AJN on MD ( 5 / 5 Stars for Scope and Solutions of MD)

The American Journal of Nurses published a helpful 2015 article on MD, citing various researcher's perspectives about MD. In this article there is a discussion about MD, as well as perspectives about how to engage best with MD and, perhaps most interestingly, a consolidated list of potential interventions to try and reduce MD. Some of the most effective MD reduction techniques will focus around improved communication and collaboration, in particular at the end of life.

http://journals.lww.com/ajnonline/Fulltext/2015/03000/Moral_Distress_in_Nursing.17.aspx

The AACN's Take on MD + Resources ( 5 / 5 Stars for Scope and Solutions of MD)

This site brought to us by the AACN is a list of resources touching on MD and concepts correlated with MD as a repository of information. Critical care nurses often score some of the highest scores in MD among nurses. The resources provided in this link are also for allied professions and some even have CE credit attached / available! 




https://www.aacn.org/clinical-resources/ethics-moral-distress#page/1?%7B75C75579-1BCC-4DD7-9044-A01AB54B2FAD%7D%5B%5D=%7B09A81BC8-D5CC-4361-8290-2102B05E715F%7D

Big Plug from the AMA for Awareness and Action! ( 5 / 5 Stars for Scope and Solutions of MD)

The AMA has come to realize that MD is an accepted occurrence in work environments and has acknowledged that it is time to change the tolerance of MD. This likely mirrors the call to action by the AMA on Burnout, and it is wonderful news that in 2017 there is enough research and attention on MD in order to foster a call to action. While interventions to reduce MD are still largely being trialed and tested at various institutions during this time, it is nevertheless excellent to see a major institution acknowledge that MD continuing to exist is problematic for health systems, patients, and providers alike.

Helpfully, this article is somewhat of a primer on MD, containing the original definition of MD given by Dr. Andrew Jameton in 1984 "moral distress occurs when a clinician makes a moral judgment about a case in which he or she is involved and an external constraint makes it difficult or impossible to act on that judgment, resulting in 'painful feelings and/or psychological disequilibrium' Moral distress has subsequently been shown to be associated with burnout, which includes poor coping mechanisms such as moral disengagement, blunting, denial, and interpersonal conflict."


http://journalofethics.ama-assn.org/2017/06/fred1-1706.html

Google Scholar Search: The Crescendo Effect ( 4 / 5 Stars for Scope and Solutions of MD)

One of the more interesting aspects of moral distress is a component first described by nurse researchers Dr. Ann Hamric and Dr. Beth Epstein in a 2009 article published in the Journal of Clinical Ethics. There they characterize MD as having a crescendo effect, where mild to moderate encounters with MD that are not fully resolved can lead to a rising level of overall MD over time. The researchers termed this "moral residue" and characterized the effect in a figure depicted below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612701/

Google Scholar Resources: Ethical Climate ( 4 / 5 Stars for Scope and Solutions of MD)

A search on Google Scholar for "Moral Distress returns over 600,000 results, many of which are scholarly journal articles. One example of these is a discussion of how there tends to be a correlation between a work environment's ethical climate, and moral distress levels. This was published in the journal of critical care medicine in 2007 by nurse researcher Dr. Ann Hamric and Dr. Leslie Blackhall. The researchers discuss how important collaboration and open discussion and resolution of moral distress is for resolving both MD and improving the ethical climate of a work space.

One question from this article is: Why are health care workers unable to resolve morally distressing events when they arise in the work environment? Do they lack courage, or are there more systemic restraints that exceed a fair expectation of individual courage?

http://journals.lww.com/ccmjournal/Abstract/2007/02000/Nurse_physician_perspectives_on_the_care_of_dying.13.aspx

A more in-depth look into MD, intervew style! ( 3 / 5 Stars for Scope and Solutions of MD)

Another enjoyable and informative link from youtube circa 2013. This is a discussion between two nurse researchers where Dr. Vicki D. Lachman, PhD, APRN, MBE, FAAN from Drexel University SON is interviewed about her research into moral courage. They delve in to MD and advocate a perspective of training HCPs to have moral courage during conversations around the end of life. This is one perspective about what to do to attempt to resolve MD. They also touch on informed consent, professional codes of ethics, and factors that contribute to MD.

https://www.youtube.com/watch?v=t0ccLTf3R1Y

Entrepreneurship & MD ( 3 / 5 Stars for Scope and Solutions of MD)

This is another youtube video with a researcher explaining what MD is and how it can impact retention in nurses, costing health systems money.

https://www.youtube.com/watch?v=3qpRkDSwkGA&t=82s

The researcher, LeAnn Thieman, began what seems to be a consulting company to attempt to mitigate the attrition issues associated with MD and poor work environment!

https://www.selfcareforhealthcare.com/

Gaining the Spotlight on Youtube! ( 3 / 5 Stars for Scope and Solutions of MD)

This is a video from researchers at the ethics center at Johns Hopkins explaining that ethics consultation is one potential resource for HCPs that feel MD. The researcher details a brief explanation of when nurses, in particular, feel MD. She also speaks a small portion about extrapolating why the nurse is experiencing MD from an ethical perspective.

https://www.youtube.com/watch?v=kgfX2FhQwTA

What to Do, What to Do? ( 4 / 5 Stars for Scope and Solutions of MD)

One of the reason why moral distress remains in the work environment is because it is difficult to combat. Tools have been developed to assess levels of MD, such as the MDS-I and the MDS-II, that use surveys to assess MD levels in HCPs. However, the data collected can be prone to being deemed not actionable because there are few known reliable MD interventions that will reduce MD. Thus, these researchers developed a moral distress consult service. Their article summarizing root cause analyses of MD and the potential utility of the consult service was then published in the international and peer-reviewed journal HealthCare Ethics Committee Forum in June of 2017.

Hamric, A.B. & Epstein, E.G. HEC Forum (2017) 29: 127. https://doi.org/10.1007/s10730-016-9315-y

https://link.springer.com/article/10.1007/s10730-016-9315-y

American Thoracic Society Talks About Burnout Syndrome, Noting Moral Distress Within Its Framework ( 4 / 5 Stars for Scope and Solutions of MD)

One of the corollaries in moral distress research is how MD fits into other pathological syndromes. In the article below, the American Thoracic Society notes that Burnout syndrome is a phenomena that is may be correlated to poor outcomes, high rates of attrition for clinicians, and increased medical error, among other problems. Moreover, the CCSC supported the publication of the article and the research behind it in order to have a call to action about burnout and the ways that it is affecting HCPs and patients. The authors defined burnout syndrome as manifesting with three classic symptoms: exhaustion, depersonalization, and reduced personal accomplishment. ATS is publishing information on burnout because it has been increasing in the last few decades. They cite information that up to 40% ER physicians have burnout syndrome, and up to 50% of ICU/CC clinicians experience burnout. They also cite potential risk factors for burnout, as well as potential solutions for reduction, such as mindfulness and resilience training, and motivating the health care workers to keep physically healthy. Moral distress fits into their model as depicted in their figure below:



Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). A critical care societies collaborative statement: Burnout syndrome in critical care health-care professionals. A call for action. Am J Respir Crit Care Med, 194(1), 106-113. doi:10.1164/rccm.201604-0708ST