Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, (...) we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic factors. We conclude by reflecting on how and why this conceptual clarity matters for improving clinicians’ professional wellbeing, and offer preliminary pathways for intervention. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s (...) moral sensitivity. The nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses (...) feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress. (shrink)

Somatic diversification of antigen receptor genes depends on the activity of enzymes whose homologs participate in a mutagenic DNA repair in unicellular species. Indeed, by engaging error-prone polymerases, gap filling molecules and altered mismatch repair pathways, lymphocytes utilize conserved components of genomic stress response systems, which can already be found in bacteria and archaea. These ancient systems of mutagenesis and repair act to increase phenotypic diversity of microbial cell populations and operate to enhance their ability to produce fit variants (...) during stress. Coopted by lymphocytes, the ancient mutagenic processing systems retained their diversification functions instilling the adaptive immune cells with enhanced evolvability and defensive capacity to resist infection and damage. As reviewed here, the ubiquity and conserved character of specialized variation-generating mechanisms from bacteria to lymphocytes highlight the importance of these mechanisms for evolution of life in general. (shrink)

Stress is prevalent in our daily life, and people often make moral decision-making in a stressful state. Several studies have indicated the influence of acute stress on moral decision-making and behavior. The present study extended the investigation to chronic stress, and employed a new approach, the CNI model, to add new insights regarding the mechanism underlying the association between chronic stress and moral decision-making. A total of 197 undergraduates completed the Perceived Stress Scale and made (...) moral decision-making on a series of deliberately designed moral dilemmas. The results indicated that the high-stress group (one standard deviation above the mean) preferred more deontological options than the low-stress group (one standard deviation below the mean). Process-dissociation analysis revealed that the two groups had differences on deontological inclinations but not on utilitarian inclinations. And CNI model analyses suggested that the high-stress group showed a stronger general preference for inaction than the low-stress group did, but there were no significant differences in sensitivity to consequences or sensitivity to moral norms between the two groups. Finally, the implications of our findings were discussed. (shrink)

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, (...) municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked. (shrink)

The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive Behavior were (...) related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff. (shrink)

Cullin‐RING ligases (CRLs) are central regulators of environmental and cellular stress responses, orchestrating diverse processes through the ubiquitination of substrate proteins. As modular complexes, CRLs employ substrate‐specific adaptors to target proteins for degradation and other ubiquitin‐mediated processes, enabling dynamic adaptation to environmental cues. Recent advances have highlighted the largest CRL subfamily SCF (Skp1‐cullin‐F‐box) in environmental sensing, a role historically underappreciated for SCF ubiquitin ligases. Notably, emerging evidence suggests that the F‐box domain, a 50‐amino acid motif traditionally recognized for mediating (...) protein‐protein interactions, can act as a direct environmental sensor due to its ability to bind heavy metals. Despite these advances, the roles of many CRL components in environmental sensing remain poorly understood. This review provides an overview of CRLs in stress response regulation and emphasizes the emerging functions of F‐box proteins in environmental adaptation. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of mistaken (...) moral self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)

Humanitarian aid professionals frequently encounter situations in which one is conscious of the morally appropriate action but cannot take it because of institutional obstacles. Dilemmas like this are likely to result in a specific kind of stress reaction at the individual level, labeled as moral stress. In our study, 16 individuals working with international humanitarian aid and rescue operations participated in semistructured interviews, analyzed in accordance with a grounded theory approach. A theoretical model of ethical decision making from (...) a moral stress perspective was developed. The practical implications of the study are discussed. (shrink)

Genotoxic stress, arising from various environmental sources and endogenous cellular processes, pose a constant threat to genomic stability. Cells have evolved intricate mechanisms to detect and repair DNA damage, orchestrating a robust genotoxic stress response to safeguard the integrity of the genome. Recent research has shed light on the crucial role of co‐ and post‐transcriptional regulatory mechanisms in modulating the cellular response to genotoxic stress. Here we highlight recent advances illustrating the intricate interplay between pre‐mRNA processing, with (...) a focus on 3′‐end processing, and genotoxic stress response. (shrink)

