Given the sensitive nature of trauma-focused research, it is important that researchers understand the impact of research participation on study participants. The current study examined the relationship between type of child abuse, psychological adjustment, and self-reported participatory distress in 105 female adult survivors of childhood abuse. Several key findings emerged: (a) overall, participants reported low levels of participatory distress; (b) greater levels of participatory distress were reported by sexual abuse survivors and were associated with (...) higher scores on depressed mood and posttraumatic stress; and (c) posttraumatic stress symptomatology served as a mediator in the relationship between abuse type and participatory distress. The findings inform researchers and members of Institutional Review Boards on variables related to participatory distress in studies of child abuse. (shrink)

Research question/aim/objectives Providing care for hospitalized children causes moral distress to nurses. Employee participation in discovering and solving the everyday problems of the workplace is one of the ways to hear the voices of nurses. This study aimed to evaluate the effect of participatory management programs on perceived organizational support and moral distress in pediatric nurses. Research design A quasi-experimental study. Participants and research context The present study was conducted on 114 pediatric nurses in Iran. Data were (...) collected using the Perceived Organizational Support Scale and the Moral Distress Scale of nurses. The intervention included implementing a participatory management program in three treatment departments that were randomly selected and it lasted 4 months. Participatory management was at the level of problem-solving with a focus on investigating, solving, and correcting issues and problems of work shifts and departments concerning the physical environment, equipment of the department, improvement of work processes, and team cooperation. In the control group, ordinary organizational approaches to problem-solving were used. Ethical considerations This study was approved by the Ethics Committee of Mashhad School of Nursing and Midwifery. Informed consent was obtained from the study participants. Findings/results Based on the results, both groups were homogenous before the intervention in terms of moral distress and perceived organizational support. The results showed that the moral distress mean scores in the intervention group decreased from 1.45 (0.52) to 1.03 (0.37) after the intervention. Also, the score of the perceived organizational support was 2.12 (1.2) increased after the intervention to 2.68 (1.10) in the intervention group. Conclusions It was found that the participation of nurses in the problem-solving process to solve daily workplace issues can be effective in increasing their perceived organizational support and reducing their moral distress. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research (...) Design In this qualitative study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

Background:The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied.Purpose:This study examined the moral experiences of caregivers related to challenging behaviours’ management and alternatives to control measures.Research design:Using Charles Taylor’s hermeneutic framework, a 2-month focused ethnography with a (...) class='Hi'>participatory approach was used.Participants and research context:Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity.Ethical considerations:The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants.Findings:By accounting for caregivers’ moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver’s vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures.Discussion:A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability.Conclusion:The recognition of caregiver’s vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers’ self-concern can be understood as fostering mutual respect. (shrink)

This paper explores the implications that arise when those of us with experiences of distress/mental health system encounters deploy lived experience as expertise to produce research. In recent years, some mental health service and research systems have conceded to disability rights demands of ‘nothing about us without us,’ and slowly, select people with direct contact with psychiatric systems and experiences of distress have been incorporated as experts by experience into mental health assemblages. In my own professional encounters, I (...) have largely benefited from these inclusive, participatory, and diversity-oriented best practices: using my experiences of distress, psychiatric encounters... (shrink)

Sex workers in the Netherlands experienced severe financial and social distress during the COVID-19 health crisis. Notwithstanding them paying taxes over the earnings, they were excluded from government financial support, faced discriminatory treatment concerning safe reopening, and experienced increased repression and stigmatization. In this contribution, I explore whether the concept of “vulnerability” contributes to understanding (and addressing) that situation. Data acquired through participatory action research, partly taking place online during lock-down measures, and literature and content analysis show that (...) labeling sex workers “vulnerable” deflects attention away from the (in)actions of Dutch authorities responsible for sex workers’ precarious conditions during the pandemic. Government denial and strategies of abjection explain these conditions better than “vulnerability” does, as they return the gaze to actors and processes accountable for sex workers’ exclusion and criminalization during the COVID-19 health crisis and thereby put responsibility where it belongs. (shrink)

