The Challenged Resident: Moral Distress, Moral Disengagement, and Ethical Climate in U.S. Medical Residencies

Foreword
Acknowledgments
Introduction
References
Contents
List of Figures
List of Tables
About the Author
Chapter 1: The Issue of Moral Distress
	Moral Distress
	Empirical Research on Moral Distress Among Nurses
	Moral Distress Among Other Healthcare Professionals
	Moral Distress and Medical Residents
	References
Chapter 2: Experiencing Moral Disengagement
	Mechanisms of Moral Disengagement
	References
Chapter 3: The Effects of Ethical Climate on Moral Distress
	References
Chapter 4: Carrying Out the Quantitative Study
	Instruments
	Participants
	Descriptive Statistics
	Frequencies and Percentages
	Means and Standard Deviations
	Reliability
	Pearson Correlation Analysis
	Linear Regression Analysis
	Moderation
	Summary of Quantitative Results
	References
Chapter 5: Qualitative Results and Themes
	Themes and Responses
		Futile and Aggressive Treatment for Dying Patients
		Disregard for Patients’ Wishes Due to Pressures from Family and Inhibiting Medical Power Structure
		Giving False Hope to Patients (Deception)
		Lack of Truth Telling/Nondisclosure of Terminal Illness
		Not Doing What Is in the Best Interest of the Patient for Fear of Litigation
	Effects of Moral Distress on Residents
		Anger Due to Unsuccessful Advocacy for Terminal Patients
		Feelings of Helplessness and Powerlessness
	Analysis of Moral Disengagement Themes
		Emotional Bluntness and Indifference
		Gallows Humor
		Detachment and Avoidance
	Themes That Align with Bandura’s Mechanisms of Moral Disengagement
		Victim Blaming (Attribution of Blame)
		Rationalization (Moral Justification)
		Evading Personal Responsibility (Displacement of Responsibility)
	Degradation (Dehumanization)
	Analysis of Ethical Climate Themes
		Emphasis on Law and Avoiding Litigation over Ethics
		Lack of Supervisory Support for Residents
		Perceptions of a Weak and Negative Ethical Climate
	References
Chapter 6: Discussion of Findings
	A Summary of the Qualitative Portion of the Study
	Implication for Leadership of Residency Programs
	References
Chapter 7: Residency During COVID-19
	Education
	Long Working Hours
	Safety Protocols
	Fear of Getting the Virus
	Compromising Their Integrity
	Rationing of Equipment
	Changing Policy Factors
	Telehealth
	Feelings of Isolation
	Evolution and Response to Moral Distress
	References
Chapter 8: What Individuals Can Do
	Meditation and Mindfulness
	Physical Relaxation Methods
	Creative Arts Therapy
	Prayer
	References
Conclusion
Appendix A: Moral Distress Physician Questionnaire (ADULT)
Appendix B: Moral Disengagement
Appendix C: Ethical Climate Questionnaire
Appendix D: Interview Questions (Qualitative Phase)
References