Browsing by Subject "Moral distress"
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Item High Moral Distress in Clinicians Involved in the Care of Undocumented Immigrants Needing Dialysis in the United States(Mary Ann Liebert, Inc., 2021-07-15) Jawed, Areeba; Moe, Sharon M.; Anderson, Melissa; Slaven, James E.; Wocial, Lucia De.; Saeed, Fahad; Torke, Alexia M.; Medicine, School of MedicinePurpose: To understand clinicians' perspectives on dialysis care of undocumented immigrants. Methods: A 21-item Internet-based survey using Survey Monkey® was sent to 765 physicians and nurses at a safety-net hospital located in Indianapolis, IN. Moral distress thermometer score was used to assess moral distress (MD). Participants were asked to rate their MD regarding five ethically challenging clinical situations: (1) frail patients with multiple comorbidities and poor quality of life, (2) patients with dementia, (3) a noncompliant patient with frequent emergency room (ER) visits, (4) violent patients with potential harm to others, and (5) undocumented immigrants receiving emergent dialysis only. Key Results: There were 299 of 775 participants (38.5% response rate) who completed the survey; 49.5% were physicians. Nearly half (48%) reported severe MD and 33% reported none to mild. In adjusted ordered logistic regression, females had significantly higher odds of MD (odds ratio [OR]=2.12, CI 1.03-4.33), and nurses had lower MD than fellows/residents (OR=0.14, CI 0.03-0.63). Over 70% of respondents attributed their distress to suffering of patients due to inadequate dialysis and tension between what is considered ethical and the law allows or forbids; 78% believed the patients' quality of life to be worse than those who receive routine hemodialysis. Among nephrologists, caring for these patients led to MD levels like that of dealing with a violent dialysis patient. Conclusions: Emergent-only dialysis causes significant MD in clinicians. Legal and fiscal policies need to be balanced with the ethical and moral commitments of providers for ensuring standard of care to all.Item “I Don’t Want to Go to Work”: A Mixed-Methods Analysis of HealthcareWorker Experiences from the Front- and Side-Lines of COVID-19(MDPI, 2023-05-25) Heavner, Smith F.; Stuenkel, Mackenzie; Russ Sellers, Rebecca; McCallus, Rhiannon; Dean, Kendall D.; Wilson, Chloe; Shuffler, Marissa; Britt, Thomas W.; Stark Taylor, Shannon; Benedum, Molly; Munk, Niki; Mayo, Rachel; Buford Cartmell, Kathleen; Griffin, Sarah; Kennedy, Ann Blair; Health Sciences, School of Health and Human SciencesDuring the COVID-19 pandemic, healthcare workers (HCW) were categorized as “essential” and “non-essential”, creating a division where some were “locked-in” a system with little ability to prepare for or control the oncoming crisis. Others were “locked-out” regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.Item I’m supposed to be a helper: Spiritual distress of abortion providers after Dobbs v. Jackson(2024-04) Bode, Leah; Kumar, Komal; McQuillan, Josie; Scott, Nicole; Bernard, CaitlinOn June 24, 2022, the Supreme Court of the United States voted to overturn Roe v. Wade, the 1970 landmark case protecting abortion rights in America, in Dobbs v. Jackson Women’s Health Organization. The decision has the potential to affect the way that physicians and learners in the field of Obstetrics and Gynecology (OBGYN), and specifically abortion providers, practice their specialty by interacting with patients and making meaning from their work. Meaning making in one’s work has been shown to be integral in fostering spiritual well-being and preventing burnout in medicine. We sought to demonstrate the spectrum of spirituality of abortion providers and their subsequent spiritual distress in the aftermath of Dobbs. We conducted thirty-minute interviews on Zoom with 26 abortion providers from 17 states from November 2022 to February 2023. Demographics collected included age, racial identity, location of practice (by state), years in practice, fellowship training, and practice setting (community, academic, hybrid). States were then classified according to the Guttmacher Institute classifications of Most Restrictive, Restrictive, Some restrictions/protections, Protective, and Very protective as of December 2022. Interviews consisted of questions such as "What are the major tenants of your spiritual beliefs (if none, how you make meaning)?” and “Tell me about any spiritual distress or alienation from your religious or spiritual community as a result