Genotoxic stress leads to DNA damage which can be detrimental to the cell. A well‐orchestrated cellular response is mounted to manage and repair the genotoxic stress‐induced DNA damage. Our understanding of genotoxic stress response is derived mainly from studies focused on transcription, mRNA splicing, and protein turnover. Surprisingly not as much is understood about the role of mRNA translation and decay in genotoxic stress response. This is despite the fact that regulation of gene expression at the (...) level of mRNA translation and decay plays a critical role in a myriad of cellular processes. This review aims to summarize some of the known findings of the role of mRNA translation and decay by focusing on two categories of examples. We discuss examples of mRNA whose fates are regulated in the cytoplasm and RNA‐binding proteins that regulate mRNA fates in response to genotoxic stress. (shrink)

This study examined the cognitive mechanism underlying acute stress in creative cognition among individuals with high and low trait anxiety. Specifically, cognitive inhibition was assessed using the flanker task during acute stress. Fifty-two participants (26 high trait anxiety, 26 low trait anxiety) (mean age = 18.94 years) underwent stress induction via the Trier Social Stress Test (TSST). They all completed the Alternative Uses Test (AUT) and the Remote Associates Test (RAT) before and after the TSST. Biochemical (...) markers (salivary cortisol and salivary alpha amylase) were recorded at regular intervals. The results showed that cognitive inhibition was influenced by trait anxiety and acute stress. Compared to before experiencing acute stress, there was a lack of cognitive inhibition in low trait anxious individuals and they performed better in AUT (fluency) after acute stress, whereas high trait anxious individuals showed a decreased interference effect and reduced performance in AUT (fluency, flexibility, and originality). In the RAT, there were shorter response times and increased accuracy after acute stress in both high and low trait anxiety groups. Thus, we suggest that cognitive control, which modulates changes in acute stress, influences creative cognition. These findings provide evidence that inhibition control mediates the effect of stress on the creativity of individuals with different trait anxiety. (shrink)

Research indicates that the well‐being and productivity of over 100 million people in the global workforce may be compromised by posttraumatic stress (PTS). Given that work‐related experiences are often the source of the trauma that leads to PTS, and that PTS due to any cause can interfere with employees’ job performance, organizations would do well to consider the antecedents and consequences of PTS. This review of research—primarily within fields adjacent to business—on the types, antecedents, consequences, and organizational implications of (...) PTS is presented to advance inquiry within the field of business. The definition of PTS requires attention to the new classification of complex posttraumatic stress disorder that can result from threats that are not life‐threatening such as bullying and sexual harassment. PTS antecedents include organizational and extraorganizational traumas, and risk and resilience factors. Absenteeism, impaired cognitive functioning, strained relationships, and growth are among the consequences of PTS. Organizations can assist through disaster planning, empathetic leaders, mental health literacy initiatives, and employee assistance programs. Many research questions arise that, when answered, will allow organizations to better understand how they can improve employee productivity and well‐being by attending to PTS. (shrink)

Objectives Older adults are considered one of the most vulnerable groups to COVID-19. However, previous studies on emotion and aging have found that older adults report better well-being than younger adults in global survey and daily report. To better understand older adults’ well-being during the COVID-19 outbreak, we examined age differences in daily affective experiences in this study. Method Two hundred and thirty-one participants from mainland China aged 18 to 85 were recruited to participate in the 14-day daily diary study, (...) after a pretest. Their trait affect and demographic information were measured in the pretest. Their daily affect and stress levels were measured in the daily assessments. Results We found that older adults reported lower perceived stress related to COVID-19 in daily life, compared to younger adults. The negative relationship between daily perceived stress and high arousal positive affect and the positive relationship between daily perceived stress and high arousal negative affect was weaker in older than younger adults. Discussion These results provide initial evidence of daily affective well-being across different age groups in adulthood during the COVID-19 outbreak. Such information is important for developing interventions to promote better well-being during the COVID-19 outbreak. (shrink)

