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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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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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Chicago
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.
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.
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.
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.
@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},
  keyword      = {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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