A Phenomenological Exploration of Physicians' Moral Distress: Situating Emotion Within Lived Experiences.

IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Academic Medicine Pub Date : 2024-11-01 Epub Date: 2024-07-22 DOI:10.1097/ACM.0000000000005817
Derek C Chang, Martina Kelly, Kevin W Eva
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Abstract

Purpose: Physicians often experience moral distress from being prevented from taking what they believe to be the right course of action. Although causes and consequences of moral distress have been studied, little research offers insight into the significance of feeling morally challenged, especially in medicine. This study was undertaken to advance understanding of what physicians experience when encountering morally challenging situations and to examine how those experiences influence their interactions with the world of health care.

Method: Guided by hermeneutic phenomenology, the authors conducted semistructured interviews with purposefully sampled Canadian physicians from September 2022 to January 2023. Analysis used Van Manen's 6 activities of hermeneutic research and included "story crafting" to sharpen insights. Late in that process, Van Manen's "lived existentials" was determined to provide a strong framework for physicians' experiences of moral distress.

Results: Of the 12 physicians interviewed, all experienced varied and long-lasting emotional reactions to morally challenging experiences. The emotions associated with moral distress, reported as inevitable, were experienced in ways that aligned with the lived existentials of body, space, time, and relations.

Conclusions: A richer understanding of physicians' lived experiences with moral distress can help mentors and educators more thoughtfully engage in conversations about it with colleagues and learners. This study highlights the core dimensions of moral distress through body, space, time, and relations, thereby providing a means to enrich discussion about emotions and their transformational power. Through such nuanced consideration, calls for emotional candor may be strengthened to enhance practice by acknowledging the scope of impact that efforts to deliver care are likely to provoke.

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对医生道德压力的现象学探索:将情感置于生活经历之中。
目的:医生经常会因为无法采取他们认为正确的行动而感到道德上的痛苦。虽然人们已经对道德困扰的原因和后果进行了研究,但很少有研究能深入探讨道德挑战感的意义,尤其是在医学领域。本研究旨在进一步了解医生在遇到道德挑战时的体验,并探讨这些体验如何影响他们与医疗世界的互动:在诠释现象学的指导下,作者于 2022 年 9 月至 2023 年 1 月有目的地对抽样的加拿大医生进行了半结构化访谈。分析采用了范马南的诠释学研究的 6 项活动,包括 "故事加工",以提高洞察力。在这一过程的最后阶段,范马南的 "活生生的存在 "被确定为医生道德困扰经历的有力框架:结果:在接受访谈的 12 名医生中,所有医生都对道德挑战经历经历了各种持久的情绪反应。据报告,与道德困扰相关的情绪是不可避免的,其体验方式与身体、空间、时间和关系等生活存在方式相一致:对医生在道德困境中的生活体验有更丰富的理解,有助于指导者和教育者更周到地与同事和学员进行有关道德困境的对话。这项研究通过身体、空间、时间和关系突出了道德困扰的核心维度,从而为丰富关于情绪及其转化力的讨论提供了一种方法。通过这种细致入微的考虑,可以加强对情感坦诚的呼吁,从而通过承认提供护理的努力可能引发的影响范围来加强实践。
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来源期刊
Academic Medicine
Academic Medicine 医学-卫生保健
CiteScore
7.80
自引率
9.50%
发文量
982
审稿时长
3-6 weeks
期刊介绍: Academic Medicine, the official peer-reviewed journal of the Association of American Medical Colleges, acts as an international forum for exchanging ideas, information, and strategies to address the significant challenges in academic medicine. The journal covers areas such as research, education, clinical care, community collaboration, and leadership, with a commitment to serving the public interest.
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