This article deals with political socialization and political participation, in the context of visiting phenomenon, in Turkey. We took the Ali Baba Tomb in central Sivas and Celtek Baba Tomb in Celtek village as the sample of our study. In the study, political socialization and participation was seen as a dialectical process between individual and society. Visiting phenomenon embodying a rich historical, religious and cultural accumulation is important in that it defines the religious tendency of huge masses. As a matter (...) of fact, they have realized their potitical socialization in a pretty much authentic culture with different interests, duties, roles and positions. At the same time, they have shown their political participation with reference to the religious world of meaning. -/- SUMMARY In the contrast to the secular paradigm, religion continues to keep its reciprocal relations with the whole social system without giving an opportunity to any speculation. Religion and politics are two important fields in which this living relationship is stood for institutional structures. This article focuses on political socialization and political participation in Turkey by taking into consideration the phenomenon of visiting. The question of how the visiting phenomenon provided an input to the political system in terms of political socialization and political participation constitutes the problem of the research. Ali Baba Tomb in the center of Sivas province and Celtek Baba Tomb situated in central Celtek Village were selected as samples for the study. The political socialization and participation were talked with 33 visitors who had been selected randomly from different days between September and December 2015 and were tried to understand the data obtained by semi-standardized interview form. It has been examined in terms of its historical development and orientation of relationship between the visiting phenomenon in the research and the political system. For this reason, the basic methodological acceptance of the research has been to understand and interpret political socialization and participation in its specific environment. In this framework, firstly, the socialization of the sample in the context of family, school, mass communication and social environment was evaluated. Later, it has been tried to understand the religiousness in the context of the visiting through the same group. Their political participation has also been resolved according to the classification of Milbrath and Goel’s hierarchical political participation level through the field of political socialization and religiousness. Finally, this research, which is considered as a singular case study, has been subjected to a systematic and phenomenological analysis according to gender, age, education and belief variables on the basis of data obtained through problem-centered interviewing and participatory observation. The visiting in a phenomenological sense involves a trip and travel made with certain requests to the people who are believed to have been buried in places such as tombs, attributed to certain spiritual powers and virtues. The visiting phenomenon in the field of research had brought a rich historical and cultural content, exceeding a simple grave visit. Today, in the religious and traditional meaning world the traumas caused by the modernization and other socio-psychological thrillers have brought a different interest in Turkish society than ever before. The visiting phenomenon has created a continuity with a perception of sanctity and understanding which were shaped by an interaction with many different cultures, pre-Islamic beliefs and eventually mystical and charismatic personalities. However, the visiting phenomenon according to the severity of the individual and social crises experienced in the modern period has also revealed some variations that included popular patterns in both structural and practical contexts. Thus, the visiting phenomenon today is seen in a change by creating new universes appropriate to tradition in different social categories. In the modern era the influence of this change on the political culture is evident. This effect is generally related to the social structure of Turkish society and manifests itself as a closing within the sense of protection of the world of meaning. The visiting phenomenon, which has a special place in the religious life of very large masses in Turkey, has created a peculiar structure of political socialization and political participation around a profound historical accumulation. The participants have realized their political socialization in a unique cultural environment. This culture was formed in the context of family, school, mass communication and social environment. The dramatic situations that have taken place in the process have brought the important socialization problems in this environment. The community associations, the system of obsolete values, the distorted hierarchical relationships and the insecure environments created no longer lead to the searching for meaning by them. These people, who express themselves not like politics (27 people) at last, instead of expressing politics themselves with ideological concepts like ideological rightist, leftist, Islamist, communities people (ʾumma), Kemalist (5 people), but rather Turkish, Muslim, homeland, nation, human and righteousness as the concepts and words to prefer to identify. This should be a socialization that they carry out by transferring the objective world they created outwardly around a set of meanings to their subjective consciousness again. It should be a socialization again that they carry out by transferring the objective world they created outwardly around a set of meanings to their subjective consciousness. The visitors have carried out a political participation with the accumulation created by this field of political socialization. They saw themselves as often religious and the visiting activity as a sign of religiosity. As a result, the visiting a tomb could have been a simple manifestation of inner happiness and ease in a happy moment or an entertainment as much as it was in distress in this environment. The mystical attitude which is far from the world that many poor people built around the visit has caused them to put reserves in the political institution that represents a secular field. As a matter of fact, the visitors often characterize the world with the terms like empty, lie, trial, and so on. Politics, on the other hand, had been seen as a relationship of interest, cheating and lying. It has been understood that it provides a political input in the framework that Milbrath and Goel conceptualize as audience actions when we look at the political participation of the visiting phenomenon in the Sivas universe. According to this visit, in the sample of the phenomenon 29 people of the participants said that they are not open to the politics while 4 of them said that they are open to the politics. However, given that voting attitudes in the elections, only 2 of the participants did not see this very important; others (31 people) regard voting as a responsibility in the name of country, nation, country or even religion. From time to time, those who say either that they have started to the political discussions or that they have participated in political debates (11 people of them) are less than those who have never attended this kind of debates (22 people). In this sample, the number of people trying to persuade a person to vote for a particular party is 6; the number of people carrying a rosette of a party or hanging the symbols of the party to the house, to the car, was only 4 among those participants. Visiting people usually provide the political socializations in a fatalistic and restrictive environment. Their political participation is also in accord with the symbolic world of this hierarchical structure in which life is defined by certain rules. Therefore, they had produced an unquestionability of the authority as it is in family as well as political institutions. The politics is frightening for them; it is not interested in them and they should be away from it. (shrink)