Stress and anxiety can both influence risk-taking in decision-making. While stress typically increases risk-taking, anxiety often leads to risk-averse choices. Few studies have examined both stress and anxiety in a single paradigm to assess risk-averse choices. We therefore set out to examine emotional decision-making under stress in socially anxious participants. In our study, individuals (N= 87) high or low in social anxiety completed an expanded variation of theBalloon Analogue Risk Task(BART). While inflating a balloon to a (...) larger degree is rewarded, a possible explosion leads to (a) a loss of money and (b) it is followed by an emotional picture (i.e., a calm vs. an angry face). To induce stress before this task, participants were told that they would have to deliver a speech. We operationalized risk-taking by the number of pumps during inflation and its functionality by the amount of monetary gain. In addition, response times were recorded as an index of decisional conflict. Without the stressor, high socially anxious compared to low socially anxious participants did not differ in any of the dependent variables. However, under stress, the low socially anxious group took more risk and earned more money, while high socially anxious individuals remained more cautious and did not change their risk-taking under social stress. Overall, high socially anxious individuals made their decisions more hesitantly compared to low socially anxious individuals. Unexpectedly, there were no main effects or interactions with the valence of the emotional faces. This data shows that stress affects socially anxious individuals differently: in low socially anxious individuals stress fosters risk-taking, whereas high socially anxious individuals did not alter their behavior and remained risk-averse. The noveleBARTis a promising research tool to examine the specific factors that influence decision-making. (shrink)

In this paper, we will attempt to describe an integrative model that links stress, trauma, and post-traumatic health disorders through biological, psychological, and behavioral mechanisms of influence. Each of these phenomena has its specificities but also shares common characteristics (sources, symptoms, and consequences) related to health and an individual’s functioning. Prolonged stress and sudden experiences can lead to trauma, and repeated experiences of trauma over time can result in the development of post-traumatic stress disorder (PTSD). This key (...) mechanism illustrates how long-term stress and trauma can lead to severe health impairment. A review of the literature on this topic, along with our many years of experience and research in these areas, reveals that the majority of authors in their research primarily focus on one of these topics, usually stress. There are fewer studies that provide a comprehensive representation of both stress and trauma. We have not come across any research that unifies all three topics in their presentation, highlighting the common elements as well as the specificities and differences. The aim of this paper is to demonstrate, through an integrative approach, the combined impact of these three phenomena on health and an individual’s functioning. First, we will describe each of these phenomena along with their respective specifications. Finally, we will attempt to integrate the knowledge of physiological and psychological mechanisms for dealing with stress, trauma, and post-traumatic stress disorder. Although challenging, we will also touch upon prevention strategies towards the end. (shrink)

European Portuguese (EP) is a language with variable stress, and the main cues for stress are duration and vowel reduction. A previous behavioral study has reported a stress “deafness” effect in EP when vowel quality cues are unavailable. The present study recorded both event-related potentials (ERPs) and behavioral data to examine the stress processing by native EP speakers in the absence of the vowel quality cues. Our behavioral result was consistent with previous research, showing that when (...) vowel reduction is absent EP speakers demonstrated a stress “deafness” effect similar to that found in speakers of languages with fixed stress or without any lexical stress marking. In the ERP task, both the trochaic and iambic conditions yielded mismatch negativity (MMN) and late negativity, suggesting that EP speakers are able to discriminate the two stress patterns without vowel reduction at the pre-attentive stage. Moreover, the ERP and behavioral data revealed compatible results regarding the pattern of stress bias in EP. In the EPR task, the MMN and late negativity components were more negative and span over a larger temporal window in the iambic condition than in the trochaic condition, indicating a higher sensitivity for the iambic stress pattern. In the behavioral task, EP speakers responded more accurately and more quickly to the iambic stress. These results match recent developmental findings in the acquisition of stress, but speak against the dominant view in EP phonological literature which assumes penultimate stress to be the regular stress pattern. In addition, both the ERP and the behavioral data showed that EP speakers’ stress processing was influenced by their working memory (WM) capacity. The participants with high WM capacity outperformed the participants with limited WM capacity in the iambic condition. In sum, our results broaden the current knowledge on stress processing by EP speakers at both the pre-attentive and attentive levels. (shrink)

The working poor are not a clearly defined group. There are still people who work full-time, but have incomes bordering on poverty level. They tend to remain in work despite their low wages simply to avoid becoming unemployed and risk social exclusion. However, working in low-income jobs for long periods creates stress and gives rise to further problems. Stress affects sleep patterns and leads to problems associated with food intake and nutrition, and thus to disorders of the gastrointestinal (...) system. Cardiovascular and neurological disorders may occur too. A lack of finances, and the stresses stemming from that are statistically significant and a strong predictor of a worse mental state. There is also a higher probability of psychosis occurring. All this affects the entire family, especially children. The inability to invest money and time in their development is another consequence. (shrink)