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: 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.

Final Thoughts (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Palliative Care ◽  
Moral Distress ◽  
Ethical Dilemmas ◽  
Economic Resources ◽  
Emotional Challenges ◽  
Seriously Ill Patients ◽  
External Forces ◽  
The Right ◽  
Developed World ◽  
Seriously Ill

It is not enough to know how to respond to ethical dilemmas in palliative care. Sufficient resources are required to implement the nuanced approach to ethical dilemmas presented in this textbook. In the developed world, there exists a profound shortage of palliative care clinicians, as well as regulatory barriers which may impede the provision of optimal palliative care. The situation is far more serious in the developing world, where access to symptomatic medications may be severely restricted due to lack of economic resources or bureaucratic barriers. Even when a qualified team is available and necessary tools are at hand, the emotional challenges inherent in caring for seriously ill patients may negatively impact team dynamics. This is particularly true in situations where members of the team believe they know what the “right” thing to do is, but external forces prevent them from doing it, thus causing moral distress.

Individual Moral Perspectives of Professional Nurses

2000 ◽  
Vol 4 (3) ◽  
pp. 35-44 ◽  
Author(s):  
Gail Ann DeLuca Havens,
Keyword(s):  
Nursing Practice ◽  
Moral Distress ◽  
Psychometric Assessment ◽  
Ethical Ideologies ◽  
Professional Nursing Practice ◽  
Professional Nurses ◽  
The Right ◽  
Position Questionnaire ◽  
Insight Into ◽  
Moral Stance

Exploring nurses’ moral perspectives may provide insight into the varying degrees of caring that nurses integrate into their professional nursing practice. Building an understanding of nurses’ moral perspectives also can illuminate the moral experiences of professional nurses who endorse different ethical ideologies, as well as the consequences, such as moral distress, of such experiences. Psychometric assessment of the Modified Ethics Position Questionnaire (MEPQ) yielded a reliable and valid measure of the moral perspectives of practicing nurses. Findings suggest that respondents assumed that desirable consequences can, with the right ethical action, always be obtained. Whether this is a common moral stance among professional nurses requires further inquiry.

Ethics in Palliative Care

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Moral Distress ◽  
Clinical Medicine ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Age Groups ◽  
Life Threatening Illness ◽  
Unique Nature ◽  
The Right

No specialty faces more diverse and challenging ethical dilemmas than palliative medicine. What is the best way to plan ahead for the end of life? How should physicians respond when patients refuse treatments likely to be beneficial or demand treatments not likely to be? Who makes medical decisions for patients who are too ill to decide for themselves? Do patients have the “right to die” (and, if so, what exactly does that mean)? Other ethics texts have explored these issues but often from an academic perspective that overlooks the practical realities of clinical medicine. Conversely, medical textbooks frequently lack sufficient philosophical depth to fully explore the complexities of these issues. This complete guide to the ethics of palliative care combines clinical experience with philosophical rigor to provide a comprehensive analysis of this fascinating field. Using relevant case studies, core subjects such as intensive symptom management at the end of life, physician-assisted dying, and palliative sedation are examined from historical, legal, clinical, and ethical perspectives. Whereas pediatric issues are often an afterthought in palliative care textbooks, this guide explores the unique nature of ethical dilemmas in the prenatal, neonatal, and adolescent age groups. Other important topics such as neuro-palliative care, organ donation, research, and moral distress are also covered in detail. Written with clinical nuance for medical professionals—and clear language as well as a glossary for lay readers—this guide offers all readers an opportunity to explore and understand the fascinating ethical issues facing patients suffering from life-threatening illness.

scholarly journals ‘Powerlessness’ or ‘doing the right thing’ – Moral distress among nursing home staff caring for residents at the end of life: An interpretive descriptive study

