The Temporal Uses of Moral Things: Manifesting, Anchoring and Conserving Caring Relations within the Sensorium.
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ABSTRACT:
SUBMITTER: Balmer A
PROVIDER: S-EPMC8188994 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundMoral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics.MethodsA cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1-10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale.ResultsTwo-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4-7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers and faculty on the inpatient clerkships on medicine, neurology, and surgery, where students most often reported experiencing moral distress.ConclusionsMoral distress is highly prevalent among medical students while caring for older patients, and associated with burnout. Incorporating geriatrics education and debriefing sessions into inpatient clerkships could alleviate medical student moral distress and burnout.
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Project description:Background:Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians' empathy and patients' adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, poor job satisfaction, and intention to quit their job. Methods:Italian clinicians who attended the 2016 "Smart Meeting Anesthesia Resuscitation in Intensive Care" completed the Empathy Quotient questionnaire, the Moral Distress Scale-Revised, and two questions assessing job satisfaction and intention to quit the job. Multiple linear and logistic regressions were performed to determine if clinicians' empathy influences moral distress, job satisfaction, and intention to quit. Age, gender, and profession were used as control variables. Results:Out of 927 questionnaires distributed, 216 were returned (23% response rate) and 210 were used in the analyses. Respondents were 56% physicians, 24% nurses, and 20% residents. Over half of the clinicians (58%) were female. Empathy resulted the only significant predictor of job satisfaction (? = 0.193; p < 0.05). None of the variables included in the model predicted moral distress. Conclusion:Empathy determined neither moral distress nor intention to quit. Findings suggest that empathy is not a risk factor for critical care clinicians in developing moral distress and the intention to quit their job. On the contrary, empathy was found to enhance clinicians' job satisfaction.
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Project description:We investigated whether chimpanzees use the temporal sequence of external events to determine causation. Seventeen chimpanzees (Pan troglodytes) witnessed a human experimenter press a button in two different conditions. When she pressed the "causal button" the delivery of juice and a sound immediately followed (cause-then-effect). In contrast, she pressed the "non-causal button" only after the delivery of juice and sound (effect-then-cause). When given the opportunity to produce the desired juice delivery themselves, the chimpanzees preferentially pressed the causal button, i.e., the one that preceded the effect. Importantly, they did so in their first test trial and even though both buttons were equally associated with juice delivery. This outcome suggests that chimpanzees, like human children, do not rely solely on their own actions to make use of novel causal relations, but they can learn causal sequences based on observation alone. We discuss these findings in relation to the literature on causal inferences as well as associative learning.
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Project description:BackgroundWhen working with surrogate decision-makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians.ObjectiveTo determine frequency of and factors associated with physicians' moral distress caring for patients requiring a surrogate.DesignProspective survey.ParticipantsPhysicians (n = 154) caring for patients aged 65 years and older and their surrogate decision-makers (n = 362 patient/surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified surrogate.Main measuresMoral distress thermometer.Key resultsPhysicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and surrogate characteristics, physician/surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02-1.10), and facing a decision about life-sustaining treatment (3.58, 1.54-8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23-0.69), patients who previously discussed care preferences (0.56, 0.35-0.90), and higher surrogate ratings of emotional support from clinicians (0.94, 0.89-0.99). Physicians' internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33-3.70) after adjusting for patient, surrogate, and physician characteristics.ConclusionsPhysician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
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Project description:Despite the repeatedly raised criticism that findings in economic games are specific to situations involving trivial incentives, most studies that have examined the stake-size effect have failed to find a strong effect. Using three prisoner's dilemma experiments, involving 479 non-student residents of suburban Tokyo and 162 students, we show here that stake size strongly affects a player's cooperation choices in prisoner's dilemma games when stake size is manipulated within each individual such that each player faces different stake sizes. Participants cooperated at a higher rate when stakes were lower than when they were higher, regardless of the absolute stake size. These findings suggest that participants were 'moral bargain hunters' who purchased moral righteousness at a low price when they were provided with a 'price list' of prosocial behaviours. In addition, the moral bargain hunters who cooperated at a lower stake but not at a higher stake did not cooperate in a single-stake one-shot game.
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