolley-like dilemmas, we tested whether an other-serving bias might appear as a function of judgment type. That is, participants were asked to make a prescriptive judgment (whether the described action should or should not be done) or a normative judgment (whether the action is right or wrong). We found that participants exhibited an other-serving bias only when asked whether self- or other-sacrifice is wrong. That is, when the judgment was normative and in a negative frame (in contrast to the positive frame asking whether the sacrifice is right). Otherwise, participants tended to exhibit a self-serving bias; that is, they approved sacrificing others more. The results underscore the importance of question wording and suggest that some effects on moral judgment might depend on the type of judgment.

scholarly journals Optimal Application of Forced Air Warming to Prevent Peri-Operative Hypothermia during Abdominal Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (5) ◽  
pp. 2517
Author(s):  
Yoonyoung Lee ◽  
Kisook Kim
Keyword(s):  
Systematic Review ◽  
Abdominal Surgery ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Upper Body ◽  
Cochrane Library ◽  
Randomized Controlled ◽  
Forced Air Warming ◽  
Forced Air ◽  
Full Body

Patients who undergo abdominal surgery under general anesthesia develop hypothermia in 80–90% of the cases within an hour after induction of anesthesia. Side effects include shivering, bleeding, and infection at the surgical site. However, the surgical team applies forced air warming to prevent peri-operative hypothermia, but these methods are insufficient. This study aimed to confirm the optimal application method of forced air warming (FAW) intervention for the prevention of peri-operative hypothermia during abdominal surgery. A systematic review and meta-analysis were conducted to provide a synthesized and critical appraisal of the studies included. We used PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL to systematically search for randomized controlled trials published through March 2020. Twelve studies were systematically reviewed for FAW intervention. FAW intervention effectively prevented peri-operative hypothermia among patients undergoing both open abdominal and laparoscopic surgery. Statistically significant effect size could not be confirmed in cases of only pre- or peri-operative application. The upper body was the primary application area, rather than the lower or full body. These findings could contribute detailed standards and criteria that can be effectively applied in the clinical field performing abdominal surgery.

scholarly journals The Multifocal Approach to Sharing in Shared Decision Making: A Critical Appraisal of the MAPPIN’SDM

2021 ◽  
pp. 0272989X2110107
Author(s):  
David Forner ◽  
Christopher W. Noel ◽  
Laura Boland ◽  
Arwen H. Pieterse ◽  
Cornelia M. Borkhoff ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Critical Appraisal ◽  
Reliability And Validity ◽  
Measurement Instrument ◽  
Face Validity ◽  
Shared Decision ◽  
Measurement Instruments ◽  
Multiple Perspectives ◽  
Property Assessment

Objective Shared decision making integrates health care provider expertise with patient values and preferences. The MAPPIN’SDM is a recently developed measurement instrument that incorporates physician, patient, and observer perspectives during medical consultations. This review sought to critically appraise the development, sensibility, reliability, and validity of the MAPPIN’SDM and to determine in which settings it has been used. Methods This critical appraisal was performed through a targeted review of the literature. Articles outlining the development or measurement property assessment of the MAPPIN’SDM or that used the instrument for predictor or outcome purposes were identified. Results Thirteen studies were included. The MAPPIN’SDM was developed by both adapting and building on previous shared decision making measurement instruments, as well as through creation of novel items. Content validity, face validity, and item quality of the MAPPIN’SDM are adequate. Internal consistency ranged from 0.91 to 0.94 and agreement statistics from 0.41 to 0.92. The MAPPIN’SDM has been evaluated in several populations and settings, ranging from chronic disease to acute oncological settings. Limitations include high reading levels required for self-administered patient questionnaires and the small number of studies that have employed the instrument to date. Conclusion The MAPPIN’SDM generally shows adequate development, sensibility, reliability, and validity in preliminary testing and holds promise for shared decision making research integrating multiple perspectives. Further research is needed to develop its use in other patient populations and to assess patient understanding of complex item wording.

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