Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada.
Health Care Anal. 2011 Jun;19(2):107-21. doi: 10.1007/s10728-010-0145-9.
Moral distress is a concept used to date in clinical literature to describe the experience of staff in circumstances in which they are prevented from delivering the kind of bedside care they believe is expected of them, professionally and ethically. Our research objective was to determine if this concept has relevance in terms of key health care managerial functions, such as priority setting and resource allocation. We conducted interviews and focus groups with mid- and senior-level managers in two British Columbia (Canada) health authorities. Transcripts were analyzed qualitatively using constant comparison to identify key themes related to moral distress. Both mid- and senior-level managers appear to experience moral distress, with both similarities and differences in how their experiences manifest. Several examples of this concept were identified including the obligation to communicate or 'sell' organizational decisions or policies with which a manager personally may disagree and situations where scarce resources compel managers to place staff in situations where they meet with predictable and potentially avoidable risks. Given that moral distress appears to be a relevant issue for at least some health care managers, further research is warranted into its exact nature, prevalence, and possible organizational and personal responses.
道德困境是一个在临床文献中使用的概念，用于描述在某些情况下，工作人员无法提供他们认为在专业和道德上应该提供的床边护理的体验。我们的研究目的是确定这个概念在关键的医疗保健管理功能方面是否具有相关性，例如优先级设置和资源分配。我们对不列颠哥伦比亚省（加拿大）两个卫生当局的中层和高层管理人员进行了访谈和焦点小组讨论。使用恒定比较对转录本进行定性分析，以确定与道德困境相关的关键主题。中层和高层管理人员似乎都经历了道德困境，他们的经历在表现方式上既有相似之处，也有不同之处。这个概念的几个例子包括有义务与个人可能不同意的组织决策或政策进行沟通或“推销”，以及在资源稀缺的情况下，管理者不得不将员工置于他们面临可预见且可能避免的风险的情况下的情况。鉴于道德困境似乎是至少一些医疗保健管理者的一个相关问题，因此需要进一步研究其确切性质、普遍性以及可能的组织和个人反应。
