Abstract:<b><i>Introduction:</i></b> Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one’s values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. <b><i>Methods:</i></b> We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0–4) scale, fellows rated both the frequency (… Show more
“…Racial or ethnic categories reflected the study contexts. A USA study, while seemingly adapting categories used to collect federal data, differentiated between “White” and “Middle Eastern or North African” (Saeed et al., 2021); categories which would be grouped together in official data (US Office of Management and Budget, 1997). The “White” racial category was seemingly used to mean people of European ancestry, with Morley, Bradbury‐Jones, et al.…”
AimTo inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research.DesignScoping review.MethodsThe PRISMA (Preferred Reporting Items for Systematic and Meta‐Analysis) Extension for Scoping Reviews was adopted.Data SourcesSystematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022.ResultsAfter screening and full‐text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals.ImpactThis study found that while there is an upward trend in including gender and race‐disaggregated data in moral distress research, over half of such research did not conduct in‐depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis‐à‐vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings.ConclusionThere is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race‐based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences.Implications for the Profession and/or Patient CareMoral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches.Patient or Public ContributionNo patient or public contribution.
“…Racial or ethnic categories reflected the study contexts. A USA study, while seemingly adapting categories used to collect federal data, differentiated between “White” and “Middle Eastern or North African” (Saeed et al., 2021); categories which would be grouped together in official data (US Office of Management and Budget, 1997). The “White” racial category was seemingly used to mean people of European ancestry, with Morley, Bradbury‐Jones, et al.…”
AimTo inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research.DesignScoping review.MethodsThe PRISMA (Preferred Reporting Items for Systematic and Meta‐Analysis) Extension for Scoping Reviews was adopted.Data SourcesSystematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022.ResultsAfter screening and full‐text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals.ImpactThis study found that while there is an upward trend in including gender and race‐disaggregated data in moral distress research, over half of such research did not conduct in‐depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis‐à‐vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings.ConclusionThere is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race‐based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences.Implications for the Profession and/or Patient CareMoral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches.Patient or Public ContributionNo patient or public contribution.
“… 53 A recent American survey of 142 nephrology fellows showed that 81% of respondents experienced moral distress related to starting dialysis in futile circumstances and 75% experienced moral distress when continuing dialysis on hopelessly ill patients. 54 Therefore, more education, training, and support is urgently needed for clinicians to prevent moral distress resulting from compromised end-of-life care experiences.…”
“…Dies spüren Mitglieder des Pflegeteams ebenso wie Ärzt*innen. Saeed et al untersuchten Häufigkeit, Ausmaß und Ursachen von Moral Distress von angehenden Fachärzt*innen für Nephrologie [23]. Die Interaktion mit An-und Zugehörigen wurde von 76 % der Befragten mit einem hohen Stresslevel assoziiert.…”
Zusammenfassung
Hintergrund Dialyseteams betreuen immer häufiger betagte Patient*innen mit Hämodialyse. Diese verursacht im Laufe der Behandlung vielfältige Symptome, die die Lebensqualität beträchtlich einschränken. Die Lebenszeit der betreuten Patient*innen ist durch Alter, Polymorbidität und nicht zuletzt durch die Therapie selbst begrenzt.
Forschungsziel Ziel der Untersuchung war es, herauszufinden, wie ein Team aus Nephrolog*innen und Pflegepersonen die Hämodialyse betagter Patient*innen erlebt und welchen Herausforderungen es sich bei der Betreuung und Begleitung stellen muss.
Studiendesign und Methodik Im Rahmen eines qualitativen Forschungsansatzes wurden mit 9 Mitgliedern eines Dialyseteams, das > 120 Patient*innen in der Dialyseambulanz eines Krankenhauses betreut, leitfadengestützte Interviews geführt. Die Auswertung der Transkripte erfolgte anhand einer inhaltlich-strukturierenden qualitativen Inhaltsanalyse nach Kuckartz.
Ergebnisse In jeder der 4 definierten Hauptkategorien (Prädialyse und Indikationsstellung, Beginn und Stabilisierung, Destabilisierung und Therapiezieländerung, Abschied) wurde deutlich, dass die Betreuung betagter Patient*innen ein Dialyseteam vor besondere Herausforderungen stellt. Die Mitglieder des Teams beschrieben diese in ähnlicher Weise und zeigten auf, welche Bedingungen für eine als gut erlebte Betreuung erfüllt sein sollten.
Schlussfolgerung Die Betreuung betagter Patient*innen wird von der Indikationsstellung zur Hämodialyse bis zur Beendigung der Nierenersatztherapie vom Dialyseteam als ein sensibler Prozess betrachtet, der nicht nur die individuellen Bedürfnisse und Ressourcen der Patient*innen, sondern auch die der An- und Zugehörigen einbezieht. Diesen kommt vor allem bei Therapiezieländerungen eine Schlüsselrolle zu.
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