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  1. Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure.Mara Buchbinder, Alyssa Browne, Nancy Berlinger, Tania Jenkins & Liza Buchbinder - 2023 - American Journal of Bioethics 24 (12):8-22.
    Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we (...)
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  • Re-defining moral distress: A systematic review and critical re-appraisal of the argument-based bioethics literature.Christine Sanderson, Linda Sheahan, Slavica Kochovska, Tim Luckett, Deborah Parker, Phyllis Butow & Meera Agar - 2019 - Clinical Ethics 14 (4):195-210.
    The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. (...)
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  • Safe and competent nursing care: An argument for a minimum standard?Siri Tønnessen, Anne Scott & Per Nortvedt - 2020 - Nursing Ethics 27 (6):1396-1407.
    There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is unclear. Thus, (...)
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  • Moral Distress in Residential Child Care.Neil McMillan - 2020 - Ethics and Social Welfare 14 (1):52-64.
    Neoliberalism has ushered in a rise in managerialism, technocracy and bureaucratisation in residential child care where economy, efficiency, and effectiveness have been prioritised over the moral imperative to care. One implication has been the commodification of children who are traded in a culture of procurement and commissioning compounded by a climate of austerity, and where moral regulation has been replaced by contractual regulation. The impact of this upon the care that children receive has raised concern. The impact upon frontline carers (...)
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  • Intensive care unit professionals’ responses to a new moral conflict assessment tool: A qualitative study.Soodabeh Joolaee, Deborah Cook, Jean Kozak & Peter Dodek - 2023 - Nursing Ethics 30 (7-8):1114-1124.
    Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...)
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