scholarly journals Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13367
Author(s):  
Giulia Lamiani ◽  
Davide Biscardi ◽  
Elaine C. Meyer ◽  
Alberto Giannini ◽  
Elena Vegni
Keyword(s):  
Critical Care ◽  
Grounded Theory ◽  
Moral Distress ◽  
Working Environment ◽  
Moral Integrity ◽  
Structured Interviews ◽  
Good Doctor ◽  
Lombardy Region ◽  
Core Category ◽  
Moral Outcomes

The COVID-19 pandemic has confronted emergency and critical care physicians with unprecedented ethically challenging situations. The aim of this paper was to explore physicians’ experience of moral distress during the pandemic. A qualitative multicenter study was conducted using grounded theory. We recruited 15 emergency and critical care physicians who worked in six hospitals from the Lombardy region of Italy. Semi-structured interviews about their professional experience of moral distress were conducted from November 2020–February 2021 (1 year after the pandemic outbreak). The transcripts were qualitatively analyzed following open, axial, and selective coding. A model of moral distress was generated around the core category of Being a Good Doctor. Several Pandemic Stressors threatened the sense of Being a Good Doctor, causing moral distress. Pandemic Stressors included limited healthcare resources, intensified patient triage, changeable selection criteria, limited therapeutic/clinical knowledge, and patient isolation. Emotions of Moral Distress included powerlessness, frustration/anger, and sadness. Physicians presented different Individual Responses to cope with moral distress, such as avoidance, acquiescence, reinterpretation, and resistance. These Individual Responses generated different Moral Outcomes, such as moral residue, disengagement, or moral integrity. The Working Environment, especially the team and organizational culture, was instrumental in restoring or disrupting moral integrity. In order for physicians to manage moral distress successfully, it was important to use reinterpretation, that is, to find new ways of enacting their own values by reframing morally distressing situations, and to perceive a cooperative and supportive Working Environment.

scholarly journals Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1307
Author(s):  
Giulia Villa ◽  
Federico Pennestrì ◽  
Debora Rosa ◽  
Noemi Giannetta ◽  
Roberta Sala ◽  
...  
Keyword(s):  
Grounded Theory ◽  
Protective Factor ◽  
Moral Distress ◽  
The Elderly ◽  
Single Type ◽  
Theory Approach ◽  
Structured Interviews ◽  
Healthcare Settings ◽  
Core Category ◽  
Care Of Elderly

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences.

Moral distress of critical care nurses

1995 ◽  
Vol 4 (4) ◽  
pp. 280-285 ◽  
Author(s):  
MC Corley
Keyword(s):  
Factor Analysis ◽  
Critical Care ◽  
Intensive Care ◽  
Private Hospital ◽  
Moral Distress ◽  
Medical Center ◽  
Critical Care Nurses ◽  
Moral Integrity ◽  
Healthcare Organizations ◽  
Aggressive Care

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

scholarly journals Enacting affordances: an investigation of digitally mediated multimodal assessment in higher education

2020 ◽  
Author(s):  
◽  
Geir Petter Laingen
Keyword(s):  
Grounded Theory ◽  
Self Regulation ◽  
Careful Consideration ◽  
Structured Interviews ◽  
Multimodal Assessment ◽  
Assessment Design ◽  
Core Category ◽  
Beneficial Action ◽  
Potential Impact ◽  
Prior Experiences

This thesis examines the incorporation of a digitally mediated audio-visual assignment into theoretical-contextual modules at a UK post-1992 University. A sample of seven student-produced artefacts has been analysed, highlighting the semiotic work undertaken, the expressive resources used, and the types of knowledge conveyed. Semi-structured interviews were conducted with sixteen participants, who provided accounts of their experiences and discussed the perceived value of the assignment. These two sets of empirical material were analysed using grounded theory methods, providing the basis for developing a grounded theory of enacted affordances. The theory is substantive in that it is derived from researching only one specific educational context. However, the final categories are sufficiently abstract to allow transferability, adaptation and refinement in further research within other contexts. The interview analysis created a strong foundation for the theory, by developing a core category of “Assessing subjective task value”, and its main properties and dimensions: academic emotions, relevance, materiality and self-regulation. Combining this with the insights from the artefact analysis, and with the concepts from Gibson’s affordance theory, the thesis reconceptualises digitally mediated multimodal assessment as the dynamic process of affordance enactment The study concludes that different kinds of positive and negative affordances are potentially present within any assignment, and their realisation depends both on the specific assignment features as affordance-bearers, and on the students’ ability to perceive, select and implement beneficial action possibilities. The conclusion is that whilst digitally mediated multimodal assignments can offer additional advantages compared to traditional written coursework, it is not a given that students will engage in an academically meaningful way or have beneficial and motivating experiences. Careful consideration of assessment design is therefore crucial for the successful incorporation of such assignments, weighing up the relevant affordance bearers and their potential impact on students with diverse skills, strategies and prior experiences.