2017 ◽  
Vol 31 (9) ◽  
pp. 853-860 ◽  
Author(s):  
Amanda Young ◽  
Katherine Froggatt ◽  
Sarah G Brearley
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Critical Incident ◽  
Nurse Managers ◽  
Moral Distress ◽  
Structured Interviews ◽  
Nursing Home Staff ◽  
The Right ◽  
Do The Right Thing

Background: Caring for dying people can contribute to moral distress experienced by healthcare professionals. Moral distress can occur when this caring is restricted by organisational processes, resources or the provision of futile care. These factors apply to end of life care in nursing homes but research is lacking. Aim: To describe how nursing home staff experience moral distress when caring for residents during and at the end of life. Methods: An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff. Data were analysed using a thematic analysis approach. Setting: Four nursing homes in one large metropolitan area. Participants: A total of 16 staff: 2 nurse managers, 4 nurses and 10 care assistants. Findings: Participants described holding ‘good dying’ values which influenced their practice. The four practice-orientated themes of advocating, caring, communicating and relating with residents were found to influence interactions with residents, relatives, general practitioners, and colleagues. These led staff to be able to ‘do the right thing’ or to experience ‘powerlessness’, which could in turn lead to staff perceiving a ‘bad death’ for residents. Conclusion: When there are incongruent values concerning care between staff and others involved in the care of residents, staff feel powerless to ‘do the right thing’ and unable to influence care decisions in order to avoid a ‘bad death’. This powerlessness is the nature of their moral distress.

ID-PALL: An Instrument to Help You Identify Patients in Need of Palliative Care

Praxis ◽  
2021 ◽  
Vol 110 (15) ◽  
pp. 839-844 ◽  
Author(s):  
Fabienne Teike Lüthi ◽  
Mathieu Bernard ◽  
Claudia Gamondi ◽  
Anne-Sylvie Ramelet ◽  
Gian Domenico Borasio
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
End Of Life ◽  
Disease Trajectory ◽  
Care Project ◽  
The Right ◽  
Identification Phase

Abstract. Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the right time patients who need palliative care and to distinguish between those in need of general palliative care and those for whom a referral to specialists is required. ID-PALL has been developed as an instrument to support professionals in this identification and to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.

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.

scholarly journals Timing and nature of palliative care discussions are patient-specific according to clinicians: a qualitative study

2019 ◽  
Author(s):  
Nuno Tavares ◽  
Tom Wilkinson ◽  
Nikki Jarrett ◽  
Katherine Hunt
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Complex Disease ◽  
Qualitative Interviews ◽  
Direct Care ◽  
Patient Specific ◽  
Chronic Obstructive ◽  
Usual Practice ◽  
Disease Trajectory ◽  
Future Care

Background: Chronic obstructive pulmonary disease (COPD) is associated with an unpredictable and complex disease trajectory. Consequently, most patients are not involved in advance care planning and do not receive palliative care until the end of life. Aim: To explore clinicians experiences, opinions and recommendations for the timing and nature of palliative care discussions in COPD. Design: Qualitative interviews with nurses and doctors that provide direct care to COPD patients. Setting/Participants: 14 clinicians working across primary and secondary care in the UK were interviewed. Results: Participants suggested that those with the appropriate expertise and an established relationship with patients were best placed to initiate discussions about palliative and future care. Early, gradual and informed palliative and future care discussions were considered best practice, however they uncommon occurrence due to service, patient and clinician-related barriers. The unpredictable disease trajectory and fine balance between providing acute care and discussing palliative care options were suggested as key greatest barriers for discussions. However, damaging patient hope was a concern for clinicians and reduced their inclination to discuss palliative care. Clinicians did not seem to think that patients were ready for discussions, therefore they avoided broaching the subject leading early in the disease trajectory. Conclusion: Stand-alone conversations about and near the end of life was described as current usual practice by clinicians, however individualised early, regular and gradual discussions with patients about immediate and long-term future plans may make such discussions feel less negative and ordinary for patients and clinicians.

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.

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