The present study examines 1- to 5-year-old children’s emotion socialization in an early childhood educational setting (a preschool) in Sweden. Specifically, it examines social situations where teachers respond to children’s negative emotional expressions and negatively emotionally charged social acts, characterized by anger, irritation and distress. Data consist of 14 hours of video observations of daily activities, recorded in a public Swedish preschool, located in a suburban middle-class area and include 35 children and five preschool teachers. By adopting a sociocultural (...) perspective on children’s development and socialization, the study examines the communicative practices through which the expressions of negative emotions are responded to and the norms and values that are communicated through these practices. The data are analysed by using multimodal analysis of interaction that provides a tool for detailed analysis of participants’ verbal and embodied actions and sense-making. The analyses show that teachers responded to children’s negatively charged emotional expressions as social acts (that were normatively evaluated) and the adults instructed children how to modify their social conduct (rather than deploying explicit discussions about emotions). The teachers used communicative genres that prioritized general moral principles and implemented the non-negotiability of norms over individual children’s emotional-volitional perspectives and individual preferences. The teachers’ instructive socializing activities were characterized by movement between multiple temporal horizons, i.e., general (emotional) discourse that transcended the here-and-now, and specific instructions targeting the children’s conduct in a current situation. The study discusses how emotion socialization can be related to the institutional characteristics and collective participatory social conditions of early childhood education. (shrink)

This essay explores how it might be possible to recover a more pluralistic and therefore participatory understanding and exercise of the teaching office in the Christian Church by, first, briefly reflecting upon the historical backdrop to the emergence and development of the role of authoritative ecclesial teacher. Second, I identify some of the ecclesial fault lines and tensions that emerged in the modern and contemporary periods pertaining to teaching authority. Third, I raise the issue of the impact of such (...) developments upon the manner in which Christian churches have sought to offer teachings on ethical issues in recent times. Fourth, I explore, via an ecclesiological analysis that is both a comparative and ecumenical in nature, three visions for retrieving a more participatory and life-giving understanding of the teaching office and practice of the teaching function for our times. The visions explored come from a Reformed, Roman Catholic, and ecumenical standpoint: respectively, those of Richard Robert Osmer, Richard R. Gaillardetz, and Willem Visser 't Hooft. The final section offers some brief conclusions about the potential for truly ecumenical collaboration in moral discernment in the light of such considerations. (shrink)