scholarly journals Weighing up the costs of seeking health care for dengue symptoms: a grounded theory study of backpackers’ decision-making processes

2015 ◽  
Vol 21 (2) ◽  
pp. 245 ◽  
Author(s):  
Bálint Vajta ◽  
Mette Holberg ◽  
Jane Mills ◽  
William J. H. McBride
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Grounded Theory ◽  
Dengue Fever ◽  
Health Care Professionals ◽  
Access To Health Care ◽  
Public Health Issue ◽  
Structured Interviews ◽  
Australian Health ◽  
Core Category

Dengue fever, a mosquito-borne virus, is an ongoing public health issue in North Queensland. Importation of dengue fever by travellers visiting or returning to Australia can lead to epidemics. The mosquito can acquire the virus in the symptomatic viraemic phase, so timely recognition of cases is important to prevent epidemics. There is a gap in the literature about backpackers’ knowledge of dengue fever and the decision-making process they use when considering utilising the Australian health-care system. This study uses grounded theory methods to construct a theory that explains the process backpackers use when seeking health care. Fifty semi-structured interviews with backpackers, hostel receptionists, travel agents and pharmacists were analysed, resulting in identification of a core category: ‘weighing up the costs of seeking health care’. This core category has three subcategories: ‘self-assessment of health status’, ‘wait-and-see’ and ‘seek direction’. Findings from this study identified key areas where health promotion material and increased access to health-care professionals could reduce the risk of backpackers spreading dengue fever.

Psychotherapy with clients with addiction(s): a grounded theory study of effective therapeutic approaches

2019 ◽  
Vol 4 (2) ◽  
pp. 131-154
Author(s):  
Joanna Holroyd ◽  
Maria Luca
Keyword(s):  
Grounded Theory ◽  
Therapeutic Approach ◽  
Clinical Work ◽  
Constructivist Grounded Theory ◽  
Therapeutic Approaches ◽  
Structured Interviews ◽  
Therapist Factors ◽  
Core Category ◽  
Client Factors ◽  
Therapeutic Model

Background: addiction is a multifaceted topic with social, cultural, and political undertones and influences. It can be considered challenging to work with psychotherapeutically. Aim: to counter this pejorative conjecture, this study aimed to explore the approaches experienced therapists use in their clinical work. Methodology: to investigate what has proved important and therapeutically helpful empirically, ten qualitative semi-structured interviews were carried out with experienced clinicians of varying modalities working with addiction. Transcripts were analysed using constructivist grounded theory. Findings: one core category emerged from the data: what was revealed to be effective in working with addictions is a unique, contextualised, collaborative and creative therapeutic approach. Five sub-categories transpired: 1) contextual factors; 2) therapist factors; 3) client factors; 4) conceptualisations; 5) therapeutic work. The findings indicate that through engagement with unique psychosocial understandings of clients, therapists enhance their own understandings of the phenomenon of addiction, which then informs their therapeutic approach. It is argued that an individualised and creative approach, anchored in the particular needs, personal preferences or beliefs of the client, is given preference over rigid adherence to any particular therapeutic model.

Values and self-perception of behaviour among critical care nurses

2021 ◽  
pp. 096973302199973
Author(s):  
Kaoru Ashida ◽  
Aki Kawakami ◽  
Tetsuharu Kawashima ◽  
Makoto Tanaka
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Cross Sectional Study ◽  
Critical Care Nurses ◽  
Working Environment ◽  
Self Perception ◽  
Cross Sectional ◽  
Team Members ◽  
The Difference ◽  
Tokyo Medical

Background: Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress. Research aims: The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others. Research design: A nationwide, cross-sectional study was conducted. Participants and research context: We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item. Ethical considerations: The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045). Results: The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients. Discussion: Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse’s priorities might diverge from those of other team members, which can lead to conflict within the team. Conclusion: This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress.

scholarly journals Vaccination learning experiences of nursing students: a grounded theory study

