To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Abstract

Background: There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist. Methods: We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies.A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis.Results: A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress. Conclusions:The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.

Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study

“…These consequences eliminated nurses’ assertiveness and created unprofessionalism norms. In line with our results, Millis identified the moral distress in the surgical team was influenced by the level of support from co-workers and working alongside inadequately trained colleagues [ 14 ]. Poor communication among team members was identified as a promoting factor for moral distress [ 5 , 32 ].…”

“…It is also suggested to create team-based support, such as the development of team-based care mechanisms, and interprofessional team meetings to debate medical error, unethical behaviors, and moral distress in the operating rooms and surgical units. Moreover, mechanisms of feedback and medical error disclosure assisted the nurses in moral distress situations [ 14 ]. The construction of a culture of psychological safety and teamwork was recognized as the key mechanism for protecting against burnout and adverse outcomes of moral distress.…”

“…Alimoradi and colleagues in a systematic review and meta-analysis study indicated nurses working in developing countries reported higher levels of moral distress than those working in developed countries [ 12 ]. Since moral distress was recognized as a multifactorial phenomenon, further study was suggested to explore the source of moral distress in different cultures and communities from the perspective of different professions [ 13 , 14 ]. The method enables nurses to examine the processes, experiences, and outcomes of moral distress from their perspective [ 15 ].…”