Emotion-processing impairment represents a risk factor for the development of somatic illness, affecting negatively both health-related quality of life and disease management in several chronic diseases. The present pilot study aims at investigating the associations between alexithymia and depression, anxiety, and HRQoL in patients with Hashimoto’s thyroiditis ; examining the association between these three psychological conditions together with HRQoL, and thyroid autoantibodies status as well as thyroid echotexture in patients with HT; and comparing the intensity of all these clinical psychological (...) features in patients with HT versus controls. Twenty-one patients with serologically or ultrasonographically verified HT and 16 controls with non-toxic goiter or postsurgical hypothyroidism were recruited for this study. Serum thyrotropin and free thyroxine, as well as thyroid autoantibodies, were assayed. Alexithymia, depression, anxiety, and HRQoL were assessed with Toronto Alexithymia Scale; Beck Depression Inventory, second edition; Hamilton Anxiety Rating Scale; and Health Survey Short-Form 36, respectively. A negative relationship between the difficulty to describe feelings and the cognitive component of depression was found. Besides, patients with seronegative HT had lower somatic anxiety than patients with HT who tested positive. Besides, no statistically significant difference was found between patients with HT and controls with regard to somatic anxiety. The present study suggests the relevance of alexithymia in patients suffering from HT, which may be intertwined with a possible state of underreported depression that is mainly expressed through physical complaints. Promoting the capability to describe and communicate feelings could contribute to psychological elaboration and coping with the disease and, consequently, to the improvement of self-management and perceived HRQoL. (shrink)

Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview (...) resides in the implications moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention. (shrink)

The enactive approach to cognition distinctively emphasizes autonomy, adaptivity, agency, meaning, experience, and interaction. Taken together, these principles can provide the new sciences of language with a comprehensive philosophical framework: languaging as adaptive social sense-making. This is a refinement and advancement on Maturana’s idea of languaging as a manner of living. Overcoming limitations in Maturana’s initial formulation of languaging is one of three motivations for this paper. Another is to give a response to skeptics who challenge enactivism to connect “lower-level” (...) sense-making with “higher-order” sophisticated moves like those commonly ascribed to language. Our primary goal is to contribute a positive story developed from the enactive account of social cognition, participatory sense-making. This concept is put into play in two different philosophical models, which respectively chronicle the logical and ontogenetic development of languaging as a particular form of social agency. Languaging emerges from the interplay of coordination and exploration inherent in the primordial tensions of participatory sense-making between individual and interactive norms; it is a practice that transcends the self-other boundary and enables agents to regulate self and other as well as interaction couplings. Linguistic sense-makers are those who negotiate interactive and internalized ways of meta-regulating the moment-to-moment activities of living and cognizing. Sense-makers in enlanguaged environments incorporate sensitivities, roles, and powers into their unique yet intelligible linguistic bodies. We dissolve the problematic dichotomies of high/low, online/offline, and linguistic/nonlinguistic cognition, and we provide new boundary criteria for specifying languaging as a prevalent kind of human social sense-making. (shrink)

Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for (...) Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the (...) ultimate purpose and significance of the research is unclear. In light of these considerations, it is contended that the notion of moral distress ought to be abandoned and that concerted attention be given to advancing inquiries that are more conducive to improving the quality and safety of moral decision-making, moral conduct and moral outcomes in nursing and healthcare domains. (shrink)

In this article we address the social value of bioethics research and show how a participatory approach can achieve social impact for a wide audience of stakeholders, involving them in a process of joint moral learning. Participatory bioethics recognizes that research co-produced with stakeholders is more likely to have impact on healthcare practice. These approaches aim to engage multiple stakeholders and interested partners throughout the whole research process, including the framing of ideas and research questions, so that outcomes (...) are tailored to the interests and context, and the type of impact stakeholders envisage. There is an emphasis on realizing social change through the conduct of the research, and it is believed that the engagement of stakeholders in the research process will promote their intrinsic motivation to change their practice. Another distinctive feature of participatory bioethics research is that its central normative commitment is to reflection and dialogue, not to a particular substantive ethical approach. In reflection and dialogue there is an emphasis on inclusion and the co-production of knowledge. Furthermore, empirical and normative research are combined, and there is a deliberate attempt to give voice to otherwise marginalized positions. This provides a model of social impact which is relevant not only for bioethics research, but also for other areas of health care research. We will show the merits of a participatory approach to bioethics research with a case example. It concerns the reduction of coercion and in particular seclusion in Dutch mental healthcare. (shrink)

“Participatory research” is an umbrella term for a wide variety of scientific research projects that include participation of members of the lay public beyond simply using humans as “subjects” of research. In this chapter, we begin by surveying the variety of participatory research approaches across fields. We examine the goals of participatory research projects, including social and scientific value. Next, we apply a theoretical framework to challenges that participatory research faces. We then survey three typologies of (...) participatory research projects, each of which can illuminate and guide decisions in project development. We end by looking at participatory research approaches in health contexts, applying the theoretical resources we introduced earlier in the chapter. (shrink)

