Moral Distress in Nephrology: Perceived Barriers to Ethical Clinical Care

Ducharlet, Kathryn; Philip, Jennifer; Gock, Hilton; Brown, Mark; Gelfand, Samantha L.; Josland, Elizabeth; Brennan, Frank

doi:10.1053/j.ajkd.2019.09.018

Cited by 20 publications

(32 citation statements)

References 30 publications

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“…Our findings on priority-setting dilemmas and moral distress relate to other studies describing correlations between experienced resource scarcity and moral distress across professions, specialisations and contexts. 15,32,33 Experiences and levels of moral distress depend on external constraints, such as inadequate communication among team members, internal constraints, such as a lack of empowerment or self-doubt, and the clinical situations. 34,35 The direct and indirect effects of the COVID-19 responses may influence these factors in multiple ways.…”

Section: Discussionmentioning

confidence: 99%

Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway

Miljeteig¹,

Forthun

Hufthammer³

et al. 2021

Nurs Ethics

111

132

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Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms.

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Section: Discussionmentioning

confidence: 99%

Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway

Miljeteig¹,

Forthun

Hufthammer³

et al. 2021

Nurs Ethics

111

132

View full text Add to dashboard Cite

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“…Patients should also be involved in decision-making about-and informed ofrationing of health resources when relevant to promote transparency and accountability of resource allocation decisions. 42 SDM involves a collaborative approach in which clinicians and patients (or their substitute decision-makers) work together to make decisions about care that are based on relevant clinical information and the patient's interests, values, and preferences. In the clinical setting, there may be several practical barriers to SDM during the pandemic as a result of, for example, reliance on telemedicine or physical distancing measures in clinics.…”

Section: Q11mentioning

confidence: 99%

“…Use of well-designed guidelines and decision-making tools that are supported by stakeholders – including patients – are likely to improve impartiality in decision-making and reduce the psychological burdens of rationing on clinicians, including moral distress. 42 Procedural justice must be respected, with transparent communication of policies and guidelines, systematic monitoring and review of outcomes, and clear, accessible processes to support accountability.…”

Section: Introductionmentioning

confidence: 99%

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Ethics of kidney care in the era of COVID-19

Martin

Parsons

Caskey

et al. 2020

Kidney International

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The coronavirus disease 2019 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes in policy and practice affect the ability of all health professionals Q8 to fulfill their ethical duties toward their patients in providing best practice care. In this article, we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kidney failure treatments, specifically with regard to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared decisionmaking; and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them.

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“…The definition proposed by Jameton called attention to constraints impeding moral action(s), but others urged incorporating uncertainty-related moral distress [2], a critical precursor of threat to both personal and professional integrity [3]. Uncertainty-related moral distress is experienced while facing difficulty with decision-making or choosing the right moral action [4,5]. To illustrate both constraint-and uncertainty-related moral distress, consider a situation in which physicians confront an ethical situation with no clear answer (uncertainty-related moral distress).…”

Section: Introductionmentioning

confidence: 99%

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

et al. 2021

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Introduction: 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. Methods: 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 (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define “frequent” and “moderate-to-severe” moral distress. Results: The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. Conclusion: A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.

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Moral Distress in Nephrology: Perceived Barriers to Ethical Clinical Care

Cited by 20 publications

References 30 publications

Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway

Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway

Ethics of kidney care in the era of COVID-19

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

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