Out-of-hours decision-making in deteriorating patients by foundation year doctors: Relationship to moral distress.

IF 0.9 Q2 MEDICINE, GENERAL & INTERNAL Journal of the Royal College of Physicians of Edinburgh Pub Date : 2023-12-01 Epub Date: 2023-10-24 DOI:10.1177/14782715231203941

Justin C Geddes, Margaret MacDougall, Robin D Taylor

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Abstract

Background: Moral distress (MD) refers to psychological unease when healthcare professionals identify morally correct actions to take but are constrained in their ability to take those actions.

Methods: This study evaluated the relationship between out-of-hours decisions and MD among 40 Foundation Year 2 (FY2) doctors. They were asked to choose the 'expected' and the 'right' management options for five out-of-hours scenarios and complete an adapted Measure of Moral Distress for Health Professionals (MMD-HP) questionnaire.

Results: 28/40 (70%) reported discordance between 'expected' and 'right' options more frequently than concordance. The mean total MMD-HP score was low: 64.9 (SD = 26.9), range 13-143, maximum 288. The association between decision-making discordance and MMD-HP score was weak.

Conclusion: Out-of-hours decisions by FY2 doctors were characterised by doing what is 'expected' rather than what is perceived to be 'right'. Providing guidance regarding decision-making in deteriorating patients is needed for patient safety and staff well-being.

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基金会年度医生对病情恶化患者的非工作时间决策：与道德困境的关系。

背景：道德困扰（MD）是指当医疗保健专业人员确定要采取的道德正确的行动，但他们采取这些行动的能力受到限制时的心理不安。方法：本研究评估了40名基金会二年级（FY2）医生的非工作时间决策与MD之间的关系。他们被要求为五种非工作时间情景选择“预期”和“正确”的管理选项，并完成一份经过调整的卫生专业人员道德痛苦测量问卷（MMD-HP）。结果：28/40（70%）报告“预期”和“正确”选项之间的不一致比一致更频繁。MMD-HP平均总分较低：64.9（SD = 26.9），范围13-143，最大288。决策不一致与MMD-HP评分之间的相关性较弱。结论：FY2医生的非工作时间决策的特点是做“预期”的事情，而不是认为“正确”的事情。为了患者安全和员工福祉，需要为病情恶化的患者提供决策指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Royal College of Physicians of Edinburgh MEDICINE, GENERAL & INTERNAL-

CiteScore

1.80

自引率

0.00%

发文量

审稿时长

20 weeks

期刊介绍： The Journal of the Royal College of Physicians of Edinburgh (JRCPE) is the College’s quarterly, peer-reviewed journal, with an international circulation of 8,000. It has three main emphases – clinical medicine, education and medical history. The online JRCPE provides full access to the contents of the print journal and has a number of additional features including advance online publication of recently accepted papers, an online archive, online-only papers, online symposia abstracts, and a series of topic-specific supplements, primarily based on the College’s consensus conferences.