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Article
Publication date: 1 June 2008

Em Pijl‐Zieber, Brad Hagen, Chris Armstrong‐Esther, Barry Hall, Lindsay Akins and Michael Stingl

Nurses and other professional caregivers are increasingly recognising the issue of moral distress and the deleterious effect it may have on professional work life, staff…

Abstract

Nurses and other professional caregivers are increasingly recognising the issue of moral distress and the deleterious effect it may have on professional work life, staff recruitment and staff retention. Although the nursing literature has begun to address the issue of moral distress and how to respond to it, much of this literature has typically focused on high acuity areas, such as intensive care nursing. However, with an ageing population and increasing demand for resources and services to meet the needs of older people, it is likely that nurses in long‐term care are going to be increasingly affected by moral distress in their work. This paper briefly reviews the literature pertaining to the concept of moral distress, explores the causes and effects of moral distress within the nursing profession and argues that many nurses and other healthcare professionals working with older persons may need to become increasingly proactive to safeguard against the possibility of moral distress.

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Quality in Ageing and Older Adults, vol. 9 no. 2
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 13 March 2017

Julia Brassolotto, Tamara Daly, Pat Armstrong and Vishaya Naidoo

The purpose of this study was to explore long-term residential care provided by people other than the facilities’ employees. Privately hired paid “companions” are…

Abstract

Purpose

The purpose of this study was to explore long-term residential care provided by people other than the facilities’ employees. Privately hired paid “companions” are effectively invisible in health services research and policy. This research was designed to address this significant gap. There is growing recognition that nursing staff in long-term care (LTC) residential facilities experience moral distress, a phenomenon in which one knows the ethically right action to take, but is systemically constrained from taking it. To date, there has been no discussion of the distressing experiences of companions in LTC facilities. The purpose of this paper is to explore companions’ moral distress.

Design/methodology/approach

Data were collected using week-long rapid ethnographies in seven LTC facilities in Southern Ontario, Canada. A feminist political economy analytic framework was used in the research design and in the analysis of findings.

Findings

Despite the differences in their work tasks and employment conditions, structural barriers can cause moral distress for companions. This mirrors the impacts experienced by nurses that are highlighted in the literature. Though companions are hired in order to fill care gaps in the LTC system, they too struggle with the current system’s limitations. The hiring of private companions is not a sustainable or equitable solution to under-staffing and under-funding in Canada’s LTC facilities.

Originality/value

Recognizing moral distress and its impact on those providing LTC is critical in relation to supporting and protecting vulnerable and precarious care workers and ensuring high-quality care for Canadians in LTC.

Details

Quality in Ageing and Older Adults, vol. 18 no. 1
Type: Research Article
ISSN: 1471-7794

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Book part
Publication date: 17 December 2008

John T. Jost, Cheryl J. Wakslak and Tom R. Tyler

In addition to serving a hegemonic function, system-justifying ideologies serve the palliative function of enabling people to feel better about inequality. We summarize…

Abstract

In addition to serving a hegemonic function, system-justifying ideologies serve the palliative function of enabling people to feel better about inequality. We summarize three studies supporting this proposition. In the first study, an arbitrary hierarchy was created using the “Star Power” simulation. Results reveal that system justification is associated with increased positive affect, satisfaction, and decreased negative affect, guilt, and frustration. Two additional studies demonstrate that the dampening effect of system justification on support for the redistribution of resources is mediated by reduced moral outrage but not guilt or negative affect. Implications for social change and social justice are discussed.

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Justice
Type: Book
ISBN: 978-1-84855-104-6

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Article
Publication date: 1 July 2006

Joy Mekechuk

The purpose of this paper is to explore the concept of moral distress in particular as it impacts on the pediatric intensive care nurse caught between caring for infants…

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986

Abstract

Purpose

The purpose of this paper is to explore the concept of moral distress in particular as it impacts on the pediatric intensive care nurse caught between caring for infants and children who would not otherwise be alive were it not for the advances of modern medical technology, and their personal beliefs concerning the societal value of life at any cost.

Design/methodology/approach

Describes cases and real incidents to illustrate the moral distress experienced by these nurses caught between caring for the children and at the same time interacting with the families. Such families are too often living on hope, with a profound faith in the ever advancing world of medical technology to keep loved ones alive with little thought to the consequences.

Findings

Suggests that the impact of moral distress on pediatric nurses, particularly as it relates to burnout, may well jeoparidize their ability to deliver effective care and is another unrecognized cost in the medical world.

Practical implications

Suggests that an ethical approach to care is necessary through hard to answer questions. Due to the fact that such questions are not often addressed, the author suggests consideration be given to medical ethicists to mediate and assist those caught in this dilemma.

Originality/value

This paper will be of value to those concerned with how medical and life‐saving technologies are outstripping our human abilities to comprehend and live with the consequences, and some of the ethical issues that arise.