Background:Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.Objectives:An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.Review Methods:This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.Results:Synthesis of the (...) scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.Conclusion:Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (shrink)

Background:Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety.Objectives:The purpose of this review was to describe how dilemmas and environmental, relational, and organizational (...) factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education.Research design:The research design was a systematic literature review.Method:The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check.Ethical consideration:Since this was a systematic review, no ethical approval was required.Findings:From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses.Conclusion:Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students. (shrink)

The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-led, empirically supported, psychological intervention for managing stress and improving well-being, especially for people within organizational settings. We designed and delivered “4Ds for Dealing with Distress” during the crisis to address this need. 4Ds unifies a spectrum of familiar emotion regulation strategies, resilience exercises, and problem-solving approaches using perceptual control theory and distils them into a simple four-component rubric. In essence, the aim is to reduce distress (...) and restore wellbeing, both in the present moment through current actions, and through expressing longer-term goal conflicts to discover new perspectives that arise spontaneously after sufficient time and consideration. The intervention is user-led in that it draws on users’ own idiosyncratic and pre-existing experiences, knowledge, skills and resources to help them apply an approach, or combination of approaches, that are proportionate and timed to the nature and context of the stress they are experiencing. In this article we review the empirical basis of the approach within experimental, social, biological and clinical psychology, illustrate the novel and time-efficient delivery format, describe its relevance to sports and exercise, summarise feedback from the recipients of the intervention to date, and describe the directions for future evaluation. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative (...) data was used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led (...) them to have moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

Background:Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand.Objective:This study aims to describe the experience of moral distress and related factors among Thai nurses.Design:A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral (...) Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated.Participants:Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand.Ethical considerations:This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151.Results:A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress.Discussion:Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored.Conclusions:Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context. (shrink)

Background: Moral distress has been identified as a significant issue in nursing practice for many decades. However, most studies have involved American nurses or Western medicine settings. Cultural differences between Western and non-Western countries might influence the experience of moral distress. Therefore, the literature regarding moral distress experiences among non-Western nurses is in need of review. Aim: The aim of this integrative review was to identify, describe, and synthesize previous primary studies on moral distress experienced by (...) non-Western nurses. Review method: Whittemore and Knafl’s integrative review methodology was used to structure and conduct the review of the literature. Research context and data sources: Key relevant health databases included the Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar databases. Two relevant journals, Nursing Ethics and Bioethics, were manually searched. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Findings: A total of 17 primary studies published between 1999 and 2019 were appraised. There was an inconsistency with regard to moral distress levels and its relationship with demographic variables. The most commonly cited clinical causes of moral distress were providing futile care for end-of-life patients. Unit/team constraints (poor collaboration and communication, working with incompetent colleagues, witnessing practice errors, and professional hierarchy) and organizational constraints (limited resources, excessive administrative work, conflict within hospital policy, and perceived lack of support by administrators) were identified as moral distress’s stimulators. Negative impacts on nurses’ physical, psychological, and spiritual well-being were also reported. Conclusion: Further research is needed to investigate moral distress among other healthcare professions which may further build understanding. More importantly, interventions to address moral distress need to be developed and tested. (shrink)

Moral distress is the sense that one must do, or cooperate in, what is wrong. It is paradigmatically faced by nurses, but it is almost a universal occupational hazard.

As yet, there is no enactive account of social cognition. This paper extends the enactive concept of sense-making into the social domain. It takes as its departure point the process of interaction between individuals in a social encounter. It is a well-established finding that individuals can and generally do coordinate their movements and utterances in such situations. We argue that the interaction process can take on a form of autonomy. This allows us to reframe the problem of social cognition as (...) that of how meaning is generated and transformed in the interplay between the unfolding interaction process and the individuals engaged in it. The notion of sense-making in this realm becomes participatory sense-making. The onus of social understanding thus moves away from strictly the individual only. (shrink)

While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical (...) and logistical facts in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

