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  1. Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians.Y. Bokek-Cohen, I. Marey-Sarwan & M. Tarabeih - 2024 - Journal of Bioethical Inquiry 21 (3):449-459.
    Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience (...)
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  • What is ‘moral distress’ in nursing? A feminist empirical bioethics study.Georgina Morley, Caroline Bradbury-Jones & Jonathan Ives - 2020 - Nursing Ethics 27 (5):1297-1314.
    Background The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim To explore the (...)
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  • Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU.Lucia Wocial, Veda Ackerman, Brian Leland, Brian Benneyworth, Vinit Patel, Yan Tong & Mara Nitu - 2017 - HEC Forum 29 (1):75-91.
    This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...)
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  • Institutional Ethics Resources: Creating Moral Spaces.Ann B. Hamric & Lucia D. Wocial - 2016 - Hastings Center Report 46 (S1):22-27.
    Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...)
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  • Ethicist as Healer: Is Offering Justified Normative Recommendations All We Are Doing in Active Patient Cases?Jeffrey S. Farroni - 2019 - American Journal of Bioethics 19 (11):85-87.
    Volume 19, Issue 11, November 2019, Page 85-87.
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  • A comparative survey on potentially futile treatments between Japanese nurses and laypeople.Yasuhiro Kadooka, Atushi Asai, Miki Fukuyama & Seiji Bito - 2014 - Nursing Ethics 21 (1):64-75.
    In the issue of futile treatments, patients and healthcare professionals tend to disagree. We conducted an Internet questionnaire survey and explored the Japanese nurses’ attitude toward this topic, comparing with that of laypeople. In total, 522 nurses and 1134 laypeople completed the questionnaire. Nurse respondents were significantly less in favor of providing potentially futile treatments in hypothetical vignettes and stressed quality of life of the patient for judging the futility of a certain treatment. Of them, 85.4% reported having experienced providing (...)
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  • Making the Call: A Proactive Ethics Framework. [REVIEW]Carol Pavlish, Katherine Brown-Saltzman, Alyssa Fine & Patricia Jakel - 2013 - HEC Forum 25 (3):269-283.
    This manuscript proposes a proactive framework for preventing or mitigating disruptive ethical conflicts that often result from delayed or avoided conversations about the ethics of care. Four components of the framework are explained and illustrated with evidenced-based actions. Clinical implications of adopting a prevention-based, system-wide ethics framework are discussed. While some aspects of ethically-difficult situations are unique, system patterns allow some issues to occur repeatedly—often with lingering effects such as healthcare providers’ disengagement and moral distress (McAndrew et al. Journal of (...)
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  • Ethical Leadership and Employees’ Perceptions About Raising Ethical Concerns to Managers in the Veterans Health Administration.Mary Beth Foglia & Jennifer Hadary Cohen - 2019 - AJOB Empirical Bioethics 10 (3):155-163.
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  • Reflective Debriefs as a Response to Moral Distress: Two Case Study Examples.Georgina Morley & Cristie Cole Horsburgh - 2023 - HEC Forum 35 (1):1-20.
    Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and other clinical ethics (...)
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  • Organisational and individual support for nurses’ ethical competence: A cross-sectional survey.Tarja Poikkeus, Riitta Suhonen, Jouko Katajisto & Helena Leino-Kilpi - 2018 - Nursing Ethics 25 (3):376-392.
    Background: Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed. Research questions: This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support. Research design: (...)
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  • An Evaluation of Unit-Based Ethics Conversations.Lucia D. Wocial, Maureen Hancock, Patricia D. Bledsoe, Amy R. Chamness & Paul R. Helft - 2010 - Jona's Healthcare Law, Ethics, and Regulation 12 (2):48-54.
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  • The scope of ethical dilemmas in paediatric nursing: a survey of nurses from a tertiary paediatric centre in Australia.Ingrid Schulz, Jenny O’Neill, Peter Gillam & Lynn Gillam - 2023 - Nursing Ethics 30 (4):526-541.
    Background No previous study has provided evidence for the scope and frequency of ethical dilemmas for paediatric nurses. It is essential to understand this to optimise patient care and tailor ethics support for nurses. Research aim The aim of this study was to explore the scope of nurses’ ethical dilemmas in a paediatric hospital and their engagement with the hospital clinical ethics service. Research design This study used a cross-sectional survey design. Participants and research context Paediatric nursing staff in a (...)
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  • A Health System-wide Moral Distress Consultation Service: Development and Evaluation.Ann B. Hamric & Elizabeth G. Epstein - 2017 - HEC Forum 29 (2):127-143.
    Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...)
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  • Decreasing Perceived Moral Distress in Pediatrics Residents: A Pilot Study.Allison N. J. Lyle, Angela Quain, Sara Ali & Zeynep N. Inanc Salih - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-10.
    Pediatric residents experience ethical dilemmas and moral distress during training. Few studies have identified meaningful methods in reducing moral distress in pediatric trainees. The authors aimed to determine how residents perceive ethics case discussions, whether such a program affects trainee ethics knowledge and perceived moral distress, and if residents’ perceived moral distress changes before, during, and after a discussion series. Participants included pediatric residents in a single residency program. Five separate 1-hour sessions were presented over a 5-month period. Each session (...)
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  • Nurse managers’ perspectives on working with everyday ethics in long-term care.Siri Andreassen Devik, Hilde Munkeby, Monica Finnanger & Aud Moe - 2020 - Nursing Ethics 27 (8):1669-1680.
    Background:Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers’ ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care.Objective:The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care.Design and participants:Qualitative individual interviews were performed with 10 nurse (...)
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  • Moral Distress and Austerity: An Avoidable Ethical Challenge in Healthcare.Georgina Morley, Jonathan Ives & Caroline Bradbury-Jones - 2019 - Health Care Analysis 27 (3):185-201.
    Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...)
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  • Commentary: The Broader Context of Long-Term Care Ethics.Jason Lesandrini & Carol O’Connell - 2016 - Cambridge Quarterly of Healthcare Ethics 25 (3):554-556.
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  • Solving work-related ethical problems.Laura Laukkanen, Riitta Suhonen & Helena Leino-Kilpi - 2016 - Nursing Ethics 23 (8):838-850.
    Background: Nurse managers are responsible for solving work-related ethical problems to promote a positive ethical culture in healthcare organizations. Objectives: The aim of this study was to describe the activities that nurse managers use to solve work-related ethical problems. The ultimate aim was to enhance the ethical awareness of all nurse managers. Research Design: The data for this descriptive cross-sectional survey were analyzed through inductive content analysis and quantification. Participants and research context: The data were collected in 2011 using a (...)
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