Details

Leadership in Health Services, vol. 19 no. 3
Type: Research Article
ISSN: 1366-0756

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Article
Publication date: 20 October 2020

Kim McMillan and Amélie Perron

The aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change.

Abstract

Purpose

The aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change.

Design/methodology/approach

A critical hermeneutic approach was utilized. This was a qualitative inquiry theoretically guided by critical management studies.

Findings

Participants recognized that many change initiatives reflected an ideological shift in healthcare that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care.

Practical implications

Nurses felt morally responsible to uphold a culture of care, which proved challenging and at times unobtainable. The inability to provide quality, safe care in light of organizational changes resulted in a multitude of negative emotional repercussions, which fostered moral distress.

Originality/value

The findings from this study bring to light ideological tensions that negatively impact nurses. This study supports the conclusion that the planning, implementation and evaluation of organizational change initiatives must reflect a culture of care in order to alleviate the many negative experiences of organizational change noted in this study.

Details

Journal of Organizational Change Management, vol. 33 no. 6
Type: Research Article
ISSN: 0953-4814

Keywords

Abstract

Details

Global and Culturally Diverse Leaders and Leadership
Type: Book
ISBN: 978-1-78743-495-0

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Book part
Publication date: 21 May 2020

Ann Gallagher

Abstract

Details

Slow Ethics and the Art of Care
Type: Book
ISBN: 978-1-83909-195-7

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Article
Publication date: 7 April 2015

Vilma Zydziunaite, Daiva Lepaite, Päivi Åstedt-Kurki and Tarja Suominen

– The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

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1666

Abstract

Purpose

The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

Design/methodology/approach

The study is qualitative descriptive, in which researchers stay close to the data. The data were collected in the format of unstructured written reflections. Inductive conventional latent qualitative content analysis was applied to the data.

Findings

The issues of head nurses’ management of decision making in ethical dilemmas relate to the following aspects: taking risks in deviating from the formalities, balancing power and humaneness, maintaining the professional hierarchy, managing resistance to change, managing with limited options, and experiencing the decline of nurse’s professional and/or human dignity.

Research limitations/implications

Reflections in written form were preferred to semi-structured interviews and the researchers were unable to contact the participants directly and to ask additional questions. All the reflections were produced in a language other than English.

Practical implications

The issues of head nurses’ management of decision making in ethical dilemmas reveal the gap between societal expectations and the opportunities to improve nursing leadership in health care organizations.

Social implications

The issues of head nurses’ decision making when managing ethical dilemmas are related to contexts that reflect the attitudes of society and health care system toward nursing management.

Originality/value

The study adds to the understanding of issues of the management of decision making in ethical dilemmas. It is an ongoing systematic process that encourages head nurses to learn from practice and manage the quality of care by empowering themselves and nurses to take responsibility for leadership.

Details

Baltic Journal of Management, vol. 10 no. 2
Type: Research Article
ISSN: 1746-5265

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Article
Publication date: 11 April 2018

Clare Lynette Harvey, Shona Thompson, Eileen Willis, Alannah Meyer and Maria Pearson

The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost…

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1167

Abstract

Purpose

The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.

Design/methodology/approach

The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.

Findings

The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.

Originality/value

The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.

Details

Journal of Health Organization and Management, vol. 32 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 22 March 2021

Suparak Janjarasjit and Siew H. Chan

The purpose of this study is to examine whether users’ perceived moral affect explains the effect of perceived intensity of emotional distress on responsibility judgment…

Abstract

Purpose

The purpose of this study is to examine whether users’ perceived moral affect explains the effect of perceived intensity of emotional distress on responsibility judgment of a perpetrator and company, respectively, in an ill and good intention breach.

Design/methodology/approach

Participants completed a questionnaire containing items measuring their perceived intensity of emotional distress, perceived moral affect and responsibility judgment of a perpetrator and company, respectively.

Findings

The results support the mediating hypothesis on responsibility judgment of a perpetrator regardless of intention. The mediating hypothesis is also supported in an ill intention breach in responsibility judgment of a company. However, the mediating effect is not observed in a good intention breach when users assess a company’s responsibility.

Originality/value

The findings support the notion that users use the consequentialism approach when assessing a perpetrator’s responsibility because they focus on the victims’ emotional distress and discount a perpetrator’s intent, resulting in similar mediating effect of perceived moral affect in an ill and good intention breach. The results also indicate that perceived moral affect increases the negative effect of perceived intensity of emotional distress on responsibility judgment of a company, suggesting that users may exhibit empathetic feelings toward a company and perceive it as a victim of an ill intention breach. The lack of mediating effect in responsibility judgment of a company in a good intention breach may be attributed to the diminished effect of a perpetrator’s feelings of regret, sorrow, guilt and shame for causing emotional distress to the victims.

Details

Information & Computer Security, vol. 29 no. 1
Type: Research Article
ISSN: 2056-4961

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