Moral Distress in Pediatric Residents and Pediatric Hospitalists: Sources and Association With Burnout

Beck, Jimmy; Randall, Cameron L.; Bassett, Hannah K.; O'Hara, Kimberly; Falco, Carla; Sullivan, Erin; Opel, Douglas J.

doi:10.1016/j.acap.2020.05.017

Cited by 27 publications

(32 citation statements)

References 28 publications

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“…Other tools such as the Measure of MD for Healthcare Professionals (MMD-HP) determine the presence of MD while the MD thermometer assesses the intensity of MD. 96 127 130 151 MDS-R and MMD-HP also evaluate the sources of conflict reviewing conflicts between personal and professional expectations on conduct, and professional and familial sources of MD. 89 98 161 195 …”

Section: Resultsmentioning

confidence: 99%

Systematic scoping review on moral distress among physicians

et al. 2022

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BackgroundConcepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.MethodsA systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.ResultsA total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.ConclusionsInitial reviews suggest that MD involves conflicts within a physician’s personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician’s personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician’s MD and preventing burn-out.

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Section: Resultsmentioning

confidence: 99%

Systematic scoping review on moral distress among physicians

et al. 2022

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“…Both in paediatric and neonatal intensive care, professionals are commonly challenged by questions about their practice and the EDs they face. These can lead professionals to experience moral distress [22][23][24][25]. In the daily practice of paediatric and neonatal intensive care, moral distress is frequent and relates to several difficult situations dealing with the patients' outcome and management but also with difficulties in communication among team members.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Residents and Fellows Ethics (PERFEct) survey: perceptions of European trainees regarding ethical dilemmas

et al. 2021

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With an increasingly complex healthcare environment, ethics is becoming a more critical part of medical education. We aimed to explore European paediatric trainees’ experiences of facing ethical dilemmas and their medical ethics education whilst assessing their perceptions of ethical dilemmas in current and future practice. The Young Sections of the European Academy of Paediatrics and European Society of Paediatric and Neonatal Intensive Care developed an explorative online survey covering demographics, ethical dilemmas faced and ethics training. The survey was made available in nine languages from November 2019 to January 2020 via newsletters and social media. Participants (n = 253) from 22 countries, predominantly female (82%) and residents (70%), with a median age of 29-years, completed the survey. The majority (58%) faced ethical dilemmas monthly or more frequently. Most ethics training was received by ethics lectures in medical school (81%) and on the job (60%). A disagreement between the healthcare team and patient/family was the most frequently faced moral dilemma (45%); the second was withholding/withdrawing life-prolonging measures (33%). The latter was considered the most challenging dilemma to resolve (50%). Respondents reported that ethical issues are not sufficiently addressed during their training and wished for more case-based teaching. Many have been personally affected by moral dilemmas, especially regarding withholding/withdrawing life-prolonging measures, and often felt inadequately supported.Conclusion: Paediatric trainees face many moral issues in daily practice and consider that training about managing current and future ethical dilemmas should be improved, such as by the provision of a core European paediatric ethics curriculum. What is Known:• Paediatric services are becoming more complex with an increase in ethical dilemmas asking for rigorous training in ethics.• Ethics training is often lacking or covered poorly in both pre- and postgraduate medical education curricula.• Existing ethics training for European paediatric trainees is haphazard and lacks standardisation. What is New:• The PaEdiatric Residents and Fellows Ethics (PERFEct) survey provides insight into the European paediatric trainees’ views regarding ethical dilemmas in their current and future practice.• European paediatric trainees report a lack of ethics training during paediatric residency and fellowship.• This study provides content suggestions for standardised medical ethics training for paediatric trainees in Europe.

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“…Among 128 rheumatologists, dissatisfaction with the EHR was associated with a 2.86-times increased likelihood of burnout (also increasing this rate was lack of exercise and extended work hours) [63]. A survey of 288 pediatric residents indicated that the EHR was the most frequent source of distress, wherein the most common complaint was, "having excessive documentation requirements that compromise patient care" [64].…”

Section: Electronic Health Record (Ehr)mentioning

confidence: 99%

Wellness Review 2020, Part 2

Ferguson¹,

Huecker²

2020

JWellness

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Introduction: This article comprises Part 2 of the Journal of Wellness review of 2020 wellness literature (July – December). In this review, JWellness editors continue the goal of offering a cohesive summary of recent publications within the wellness domain. We summarize new science and resilience initiatives published outside of JWellness that seek understanding of either burnout and its prevention or thriving in the medical community. Methods: From the interval of 01 July – 31 Dec 2020, PubMed was queried for empirical research studies, review articles, and editorials in accordance with the following algorithm: an article was required to have two delineating keywords, each from a separate grouping. The first identified medical professionals in either the title or the abstract: (“clinical professionals,” “physicians,” or “caregivers”), and the other identified a wellness-related keyword in the title: (“wellness,” “burnout,” “resilience,” or “resiliency”). Literature in Review: A total of 234 articles resulted. The list for inclusion was then narrowed to sixty-three articles plus one that was hand-picked. Recent literature into physician wellness, burnout and resilience continues to focus heavily on COVID-19. Well-researched topics include burnout surveillance, proposals for and small investigations into resilience, multiple studies attempting to differentiate characteristics that predispose to burnout, and the impact of the pandemic. Less has been written on leadership, financial wellness, and sustainable resilience-building initiatives. We note relatively few control-measured interventional studies—the majority of which remain small in endeavor and short in duration, limiting generalizability. Conclusion: Recent literature into physician wellness, burnout and resilience focuses heavily on COVID-19. Many workplace / organizational factors negatively influence wellness: cumbersome EHRs, cultures not focused on socialization and self-compassion, and high physician task load. We express optimism regarding future interventional studies of burnout mitigation and resilience enhancement.

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Moral Distress in Pediatric Residents and Pediatric Hospitalists: Sources and Association With Burnout

Cited by 27 publications

References 28 publications

Systematic scoping review on moral distress among physicians

Systematic scoping review on moral distress among physicians

Paediatric Residents and Fellows Ethics (PERFEct) survey: perceptions of European trainees regarding ethical dilemmas

Wellness Review 2020, Part 2

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