How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

Hill, Terry E.

doi:10.1186/1747-5341-5-11

Cited by 63 publications

(59 citation statements)

References 143 publications

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“…Such patients were either spoken to in harsh language or were threatened with denial of treatment which suggests that they do not have the moral right to challenge the authority of health workers. Similarly, Hill [34] observes that patients who fail to validate clinician's sense of themselves as effective professionals, who threaten their control, and/or who create fruitless work are all subject to being labelled “bad patients.” This label attracted negative attitudes or behaviours of health worker towards patients as also seen in the present study.…”

Section: Discussionmentioning

confidence: 99%

Attitudes and Behaviours of Health Workers and the Use of HIV/AIDS Health Care Services

Dapaah

2016

Nursing Research and Practice

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Background. This article discusses how health workers relate to and communicate with clients of VCT and ART treatment. It also looks at how health worker practices in the form of attitudes and behaviours towards clients influence the use of these services. Methods. In-depth interviews, informal conversations, and participant observation were used to collect data from health workers providing VCT and ART and clients who access these services in two Ghanaian hospitals. Results. The study found that health workers providing these services, with the exception of a few, generally showed positive attitudes and behaviours towards clients during clinical encounters. Health workers warmly received clients to the facilities, addressing clients with courtesy, advising clients on a wide range of issues, sometimes supporting clients financially, and comfortably interacting with them. This is contrary to the findings of most studies in the literature that health workers often do not communicate and relate to these patients well. Conclusion. It concludes that dealing with clients well during interactions in the centres and clinics is crucial for reducing the perceived stigma associated with the use of services and increasing use as part of the national effort to reduce the infection rate of the disease in Ghana.

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Section: Discussionmentioning

confidence: 99%

Attitudes and Behaviours of Health Workers and the Use of HIV/AIDS Health Care Services

Dapaah

2016

Nursing Research and Practice

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“…This ignores the role of the healthcare provider, therapeutic process or environment in disengagement [62]. Such a label may have ramifications for on-going participation in rehabilitation [63] by influencing clinician attitudes and behaviors toward the individual [64] and potentially influencing decisions about on-going rehabilitation [5]. Viewing engagement as a process and asking, 'how can we facilitate engagement?'…”

Section: Discussionmentioning

confidence: 99%

A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

179

177

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A conceptual review of engagement in healthcare and rehabilitationPurpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement.Method: EBSCO and SCOPUS databases and reference lists were searched for papers that sought to understand or describe the concept of engagement in healthcare or reported the development of a measure of engagement in healthcare. We drew on a Pragmatic Utility approach to concept analysis.Results: Thirty-one articles met the criteria and were included in the review. Engagement appeared to be conceptualized in two inter-connected ways: as a gradual process of connection between the healthcare provider and patient; and as an internal state which may be accompanied by observable behaviors indicating engagement. Conclusion:Our review suggests engagement to be multi-dimensional, comprising both a coconstructed process and a patient state. While engagement is commonly considered a patient behavior, the review findings suggest clinicians play a pivotal role in patient engagement. This review challenges some understandings of engagement and how we work with patients, and highlights conceptual limitations of some measures. Introduction'Patient engagement' is a term increasingly used in rehabilitation and the broader healthcare context [1]. Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge. Levels of engagement have also been associated with lower levels of depression and with higher levels of affect, adherence and attendance [2,4]. In addition, within clinical rehabilitation practice, the 'engaged patient' is perhaps identified as being the 'desirable patient', one who is easy for providers to work with [5]. On the face of it, these findings suggest that patient engagement is both positive and desirable.While the term 'engagement' is increasingly used in clinical practice and research, there has been relatively little critical exploration of what 'engagement' means and the underpinning concept/s the term may represent. Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].It could be argued that it does not matt...

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“…[2][3][4][5][6] An extensive literature identifies the ''difficult'' patient and common characteristics and behaviors that compromise the therapeutic relationship, such as social class, occupation or employment status, appearance, age, cleanliness, and attire. [7][8][9][10][11] Previous studies confirm the characterizations of difficult patients and, more broadly, difficult clinical encounters. However, there is a gap in the literature identifying moral distress among residents and its recognition and alleviation in residency education.…”

Section: Introductionmentioning

confidence: 52%

Recognizing and Alleviating Moral Distress Among Obstetrics and Gynecology Residents

Aultman¹,

Wurzel²

2014

Journal of Graduate Medical Education

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Background Obstetrics and gynecology residents face difficult clinical situations and decisions that challenge their moral concepts. Objective We examined how moral and nonmoral judgments about patients are formulated, confirmed, or modified and how moral distress may be alleviated among obstetrics-gynecology residents. Methods Three focus groups, guided by open-ended interview questions, were conducted with 31 obstetrics-gynecology residents from 3 academic medical institutions in northeast Ohio. Each focus group contained 7 to 14 participants and was recorded. Two investigators independently coded and thematically analyzed the transcribed data. Results Our participants struggled with 3 types of patients perceived as difficult: (1) patients with chronic pain, including patients who abuse narcotics; (2) demanding and entitled patients; and (3) irresponsible patients. Difficult clinical encounters with such patients contribute to unalleviated moral distress for residents and negative, and often inaccurate, judgment made about patients. The residents reported that they were able to prevent stigmatizing judgments about patients by keeping an open mind or recognizing the particular needs of patients, but they still felt unresolved moral distress. Conclusions Moral distress that is not addressed in residency education may contribute to career dissatisfaction and ineffective patient care. We recommend education and research on pedagogical approaches in residency education in a model that emphasizes ethics and professional identity development as well as the recognition and alleviation of moral distress.

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How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

Cited by 63 publications

References 143 publications

Attitudes and Behaviours of Health Workers and the Use of HIV/AIDS Health Care Services

Attitudes and Behaviours of Health Workers and the Use of HIV/AIDS Health Care Services

A conceptual review of engagement in healthcare and rehabilitation

Recognizing and Alleviating Moral Distress Among Obstetrics and Gynecology Residents

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