Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey.
Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey.
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DOI：
10.1159/000516575
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发表时间：
2021
影响因子：
4.2
通讯作者：
Liebman, Scott E.
中科院分区：
文献类型：
--
作者：
Saeed, Fahad;Duberstein, Paul R.;Epstein, Ronald M.;Lang, Valerie J.;Liebman, Scott E.
道德困扰是一种消极的情感反应，在这种情况下，一个人被迫以一种与自己的价值观相冲突的方式行事。我们对肾脏病研究员在工作场所引发道德困扰的情况知之甚少。我们向148名肾脏病学研究员主任发送了一份道德困扰调查，并要求将其转发给他们的研究员。研究人员使用5分制（0-4），对常见的工作场所情景的频率（从不到非常频繁）和严重程度（一点也不令人不安到非常令人不安）进行评级。使用≥3的评级来定义“频繁”和“中度至重度”道德困扰。调查由64名研究金主任转发给386名研究员，其中142人（37%）作出答复。他们的平均年龄为33 ± 3.6岁，43%为女性。最常引起中度至重度道德困扰的情况是在该研究员认为无效的情况下开始透析（77%），在无望的病人中继续透析（81%）和进行高患者普查（75%），以及观察其他提供者对透析的好处过于乐观的描述（64%）。大约27%的人在培训期间考虑过退出研究金，包括在调查完成时的9%。绝大多数肾病学实习生经历了中度至重度的道德痛苦，主要与对无望的病人进行无效治疗有关。需要努力减少受训人员的精神痛苦。
Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one’s values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0–4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define “frequent” and “moderate-to-severe” moral distress. The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.
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