The Challenged Resident: Moral Distress, Moral Disengagement, and Ethical Climate in U.S. Medical Residencies

Foreword Acknowledgments Introduction References Contents List of Figures List of Tables About the Author Chapter 1: The Issue of Moral Distress Moral Distress Empirical Research on Moral Distress Among Nurses Moral Distress Among Other Healthcare Professionals Moral Distress and Medical Residents References Chapter 2: Experiencing Moral Disengagement Mechanisms of Moral Disengagement References Chapter 3: The Effects of Ethical Climate on Moral Distress References Chapter 4: Carrying Out the Quantitative Study Instruments Participants Descriptive Statistics Frequencies and Percentages Means and Standard Deviations Reliability Pearson Correlation Analysis Linear Regression Analysis Moderation Summary of Quantitative Results References Chapter 5: Qualitative Results and Themes Themes and Responses Futile and Aggressive Treatment for Dying Patients Disregard for Patients’ Wishes Due to Pressures from Family and Inhibiting Medical Power Structure Giving False Hope to Patients (Deception) Lack of Truth Telling/Nondisclosure of Terminal Illness Not Doing What Is in the Best Interest of the Patient for Fear of Litigation Effects of Moral Distress on Residents Anger Due to Unsuccessful Advocacy for Terminal Patients Feelings of Helplessness and Powerlessness Analysis of Moral Disengagement Themes Emotional Bluntness and Indifference Gallows Humor Detachment and Avoidance Themes That Align with Bandura’s Mechanisms of Moral Disengagement Victim Blaming (Attribution of Blame) Rationalization (Moral Justification) Evading Personal Responsibility (Displacement of Responsibility) Degradation (Dehumanization) Analysis of Ethical Climate Themes Emphasis on Law and Avoiding Litigation over Ethics Lack of Supervisory Support for Residents Perceptions of a Weak and Negative Ethical Climate References Chapter 6: Discussion of Findings A Summary of the Qualitative Portion of the Study Implication for Leadership of Residency Programs References Chapter 7: Residency During COVID-19 Education Long Working Hours Safety Protocols Fear of Getting the Virus Compromising Their Integrity Rationing of Equipment Changing Policy Factors Telehealth Feelings of Isolation Evolution and Response to Moral Distress References Chapter 8: What Individuals Can Do Meditation and Mindfulness Physical Relaxation Methods Creative Arts Therapy Prayer References Conclusion Appendix A: Moral Distress Physician Questionnaire (ADULT) Appendix B: Moral Disengagement Appendix C: Ethical Climate Questionnaire Appendix D: Interview Questions (Qualitative Phase) References The purpose of this timely and stimulating book is to examine the causes and impacts of moral distress among US medical residents. Based on a comprehensive study conducted by the author, the work not only delves into the causes of moral distress among medical residents but also explores how this distress can lead to moral disengagement, potentially resulting in suboptimal clinical care and adverse patient outcomes. The book begins with an overview of existing scholarship on moral distress experienced by practitioners within the medical establishment and its negative psychological impacts. Chapter two discusses how moral distress can lead to moral disengagement and its subsequent effects on patient care. In chapter three, the author explores residents’ perceptions of the role of the "ethical climate" in contributing to moral distress. Chapter four outlines the impetus behind the study and details its methodology. Chapter five reviews the study’s findings, focusing on the relationship between moral distress and moral disengagement, including the influence of the ethical climate within medical institutions. Chapter six summarizes the quantitative and qualitative findings of the study. Chapter seven addresses how these issues were managed during the recent COVID-19 pandemic, when medical personnel were often stressed, overworked, and apprehensive about contracting the virus themselves. Finally, in chapter eight, the author suggests strategies for preventing moral distress and disengagement and provides recommendations for medical residents on managing the inherent stresses of medical training. The Challenged Resident offers a unique and insightful contribution to the clinical literature on ethics and medical residency, enabling clinicians, trainees, administrators, policymakers, and other stakeholders to better understand the pressures and stressors faced by medical residents and to consider strategies and policies that address moral distress, promote resident self-care, foster a more supportive and ethical training environment, and reduce moral disengagement.