Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies

Abstract

ObjectiveTo understand the prevalence of healthcare students’ witnessing or participating in something that they think unethical (professionalism dilemmas) during workplace learning and examine whether differences exist in moral distress intensity resulting from these experiences according to gender and the frequency of occurrence.DesignTwo cross-sectional online questionnaires of UK medical (study 1) and nursing, dentistry, physiotherapy and pharmacy students (study 2) concerning professionalism dilemmas and subsequent distress for (1) Patient dignity and safety breaches; (2) Valid consent for students’ learning on patients; and (3) Negative workplace behaviours (eg, student abuse).Participants and setting2397 medical (67.4% female) and 1399 other healthcare students (81.1% female) responded.Main resultsThe most commonly encountered professionalism dilemmas were: student abuse and patient dignity and safety dilemmas. Multinomial and logistic regression identified significant effects for gender and frequency of occurrence. In both studies, men were more likely to classify themselves as experiencing no distress; women were more likely to classify themselves as distressed. Two distinct patterns concerning frequency were apparent: (1) Habituation (study 1): less distress with increased exposure to dilemmas ‘justified’ for learning; (2) Disturbance (studies 1 and 2): more distress with increased exposure to dilemmas that could not be justified.ConclusionsTomorrow's healthcare practitioners learn within a workplace in which they frequently encounter dilemmas resulting in distress. Gender differences could be respondents acting according to gendered expectations (eg, males downplaying distress because they are expected to appear tough). Habituation to dilemmas suggests students might balance patient autonomy and right to dignity with their own needs to learn for future patient benefit. Disturbance contests the ‘accepted’ notion that students become less empathic over time. Future research might examine the strategies that students use to manage their distress, to understand how this impacts of issues such as burnout and/or leaving the profession.

The influence of ethics education on awareness of nursing students with no clinical experience regarding the code of ethics: A case study

“…Furthermore, it would raise ethical awareness, which is necessary for resolving the various ethical issues that nurses may encounter in the clinical setting. [4,5] The ethical education makes nursing students ready to handle the ethical conflicts that they may encounter during their clinical practice. [6] Therefore, it is necessary for nursing education to focus on developing an understanding of desirable nursing behaviors, which will improve students' ability to cope with different medical ethical problems that they might encounter when working as nurses in the future.…”

“…[13] It has been suggested that education on the code of ethics might help to establish the identity of professional nursing behaviors and promote professional development. [4] In addition, it has been argued that educational interventions or experiential stimulation should be implemented since the initial stage of theoretical education and clinical practice, to help students to recognize the code of nursing ethics and promote the establishment of professional values. [14,15] Thus, it has been suggested that nursing students could learn to develop desirable relationships with other nurses, nursing clients as humans, and various cooperators as a result of ethics education, as well as to understand their professional obligations as experts and to establish desirable professional values.…”

How Should Resident Physicians Respond to Patients' Discomfort and Students' Moral Distress When Learning Procedures in Academic Medical Settings?

“…With their subordinate position in the health care hierarchy, medical students experience moral distress in response to many different situations, including witnessing or participating in provision of futile or nonindicated care or disrespectful behavior [7,8]. Students might remain silent because they fear that voicing concerns could offend superiors and negatively impact their evaluations, as in Lauren's case.…”

Antecedents and Consequences of Medical Students' Moral Decision Making during Professionalism Dilemmas

“…Such dilemmas arise in situations in which students witness and/or are asked to participate in professional lapses such as patient safety, dignity, and consent breaches [5] rather than in ethical dilemma situationstypically encountered by health care professionals-in which decisions need to be made about life-sustaining treatment or the patient's best interest is in question. For example, a professionalism dilemma can be experienced by medical students when they witness senior clinicians jeopardizing patient safety through poor hygiene practices or disrespecting patient dignity through physically exposing patients' bodies for longer than necessary [2,[6][7][8][9]. Furthermore, medical students' seniors frequently request that they undertake activities during workplace learning that violate ethical principles, including examinations (sometimes intimate examinations) without valid patient consent and covering up mistakes, both of which potentially result in patient harm [2, 6-8, 10, 11].…”

“…Indeed, a systematic review of research examining psychological distress in medical students suggests they suffer a high degree of depression and anxiety and greater psychological distress than the general population [1]. In this article, we consider medical students' distress, focusing on moral distress, i.e., emotional distress arising from the dissonance between one's ethical/moral beliefs and one's behavior, which occurs when one's actions are perceived as being limited by institutional constraints or unequal power relations [2][3][4]. By highlighting the concepts of professionalism dilemmas and moral decision making, we examine various types of dilemmas encountered by students, how they respond to those dilemmas, and any resultant moral distress they experience.…”