of the Dobbs decision.” Interviews were transcribed using the closed caption feature on Zoom and coded by LB, KK, and JM. After achieving consensus, interviews were analyzed using NVivo 14. Sixteen providers were fellowship trained (14 Complex Family Planning and 2 Maternal Fetal Medicine), one was a family medicine physician, and one was a Nurse Practitioner. Practice type was equally distributed amongst community (34.6%), academic (34.6%), and hybrid (30.8%). Location of practice (state) was well-distributed across the restrictive-protective spectrum: 7.7% Most Restrictive, 30.8% Restrictive, 15.4% Some restrictions/protections, 30.8% Protective, and 15.4% Very Protective. The majority of participants identified a personal spirituality, while less than half were tied to an organized religion, such as Christianity, Judaism, Hinduism, or Buddhism. Fifteen participants (57.7%) identified a concept of “good” in their spirituality, using words such as “greater good” or “common good”. Sixteen participants (61.5%) cited ethical principles of justice, non-maleficence, respect for human life, or autonomy as major tenets of their spirituality. The subject of abortion care as related to spirituality was brought up in a number of ways. Ten subjects (38.5%) felt spiritually called to provide abortion care; 11 others (42.3%) perceived abortion care as an obligation born from their spiritual beliefs. Twelve participants (46.2%) noted the act of providing an abortion as a spiritual act, for provider and/or patient. Most participants experienced spiritual distress relating to the Dobbs decision. Spiritual distress was related to conflict with differently minded community members (30%), the perceived inability to live out their calling by providing abortion care (38%), and their physical location (38%). Those who did not experience spiritual distress (26%) noted location and alignment with spiritual values as protective factors. 38% of participants identified some other form of distress (e.g., moral) but did not identify it as spiritual distress. Of note, 92% of participants described their spirituality as helpful in coping with the fall of Roe v. Wade. Sources of strength included advocacy (34.6%), agency (e.g., “I feel strength knowing that I’m still able to do this job”) (57.7%), legislative work (30.8%), and community (50%). Community strength was further broken down into the abortion provider community (57.7%), family and friends (53.8%), and a faith or spiritual community (26.9%). Eight participants (30.8%) identified a perceived conflict, discordance, or lack of discussion between spirituality and medicine. Five subjects (19.2%) acknowledged that their personal spirituality is underexplored. This qualitative study demonstrates that abortion providers are spiritual individuals. For many, the decision to be an abortion provider is motivated by this identity, or in some cases an obligation. Regarding the fall of Roe v. Wade, many abortion providers endorsed feelings of spiritual distress. Many reported being distressed due to not being able to comply with their moral and/or spiritual obligation of providing abortions secondary to new restrictions. Location played a large role in whether providers were experiencing this distress. It can be deduced that state restrictions on provision of abortions have directly impacted the spiritual well-being of abortion providers. As many laws pertaining to abortion are influenced by religious beliefs, it is important to recognize that abortion providers themselves are overwhelming spiritual.Item “I’m supposed to be a helper”: Spiritual distress of abortion providers after Dobbs v. Jackson(2024-04-26) Bode, Leah; Kumar, Komal; McQuillan, Josie; Scott, Nicole; Bernard, CaitlinINTRO On June 24, 2022, the U.S. Supreme Court voted to overturn Roe v. Wade, the 1970 landmark case protecting abortion rights in America, in Dobbs v. Jackson Women’s Health Organization. The decision has the potential to affect the way that abortion providers practice their specialty by interacting with patients and making meaning from their work. Meaning making in one’s work has been shown to be integral in fostering spiritual well-being and preventing burnout in medicine. We sought to demonstrate the spectrum of spirituality of abortion providers and their subsequent spiritual distress in the aftermath of Dobbs. METHODS We conducted thirty-minute interviews on Zoom with 26 abortion providers from 17 states from November 2022 to February 2023. Demographics collected