College of Business, Florida International University, Miami, Florida, and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
J Healthc Manag. 2022;67(5):380-402. doi: 10.1097/JHM-D-21-00263.
Moral distress literature is firmly rooted in the nursing and clinician experience, with a paucity of literature that considers the extent to which moral distress affects clinical and administrative healthcare leaders. Moreover, the little evidence that has been collected on this phenomenon has not been systematically mapped to identify key areas for both theoretical and practical elaboration. We conducted a scoping review to frame our understanding of this largely unexplored dynamic of moral distress and better situate our existing knowledge of moral distress and leadership.
Using moral distress theory as our conceptual framework, we evaluated recent literature on moral distress and leadership to understand how prior studies have conceptualized the effects of moral distress. Our search yielded 1,640 total abstracts. Further screening with the PRISMA process resulted in 72 included articles.
Our scoping review found that leaders-not just their employees- personally experience moral distress. In addition, we identified an important role for leaders and organizations in addressing the theoretical conceptualization and practical effects of moral distress.
Although moral distress is unlikely to ever be eliminated, the literature in this review points to a singular need for organizational responses that are intended to intervene at the level of the organization itself, not just at the individual level. Best practices require creating stronger organizational cultures that are designed to mitigate moral distress. This can be achieved through transparency and alignment of personal, professional, and organizational values.
道德困境文献根植于护理和临床医生的经验，但很少有文献考虑到道德困境对临床和行政医疗保健领导者的影响程度。此外，关于这一现象的少量证据尚未得到系统的绘制，以确定理论和实践阐述的关键领域。我们进行了范围综述，以阐明我们对这一基本未被探索的道德困境动态的理解，并更好地定位我们现有的道德困境和领导力知识。
我们使用道德困境理论作为概念框架，评估了关于道德困境和领导力的最新文献，以了解先前的研究如何概念化道德困境的影响。我们的搜索产生了 1640 份摘要。通过 PRISMA 过程进一步筛选，得出 72 篇入选文章。
我们的范围综述发现，领导者——不仅仅是他们的员工——个人经历道德困境。此外，我们确定了领导者和组织在解决道德困境的理论概念化和实际影响方面的重要作用。
尽管道德困境不太可能被消除，但这篇综述中的文献指出，组织需要做出单一的回应，旨在干预组织本身的层面，而不仅仅是个人层面。最佳实践需要创建更强的组织文化，旨在减轻道德困境。这可以通过透明度和个人、专业和组织价值观的一致性来实现。