Nurses and other medical practitioners often experience moral distress: they feel an anguished sense of responsibility for what they take to be their own moral failures, even when those failures were unavoidable. However, in such cases other people do not tend to think it is right to hold them responsible. This is an interesting mismatch of reactions. It might seem that the mismatch should be remedied by assuring the practitioner that they are not responsible, but I argue that this (...) denies something important that the phenomenon of moral distress tells us. In fact, both the practitioners’ tendencies to hold themselves responsible and other people’s reluctance to hold the practitioners responsible get something right. The practitioners may be right that they are responsible in the sense of having failed to meet a binding moral requirement, even when the requirement was impossible to meet. This makes moral distress a fitting response because it correctly represents their own action as a wrongdoing. However, others may meanwhile be right that the practitioners are not responsible in the sense of being culpable and blameworthy. To blame others, or oneself, for certain failures, including those that are unavoidable, would be unfair. My claim depends on distinguishing between the fittingness and the fairness of holding someone (including oneself) responsible for moral failure. Having drawn the distinction, I suggest that moral distress should be addressed in a way that both recognizes it as a fitting response and avoids the unfairness of blame. (shrink)

Moral distress is now being recognized as a frequent experience for many health care providers, and there's good evidence that it has a negative impact on the health care work environment. However, contemporary discussions of moral distress have several problems. First, they tend to rely on inadequate characterizations of moral distress. As a result, subsequent investigations regarding the frequency and consequences of moral distress often proceed without a clear understanding of the phenomenon being discussed, and thereby (...) risk substantially misrepresenting the nature, frequency, and possible consequences of moral distress. These discussions also minimize the intrinsically harmful aspects of moral distress. This is a serious omission. Moral distress doesn't just have a negative impact on the health care work environment; it also directly harms the one who experiences it. In this paper, I claim that these problems can be addressed by first clarifying our understanding of moral distress, and then identifying what makes moral distress intrinsically harmful. I begin by identifying three common mistakes that characterizations of moral distress tend to make, and explaining why these mistakes are problematic. Next, I offer an account of moral distress that avoids these mistakes. Then, I defend the claim that moral distress is intrinsically harmful to the subject who experiences it. I conclude by explaining how acknowledging this aspect of moral distress should reshape our discussions about how best to deal with this phenomenon. (shrink)

Background:Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants.Objective:This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures.Research Design:This (...) is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts.Participants and Research Context:No research participants were part of this analysis.Ethical Considerations:This article offers a conceptual analysis and recommendations only.Findings:The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress.Discussion:Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants.Conclusion:This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations. (shrink)

Background:Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress.Objectives:To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology.Research design:In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups.Participants and research context:Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. (...) A total of 278 healthcare professionals participated. The response rate was 89%.Ethical considerations:In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey.Findings:The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants.Discussion:Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings.Conclusion:The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care. (shrink)

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been (...) portrayed in some nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (shrink)

There have been recurrent reports of fragilities in the Brazilian health system, especially in public institutions. In this commentary, I argue that moral distress in nursing in Brazil can still be considered an innovative and important subject of study. I also highlight the relevance of engaging educational institutions in the development of policies about environmental sustainability. It is relevant to continue studying moral distress in nursing and in health care generally in order to contribute to the transformation of (...) reality by confronting the multiple common situations in the work environment that are recognized by many as morally problematic because they infringe upon the rights of people, patients, and health care professionals and are an affront to environmental health. (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess (...) moral distress suffered by nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing (...) students.Participants and research context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess (...) moral distress suffered by nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by (...) hand search and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact. (shrink)