2015 ◽  
Vol 12 ◽  
pp. 29 ◽  
Author(s):  
Eshagh Ildarabadi ◽  
Hossein Karimi Moonaghi ◽  
Abbas Heydari ◽  
Ali Taghipour ◽  
Abdolghani Abdollahimohammad
Keyword(s):  
Grounded Theory ◽  
Nursing Students ◽  
Learning Outcomes ◽  
Empirical Support ◽  
Structured Interviews ◽  
Undergraduate Nursing Students ◽  
Effective Learning ◽  
Undergraduate Nursing ◽  
Grounded Theory Method ◽  
Core Category

Purpose: This study aimed to explore the experiences of nursing students being trained to perform vaccinations. Methods: The grounded theory method was applied to gather information through semi-structured interviews. The participants included 14 undergraduate nursing students in their fifth and eighth semesters of study in a nursing school in Iran. The information was analyzed according to Strauss and Corbin’s method of grounded theory. Results: A core category of experiential learning was identified, and the following eight subcategories were extracted: students’ enthusiasm, vaccination sensitivity, stress, proper educational environment, absence of prerequisites, students’ responsibility for learning, providing services, and learning outcomes. Conclusion: The vaccination training of nursing students was found to be in an acceptable state. However, some barriers to effective learning were identified. As such, the results of this study may provide empirical support for attempts to reform vaccination education by removing these barriers.

Co-creating the Psychological “White Picket Fence”: Three Gay Couples’ Relationship Reconfiguration

2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Prevan Moodley ◽  
Francois Rabie
Keyword(s):  
Grounded Theory ◽  
South African ◽  
Gay Couples ◽  
Core Category ◽  
Picket Fence ◽  
Open Relationship ◽  
The Individual ◽  
The Relationship ◽  
Porous Boundaries

Many gay couples engage in nonmonogamous relationships. Ideas about nonmonogamy have historically been theorised as individual pathology and indicating relational distress. Unlike mixed-sex couples, boundaries for gay couples are often not determined by sexual exclusivity. These relationships are built along a continuum of open and closed, and sexual exclusivity agreements are not restricted to binaries, thus requiring innovation and re-evaluation. Three white South African gay couples were each jointly interviewed about their open relationship, specifically about how this is negotiated. In contrast to research that uses the individual to investigate this topic, this study recruited dyads. The couples recalled the initial endorsement of heteronormative romantic constructions, after which they shifted to psychological restructuring. The dyad, domesticated through the stock image of a white picket fence, moved to a renewed arrangement, protected by “rules” and imperatives. Abbreviated grounded theory strategies led to a core category, “co-creating porous boundaries”, and two themes. First, the couple jointly made heteronormative ideals porous and, second, they reconfigured the relationship through dyadic protection. The overall relationship ideology associated with the white picket fence remained intact despite the micro-innovations through which the original heteronormative patterning was reconfigured.

Patients’ Perspective on the Psychological Impact of Multiple Sclerosis on Their Life

2021 ◽  
pp. 105413732110068
Author(s):  
Chrysoula Baka ◽  
Kalliopi Chatira ◽  
Evangelos C. Karademas ◽  
Konstantinos G. Kafetsios
Keyword(s):  
Multiple Sclerosis ◽  
Grounded Theory ◽  
Psychological Impact ◽  
Autoimmune Disorder ◽  
Positive Outcomes ◽  
Structured Interviews ◽  
Psychosocial Wellbeing ◽  
Positive Meaning ◽  
Patients Perspective ◽  
The Way

Multiple sclerosis is a chronic autoimmune disorder that greatly impacts on patients’ physical and psychosocial wellbeing. The purpose of this study is to investigate the experiences of people diagnosed with multiple sclerosis in Greece (N = 30), with regard to the way they coped with the diagnosis and the symptoms, the psychological implications of the disorder and the meaning they attributed to it. Data were collected through semi-structured interviews and they were analyzed using grounded theory. The findings showed that despite the negative implications of the disorder and the difficulty in managing the diagnosis and the symptoms, half of the patients attributed positive meaning to the disorder. Taking care of oneself, re-evaluation of life and a sense of liberation were described as the positive outcomes of experiencing multiple sclerosis.

scholarly journals Registered nurses’ role experiences of caring for older stroke patients: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei Cheng ◽  
Jiong Tu ◽  
Xiaoyan Shen
Keyword(s):  
Nursing Education ◽  
Older People ◽  
Registered Nurses ◽  
Elderly Care ◽  
The Elderly ◽  
Working Environment ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Care Needs ◽  
Nursing Clinical Practice

Abstract Background With China’s population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses’ experiences of caring for older stroke patients. Methods A qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data. Results Two main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people’s needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment. Conclusions Sustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses’ lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

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