“I can't be the nurse I want to be”: Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving

Molinaro, Monica L; Polzer, Jessica; Rudman, Debbie Laliberté

doi:10.1016/j.socscimed.2023.115677

Cited by 8 publications

(2 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Study sites were always indicated, North America and Europe, specifically England/UK were represented more than other regions. Studies were conducted across a number of different healthcare systems from the non-universal insurance system of the USA [ 40 – 42 , 44 , 48 , 57 , 62 , 63 , 69 , 76 , 78 , 85 , 87 ] to universal government-funded health system (single-payer) of Italy [ 43 , 64 , 65 , 67 , 86 ], UK [ 6 , 46 , 51 , 66 , 68 , 72 , 74 , 77 , 81 ], Sweden [ 45 ], Canada [ 47 , 49 , 52 , 54 – 56 , 61 , 70 , 71 , 73 , 75 , 79 , 82 , 84 ], Norway [ 58 – 60 ] and Australia [ 50 ], to the universal private health insurance system of Netherlands [ 39 ], and the universal public insurance system (social insurance) of Romania [ 53 ]. Although clear themes emerged that related to different healthcare systems and funding mechanisms for care (e.g., what is available to the individuals in that system based on resources and guidelines), overall, descriptions of events which could cause moral distress showed some consiste...…”

Section: Resultsmentioning

confidence: 99%

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Beadle,

Walecka,

Sangam

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Objective At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions. Methods A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic. Results Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients’ care options, professionals’ beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals’ moral comfort. Patients’ care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change. Conclusion This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals’ disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals’ beliefs, repercussions on professionals’ wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.

show abstract

Section: Resultsmentioning

confidence: 99%

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Beadle,

Walecka,

Sangam

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Moral distress, defined as "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action"(22), has become an increasingly topical concept in both scholarly literature and news media as a significant issue facing healthcare providers worldwide (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). However, moral distress has rarely been examined within the context of family medicine, and even less so in relation to the experiences of family physicians who specifically work with patients experiencing health needs related to social inequity.…”

Section: Introductionmentioning

confidence: 99%

Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care

Molinaro,

Shen,

Agarwal

et al. 2023

Br J Gen Pract

Self Cite

View full text Add to dashboard Cite

BackgroundFamily physicians (GPs) working with patients experiencing social inequities have witnessed patients’ healthcare needs proliferate. Alongside increased workload demands fostered within current remuneration structures, this has generated concerning reports of family physician attrition and possible experiences of moral distress.AimTo explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities.Design and settingA critical narrative inquiry, informed by the analytic lens of moral distress, conducted in Ontario, Canada.MethodTwenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews and had the opportunity to review the interview transcripts.ResultsFamily physicians’ accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programmes. These structural elements left physicians unable to get patients much needed support and resources.ConclusionThis study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system. Further research is needed to critically interrogate how health and social welfare systems around the world can be reformed to improve the health of patients and increase family physicians’ professional quality of life, potentially improving retention.

show abstract

Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge

Sherman,

Klinenberg

2024

Social Science & Medicine

View full text Add to dashboard Cite

“I can't be the nurse I want to be”: Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving

Cited by 8 publications

References 34 publications

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care

Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge

Contact Info

Product

Resources

About