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Coping with moral distress in oncology practice : nurse and physician strategies

An Lievrouw (UGent) , Stijn Vanheule (UGent) , Myriam Deveugele (UGent) , Martine De Vos (UGent) , Piet Pattyn (UGent) , Simon Van Belle (UGent) and Dominique Benoit (UGent)
(2016) ONCOLOGY NURSING FORUM. 43(4). p.505-512
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Organization
Abstract
Purpose/Objectives: To explore variations in coping with moral distress among physicians and nurses in a university hospital oncology setting. Research Approach: Qualitative interview study. Setting: Internal medicine (gastroenterology and medical oncology), gastrointestinal surgery, and day clinic chemotherapy at Ghent University Hospital in Belgium. Participants: 17 doctors and 18 nurses with varying experience levels, working in three different oncology hospital settings. Methodologic Approach: Patients with cancer were interviewed based on the critical incident technique. Analyses were performed using thematic analysis. Findings: Moral distress lingered if it was accompanied by emotional distress. Four dominant ways of coping (thoroughness, autonomy, compromise, and intuition) emerged, which could be mapped on two perpendicular continuous axes: a tendency to internalize or externalize moral distress, and a tendency to focus on rational or experiential elements. Each of the ways of coping had strengths and weaknesses. Doctors reported a mainly rational coping style, whereas nurses tended to focus on feelings and experiences. However, people appeared to change their ways of handling moral distress depending on personal or work-related experiences and perceived team culture. Prejudices were expressed about other professions. Conclusions: Moral distress is a challenging phenomenon in oncology. However, when managed well, it can lead to more introspection and team reflection, resulting in a better interpersonal understanding. Interpretation: Team leaders should recognize their own and their team members' preferred method of coping and tailored support should be offered to ease emotional distress.
Keywords
UNITS, DETERMINANTS, CRITICAL-CARE, coping, oncology, cancer, caregiver, moral distress, CONFLICTS, EXPERIENCE

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Citation

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MLA
Lievrouw, An, Stijn Vanheule, Myriam Deveugele, et al. “Coping with Moral Distress in Oncology Practice : Nurse and Physician Strategies.” ONCOLOGY NURSING FORUM 43.4 (2016): 505–512. Print.
APA
Lievrouw, A., Vanheule, S., Deveugele, M., De Vos, M., Pattyn, P., Van Belle, S., & Benoit, D. (2016). Coping with moral distress in oncology practice : nurse and physician strategies. ONCOLOGY NURSING FORUM, 43(4), 505–512.
Chicago author-date
Lievrouw, An, Stijn Vanheule, Myriam Deveugele, Martine De Vos, Piet Pattyn, Simon Van Belle, and Dominique Benoit. 2016. “Coping with Moral Distress in Oncology Practice : Nurse and Physician Strategies.” Oncology Nursing Forum 43 (4): 505–512.
Chicago author-date (all authors)
Lievrouw, An, Stijn Vanheule, Myriam Deveugele, Martine De Vos, Piet Pattyn, Simon Van Belle, and Dominique Benoit. 2016. “Coping with Moral Distress in Oncology Practice : Nurse and Physician Strategies.” Oncology Nursing Forum 43 (4): 505–512.
Vancouver
1.
Lievrouw A, Vanheule S, Deveugele M, De Vos M, Pattyn P, Van Belle S, et al. Coping with moral distress in oncology practice : nurse and physician strategies. ONCOLOGY NURSING FORUM. 2016;43(4):505–12.
IEEE
[1]
A. Lievrouw et al., “Coping with moral distress in oncology practice : nurse and physician strategies,” ONCOLOGY NURSING FORUM, vol. 43, no. 4, pp. 505–512, 2016.
@article{7275562,
  abstract     = {Purpose/Objectives: To explore variations in coping with moral distress among physicians and nurses in a university hospital oncology setting. 
Research Approach: Qualitative interview study. 
Setting: Internal medicine (gastroenterology and medical oncology), gastrointestinal surgery, and day clinic chemotherapy at Ghent University Hospital in Belgium. 
Participants: 17 doctors and 18 nurses with varying experience levels, working in three different oncology hospital settings. 
Methodologic Approach: Patients with cancer were interviewed based on the critical incident technique. Analyses were performed using thematic analysis. 
Findings: Moral distress lingered if it was accompanied by emotional distress. Four dominant ways of coping (thoroughness, autonomy, compromise, and intuition) emerged, which could be mapped on two perpendicular continuous axes: a tendency to internalize or externalize moral distress, and a tendency to focus on rational or experiential elements. Each of the ways of coping had strengths and weaknesses. Doctors reported a mainly rational coping style, whereas nurses tended to focus on feelings and experiences. However, people appeared to change their ways of handling moral distress depending on personal or work-related experiences and perceived team culture. Prejudices were expressed about other professions. 
Conclusions: Moral distress is a challenging phenomenon in oncology. However, when managed well, it can lead to more introspection and team reflection, resulting in a better interpersonal understanding. 
Interpretation: Team leaders should recognize their own and their team members' preferred method of coping and tailored support should be offered to ease emotional distress.},
  author       = {Lievrouw, An and Vanheule, Stijn and Deveugele, Myriam and De Vos, Martine and Pattyn, Piet and Van Belle, Simon and Benoit, Dominique},
  issn         = {0190-535X},
  journal      = {ONCOLOGY NURSING FORUM},
  keywords     = {UNITS,DETERMINANTS,CRITICAL-CARE,coping,oncology,cancer,caregiver,moral distress,CONFLICTS,EXPERIENCE},
  language     = {eng},
  number       = {4},
  pages        = {505--512},
  title        = {Coping with moral distress in oncology practice : nurse and physician strategies},
  url          = {http://dx.doi.org/10.1188/16.ONF.505-512},
  volume       = {43},
  year         = {2016},
}

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