Looking at the Positive Side of Moral Distress: Why It's a Problem.

Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.

Impostor feelings as a moderator and mediator of the relationship between perceived discrimination and mental health among racial/ethnic minority college students.

This study investigated whether impostor feelings would both moderate and mediate the relationship between perceived discrimination and mental health in a sample of diverse ethnic minority college students (106 African Americans, 102 Asian Americans, 108 Latino/a Americans) at an urban public university. African American students reported higher perceived discrimination than Asian American and Latino/a American students, while no racial/ethnic group differences were reported for impostor feelings. Analyses revealed that among African American students, high levels of impostor feelings moderated the perceived discrimination and depression relationship and mediated the perceived discrimination and anxiety relationship. Among Asian American students, impostor feelings mediated the relationship between perceived discrimination and both depression and anxiety. Among Latino/a American students low levels of impostor feelings moderated the relationship between perceived discrimination and both depression and anxiety, and partially mediated the relationship between perceived discrimination and anxiety. Multigroup path analyses revealed a significantly stronger impact of impostor feelings on depression among African American students and a stronger impact of perceived discrimination on impostor feelings among African American and Latino/a American students. Clinical implications and future research directions are discussed. (PsycINFO Database Record

Tough Decisions for Premature Triplets.

When infants are born at the borderline of viability, doctors and parents have to make tough decisions about whether to institute intensive care or provide only palliative care. Often, these decisions are made in moments of profound emotional turmoil, and parents receive different information from different health professionals. Communication can become garbled. It may be difficult to tell when and whether the patient's clinical condition has changed enough so that certain choices that had once been permissible become impermissible. In this "Ethics Rounds," we present a case of triplets born at the borderline of viability. We sought comments from the triplets' parents, the doctors and ethicist who were caring for the infants, and a bioethicist/neonatologist from another hospital.

Dax's case redux: when comes the end of the day?

Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient's right to stop treatment and the physician's role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient's treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients must grin and bear intense pain to recover and that a patient's choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day.