ABSTRACT

This paper reports findings from a qualitative study on the triggers of hospital social workers’ moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual’s personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal hospital policies; and organizational values, such as perceptions of institutional support and validation. Implications of this research suggest that health systems need to foster positive ethical environments that nurture clinicians’ health and mental health through programs that aim to increase moral resilience, promote empowerment, and foster wellness.

摘要

本文报告了一项关于美国南部大型卫生系统医院社会工作者道德困境触发因素的定性研究结果。当道德冲突无法以符合个人和职业价值观及道德规范的方式解决时，就会出现道德困扰。与会者指出，道德困境源于个人互动以及卫生系统的文化和氛围。例如，参与者表达了道德困扰的来源如何源自以客户为中心的决策，例如临终关怀和患者自主权；人际关系动态，包括团队或主管冲突；结构性问题，例如保险壁垒或内部医院政策；和组织价值观，例如对机构支持和验证的看法。