Skip to main content

Table 2 All items, sorted by occurrence (descending); frequency scale (five-point Likert scale): 1 = nie (“never”), 2 = seltener als monatlich (“less then monthly”), 3 = monatlich (“monthly”), 4 = wöchentlich (“weekly”), 5 = mehrmals wöchentlich (“several times per week”); level of disturbance (five-point Likert scale): 1 = nicht (“not”), 0 = wenig (“a little”), 3 = mittelmäßig (“moderatly”), 4 = ziemlich (“quiet”), 5 = sehr (“a lot”)

From: Moral distress among residents in neurology: a pilot study

Ethical principle Occurence in three last three months
N (%)
Frequency of occurrence
Mean (SD)
Level of disturbance
Mean (SD)
Main constraints
N (%)
It should be possible to hold a patient or relative consultation for as long as it seems necessary. (Item 1) 103 (96.3) 3.86 (1.02) 3.29 (0.75) 1. Growing patient population n = 77 (74)
2. Increasing bureaucratization and
documentation requirements n = 63 (60.6)
A patient should be able to stay on the ward for as long as is necessary to ensure the best possible treatment of the current complaints or to establish a clear perspective for the further procedure. (Item 9) 80 (74.8) 2.8 (1.24) 3.5 (0.97) 1. Lack of resources n = 53 (63.9)
2. Incentives of the DRG- system n = 47 (56.6)
Only those diagnostics should be performed that are essential for the diagnosis, understanding of the symptoms or therapy monitoring. (Item 2) 77 (72) 2.99 (1.21) 2.76 (0.85) 1. Fear of legal consequences n = 35 (44.9)
2. Incentives of the DRG- system n = 27 (34.6)
Misjudgments, misunderstandings and circumstances that have led to errors in medical care should be communicated honestly with patients and their relatives. (Item 7) 74 (69.2) 2 (0.75) 3.74 (0.94) 1. Fear of legal consequences n = 33 (44)
2. Lack of provider continuity n = 28 (37.3)
A patient who is not capable of giving consent should be treated according to his or her presumed will in cooperation with relatives, a Patient Decree and/or legal carer. (Item 6) 64 (59.8) 1.87 (0.87) 3.68 (0.9) 1. Wishes and expectations of patient relatives N = 41 (64.1)
2. Fear of legal consequences n = 20 (31.3)
Misjudgments, misunderstandings and circumstances that have led to errors in medical care should be communicated honestly within the team. (Item 8) 61 (57) 1.89 (0.94) 3.68 (0.89) 1. Lack of support of supervisors n = 28 (43.8)
2. Miscommunication in the medical team n = 27 (42.2)
Only those therapies or therapeutic attempts should be carried out for which a clearly formulated therapeutic objective appears to be achievable. (Item 4) 61 (57) 2.22 (1.06) 3.23 (0.84) 1. Wishes and expectations of patient relatives n = 32 (51.6)
2. Fear of legal consequences n = 25 (40.3)
Patients with private and statutory health insurance should be offered the same quality of medical care. (Item 12) 57 (53.3) 2.2 (1.32) 3.33 (1.13) 1. Incentives of the DRG- system n = 34 (57.6)
2. Guidelines of the administration n = 23 (39)
If it can be assumed that the therapeutic objective intended by the patient (e.g. life without invasive ventilation, return to home) can no longer be achieved, palliative therapy concepts should also be discussed. (Item 11) 54 (50.5) 1.8 (0.88) 3.7 (1.01) 1. Wishes and expectations of patient relatives n = 38 (67.9)
2. Fear of legal consequences n = 21 (37.5)
A patient should only be restrained or medically sedated as a last resort and for as short as possible in case of acute danger to oneself or others. (Item 10) 47 (43.9) 1.77 (0.99) 3.57 (0.89) 1. Shortage of staff n = 39 (83)
2. Growing patient population n = 20 (42.6)
In the case of a patient who is capable of giving consent just therapies should be carried out to which he or she has informed agreed. (Item 5) 38 (35.5) 1.73 (1.11) 3.14 (0.96) 1. Growing patient population n = 15 (38.5)
2. Increasing bureaucratization and documentation requirements n = 12 (30.8)
In the case of a patient who is capable of giving consent just diagnostics should be performed out to which he or she has informed agreed. (Item 3) 36 (33.6) 1.63 (1.00) 2.92 (1.09) 1. Growing patient population n = 13 (35.1)
2. Lack of provider continuity n = 12 (32.4)