included age, racial identity, location of practice (by state), years in practice, fellowship training, and practice setting (community, academic, hybrid). States were then classified according to the Guttmacher Institute classifications of Most restrictive, Restrictive, Some restrictions/protections, Protective, and Very protective as of December 2022. Interviews consisted of questions such as "What are the major tenants of your spiritual beliefs (if none, how you make meaning)?” and “Tell me about any spiritual distress or alienation from your religious or spiritual community as a result of the Dobbs decision.” Interviews were analyzed using NVivo 14. RESULTS Providers were equally distributed amongst community (34.6%), academic (34.6%), and hybrid (30.8%) settings. Location of practice (state) was well-distributed across the restrictive-protective spectrum: 7.7% Most restrictive, 30.8% Restrictive, 15.4% Some restrictions/protections, 30.8% Protective, and 15.4% Very protective. The majority of participants identified a personal spirituality, while less than half were tied to an organized religion. Sixteen participants (61.5%) cited ethical principles of justice, non-maleficence, respect for human life, or autonomy as major tenets of their spirituality. Ten subjects (38.5%) felt spiritually called to provide abortion care, 11 others (42.3%) perceived abortion care as a spiritual obligation, and 12 participants (46.2%) noted the act of providing an abortion as a spiritual act, for provider and/or patient. Most participants experienced spiritual distress relating to the Dobbs decision. Those who did not experience spiritual distress (26%) noted location and the alignment of their work with spiritual values as protective factors. Of note, 92% of participants described their spirituality as helpful in coping with the fall of Roe v. Wade. Sources of strength included advocacy, agency (e.g., “I feel strength knowing that I’m still able to do this job”), legislative work, and community; 57.7% specifically cited the abortion provider community. CONCLUSION The decision to be an abortion provider is often motivated by one’s spiritual identity. Many abortion providers endorsed feelings of spiritual distress related to not being able to comply with their moral and/or spiritual obligation of providing abortions secondary to new restrictions. Location factored heavily into whether providers were experiencing this distress, suggesting that state restrictions on abortions have directly impacted the spiritual well-being of abortion providers. As many laws pertaining to abortion are influenced by religious beliefs, it is important to recognize that abortion providers themselves are overwhelming spiritual.Item Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey(Wolters Kluwer, 2022) Burns, Karen E.A.; Moss, Marc; Lorens, Edmund; Jose, Elizabeth Karin Ann; Martin, Claudio M.; Viglianti, Elizabeth M.; Fox-Robichaud, Alison; Mathews, Kusum S.; Akgun, Kathleen; Jain, Snigdha; Gershengorn, Hayley; Mehta, Sangeeta; Han, Jenny E.; Martin, Gregory S.; Liebler, Janice M.; Stapleton, Renee D.; Trachuk, Polina; Vranas, Kelly C.; Chua, Abigail; Herridge, Margaret S.; Tsang, Jennifer L.Y.; Biehl, Michelle; Burnham, Ellen L.; Chen, Jen-Ting; Attia, Engi F.; Mohamed, Amira; Harkins, Michelle S.; Soriano, Sheryll M.; Maddux, Aline; West, Julia C.; Badke, Andrew R.; Bagshaw, Sean M.; Binnie, Alexandra; Carlos, W. Graham; Çoruh, Başak; Crothers, Kristina; D'Aragon, Frederick; Denson, Joshua Lee; Drover, John W.; Eschun, Gregg; Geagea, Anna; Griesdale, Donald; Hadler, Rachel; Hancock, Jennifer; Hasmatali, Jovan; Kaul, Bhavika; Kerlin, Meeta Prasad; Kohn, Rachel; Kutsogiannis, D. James; Matson, Scott M.; Morris, Peter E.; Paunovic, Bojan; Peltan, Ithan D.; Piquette, Dominique; Pirzadeh, Mina; Pulchan, Krishna; Schnapp, Lynn M.; Sessler, Curtis N.; Smith, Heather; Sy, Eric; Thirugnanam, Subarna; McDonald, Rachel K.; McPherson, Katie A.; Kraft, Monica; Spiegel, Michelle; Dodek, Peter M.; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society; Medicine, School of MedicineObjectives: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. Design: Cross-sectional survey using four validated instruments. Setting: Sixty-two sites in Canada and the United States. Subjects: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. Intervention: None. Measurements and main results: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. Conclusions: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.