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  1. 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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  • Moral distress in nurses caring for patients with Covid-19.Henry J. Silverman, Raya Elfadel Kheirbek, Gyasi Moscou-Jackson & Jenni Day - 2021 - Nursing Ethics 28 (7-8):1137-1164.
    Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in (...)
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  • Psychometric evaluation of the Moral Distress Risk Scale: A methodological study.Rafaela Schaefer, Elma L. C. P. Zoboli & Margarida M. Vieira - 2019 - Nursing Ethics 26 (2):434-442.
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  • Can the Ethical Best Practice of Shared Decision-Making lead to Moral Distress?Trisha M. Prentice & Lynn Gillam - 2018 - Journal of Bioethical Inquiry 15 (2):259-268.
    When healthcare professionals feel constrained from acting in a patient’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. (...)
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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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  • Situating moral distress within relational ethics.Sadie Deschenes & Diane Kunyk - 2020 - Nursing Ethics 27 (3):767-777.
    Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this topic that we do (...)
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  • Doctors’ perceptions of how resource limitations relate to futility in end-of-life decision making: a qualitative analysis.Eliana Close, Ben P. White, Lindy Willmott, Cindy Gallois, Malcolm Parker, Nicholas Graves & Sarah Winch - 2019 - Journal of Medical Ethics 45 (6):373-379.
    ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...)
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