Zusammenfassung1989/90 war die DDR ein ökologisch gescheiterter Staat. Doch während Eingaben aus der Bevölkerung und kritische Umweltgruppen im Laufe der 1980er Jahre immer offener gegen die vorhandenen Umweltprobleme protestierten, blieben die etablierten Wissenschaften merkwürdig stumm und waren allem Anschein nach nicht in der Lage, geeignete Konzepte zur Lösung der Umweltkrise zu entwickeln. Knapp 20 Jahre zuvor hatte jedoch in der DDR ein umweltpolitischer Aufbruch eingesetzt, der maßgeblich von wissenschaftlichen Reforminitiativen getragen wurde. Die Aufnahme des Natur- und Umweltschutzgedankens in die Verfassung (...) von 1968 und die Verabschiedung des Landeskulturgesetzes zwei Jahre darauf, waren Ausdruck eines gesellschaftspolitischen Konsenses in der Umweltfrage.Wie ist diese scharfe Diskrepanz zu erklären? Der Aufsatz fragt nach dem Einfluss wissenschaftlicher Umweltkonzepte auf den umweltpolitischen Aufbruch in der DDR. Am Beispiel des wissenschaftlichen Naturschutzes, der seit 1951 institutionell in der Deutschen Akademie der Landwirtschaftswissenschaften verankert war, wird gezeigt, dass Naturschützer in den 1950er Jahren eine Phase der „Normalisierung“ durchliefen, die eine wesentliche Voraussetzung dafür war, ihren Anliegen politische Legitimation zu verleihen. Dieser erzwungene Anpassungsprozess beeinflusste aber nicht nur die Konzepte und Ziele des ostdeutschen Naturschutzes, sondern eröffnete seinen Protagonisten auch Partizipationsmöglichkeiten.In diesem Aufsatz plädiere ich für eine Neubewertung der ostdeutschen Umweltgeschichte, die bislang einseitig vom Ende her blickt. Zudem schlage ich vor, das begriffliche Konzept der „partizipatorischen Diktatur“ (Fulbrook) auf die Wissenschaftsgeschichte der DDR zu übertragen und vorhandene Ansätze damit zu erweitern. (shrink)

The problem we face today is that there is a huge gap between our ethical judgments about the ecological crisis on the one hand and our ethical behavior according to these judgments on the other. In this article, we ask to what extent a phenomenology of the ecological crisis enables us to bridge this gap and display more ethical or pro-environmental behavior. To answer this question, our point of departure is the affordance theory of the American psychologist and founding father (...) of ecological psychology, James Gibson. There are two reasons for taking this approach. First of all, an ontological reading of Gibson’s affordance theory provides a concept of nature which is non-dualistic, non-anthropocentric and eco-centric, but is not seen as an ‘intrinsic value’ or product of ‘human valuation’. Secondly, the affordance ontology provides us with a concept of nature which in itself calls for certain action and behavior. If we indeed face a gap between ethical judgment and ethical behavior with regard to the current ecological crisis, an affordance of nature could bridge this gap. Based on our ontological reading of Gibson’s affordance theory, we open a radically new perspective on the current ecological crisis and the responsibility of mankind with regard to this crisis. (shrink)

BackgroundThe concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity.ObjectivesTo investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between moral distress and career (...) identity among nurses.DesignA quantitative, cross-sectional study.MethodsA convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses’ Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement.Ethical considerationResearch ethics approval was obtained from the researcher’s university and hospital where this study was conducted prior to data collection.FindingsMoral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity ( β = −0.230 to −0.163, p < 0.01).DiscussionThe findings reveal a relationship between moral distress, moral courage, and career identity among nurses.ConclusionBy paying attention to nurses’ moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses. (shrink)

Bodily pain and distress come in many forms. They can well up from within at times of serious illness, but the body can also be subjected to harsh treatment from outside. The medical system is often cold and depersonalized, and much worse are conditions experienced by prisoners in our age of mass incarceration, and by animals trapped in our factory farms. In this pioneering book, Drew Leder offers bold new ways to rethink how we create and treat distress, (...) clearing the way for more humane social practices. Leder draws on literary examples, clinical and philosophical sources, his medical training, and his own struggle with chronic pain. He levies a challenge to the capitalist and Cartesian models that rule modern medicine. Similarly, he looks at the root paradigms of our penitentiary and factory farm systems and the way these produce distressed bodies, asking how such institutions can be reformed. Writing with coauthors ranging from a prominent cardiologist to long-term inmates, he explores alternative environments that can better humanize—even spiritualize—the way we treat one another, offering a very different vision of medical, criminal justice, and food systems. Ultimately Leder proposes not just new answers to important bioethical questions but new ways of questioning accepted concepts and practices. (shrink)

Background Moral distress is a complex and challenging issue in the nursing profession that can negatively affect the nurses’ job satisfaction and retention and the quality of patient care. This study focused on describing the resources and constraints, consequences, and interventions of moral distress in nurses. Methods In a literature review, an extensive electronic search was conducted in databases including PubMed, ISI, Scopus as well as Google Scholar search engine using the keywords including “moral distress” and “nurses” (...) to identify resources, constraints, consequences, and interventions about moral distress in nurses, from the earliest records up to 26 December 2020. The required data were extracted from 61 relevant studies by two independent reviewers. Results Resources and constraints in the occurrence of moral distress among nurses can be divided into three general categories including internal factors, clinical factors, and external factors. The consequences of moral distress on nurses and the medical system reduced moral sensitivity, development of psychological and physical health problems, and the intention to leave the profession. The potential effective interventions were the implementation of integrated communication programs, strengthening physician–nurse collaboration, nursing involvement in clinical decision-making and end-of-life issues, social support, using a resiliency bundle, interdisciplinary discussion, and promoting nurses’ ethical and communication skills. Conclusion There are a wide range of resources and constraints impacting moral distress in nurses that could lead to negative consequences. Further studies are necessary to identify, evaluate, and implement a range of potential effective interventions for the management of moral distress in nurses. (shrink)

BackgroundMoral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time.AimThe aim of this study was to translate the MDT and adapt it to the Swedish cultural context.Research designThe first part of this study concerns the translation of MDT to the Swedish (...) context, and the second part the psychometric testing of the Swedish version.Participants and research context89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch’s ANOVA, Games–Howell post-hoc test and Pearson’s correlation analysis were done.Ethical considerationsThe study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration.ResultsThe translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress.ConclusionThe MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context. (shrink)

When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

The Patient Protection and Affordable Care Act of 2010 is the law of the land. But it faces an uncertain future.During congressional deliberations on the 2,700-page legislation leading up to its enactment, from February to March 2010, not one major survey recorded majority support for the legislation. Since its enactment, popular opposition to the Affordable Care Act has hardened, and was a significant factor in the 2010 congressional election, in which Democrats lost 63 seats and Republicans regained the majority in (...) the House of Representatives. Ballot initiatives in Missouri and Ohio, showcasing popular opposition to the individual mandate, passed in 2010 with overwhelming majorities. While the United States Supreme Court in National Federation of Independent Business et al. v. Sebelius, 132 S. Ct. 2566, declared the mandate on the states to expand Medicaid unconstitutionally coercive, the majority of the Justices also upheld the individual mandate as a permissible tax. The new law thus emerged as a central topic in the 2012 election. (shrink)

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress. Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political economy might be integrated into the study of moral distress. Research Design: This research draws on interviews and focus groups, the transcripts of which were analyzed using framework analysis. Research (...) Participants and Context: 88 healthcare providers, based in British Columbia Canada, participated virtually. Ethical Considerations: The study received ethical approval from Simon Fraser University. Findings: Healthcare providers experienced moral dilemmas related to ability to provide quality and compassionate care while maintaining COVID-19 protocols. Moral constraints were exacerbated by staffing shortages and lack of access to PPE. Moral conflicts emerged when women tried to engage decision-makers to improve care, and moral uncertainty resulted from lack of clear and consistent information. At home, women experienced moral constraints related to inability to support children’s education and wellbeing. Moral conflicts related to lack of flexible work environments and moral dilemmas developed between unpaid care responsibilities and COVID-19 risks. Women healthcare providers resisted moral residue and structural constraints by organizing for better working conditions, childcare, and access to PPE, engaging mental health support and drawing on professional pride. Discussion: COVID-19 has led to new and heightened experiences of moral distress among HCP in response to both paid and unpaid care work. While many of the experiences of moral distress at work were not explicitly gendered, implicit gender norms structured moral events. Women HCP had to take it upon themselves to organize, seek out resources, and resist moral residue. Conclusion: A feminist political economy lens illuminates how women healthcare providers faced and resisted a double layering of moral distress during the pandemic. (shrink)

Focusing democratic theory on the pressing issue of punishment, Punishment, Participatory Democracy, and the Jury argues for participatory institutional designs as antidotes to the American penal state. Citizen action in institutions like the jury and restorative justice programs can foster the attunement, reflectiveness, and full-bodied communication needed as foundations for widespread civic responsibility for criminal justice.