Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. This survey lists situations that occur in clinical practice.  If you have experienced these situations they may or may not have been morally distressing to you.  Please indicate how frequently you have experienced each item.  Also, rank how distressing these situations are for you.  If you have never experienced a particular situation, select “0” (never) for frequency. 
    Even if you have not experienced a situation, please indicate how distressed you would be if it occurred in your practice. Note that you will respond to each item by checking the appropriate rows for two dimensions:  Frequency and Level of distress.

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1. Witness healthcare providers giving “false hope” to a patient or family.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #1

  None
0 		 1  2  3 Very distressed
4
Level of distress

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2. Follow the family’s insistence to continue aggressive treatment even though I believe it is not in the best interest of the patient.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #2

  None
0 		 1  2  3 Very distressed
4
Level of distress

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3. Feel pressured to order or carry out orders for what I consider to be unnecessary or inappropriate tests and treatments.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #3

  None
0 		 1  2  3 Very distressed
4
Level of distress

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4. Be unable to provide optimal care due to pressures from administrators or insurers to reduce costs.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #4

  None
0 		 1  2  3 Very distressed
4
Level of distress

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5. Continue to provide aggressive treatment for a person who is most likely to die regardless of this treatment when no one will make a decision to withdraw it.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #5

  None
0 		 1  2  3 Very distressed
4
Level of distress

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6. Be pressured to avoid taking action when I learn that a physician, nurse, or other team colleague has made a medical error and does not report it.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #6

  None
0 		 1  2  3 Very distressed
4
Level of distress

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7. Be required to care for patients whom I do not feel qualified to care for.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #7

  None
0 		 1  2  3 Very distressed
4
Level of distress

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8. Participate in care that causes unnecessary suffering or does not adequately relieve pain or symptoms.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #8

  None
0 		 1  2  3 Very distressed
4
Level of distress

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9. Watch patient care suffer because of a lack of provider continuity.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #9

  None
0 		 1  2  3 Very distressed
4
Level of distress

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10. Follow a physician’s or family member’s request not to discuss the patient’s prognosis with the patient/family.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #10

  None
0 		 1  2  3 Very distressed
4
Level of distress

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11. Witness a violation of a standard of practice or a code of ethics and not feel sufficiently supported to report the violation.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #11

  None
0 		 1  2  3 Very distressed
4
Level of distress

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12. Participate in care that I do not agree with, but do so because of fears of litigation.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #12

  None
0 		 1  2  3 Very distressed
4
Level of distress

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13. Be required to work with other healthcare team members who are not as competent as patient care requires.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #13

  None
0 		 1  2  3 Very distressed
4
Level of distress

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14. Witness low quality of patient care due to poor team communication.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #14

  None
0 		 1  2  3 Very distressed
4
Level of distress

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15. Feel pressured to ignore situations in which patients have not been given adequate information to ensure informed consent.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #15

  None
0 		 1  2  3 Very distressed
4
Level of distress

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16. Be required to care for more patients than I can safely care for.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #16

  None
0 		 1  2  3 Very distressed
4
Level of distress

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17. Experience compromised patient care due to lack of resources/equipment/bed capacity.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #17

  None
0 		 1  2  3 Very distressed
4
Level of distress

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18. Experience lack of administrative action or support for a problem that is compromising patient care.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #18

  None
0 		 1  2  3 Very distressed
4
Level of distress

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19. Have excessive documentation requirements that compromise patient care.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #19

  None
0 		 1  2  3 Very distressed
4
Level of distress

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20. Fear retribution if I speak up.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #20

  None
0 		 1  2  3 Very distressed
4
Level of distress

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21. Feel unsafe/bullied amongst my own colleagues.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #21

  None
0 		 1  2  3 Very distressed
4
Level of distress

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22. Be required to work with abusive patients/family members who are compromising quality of care.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #22

  None
0 		 1  2  3 Very distressed
4
Level of distress

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23. Feel required to overemphasize tasks and productivity or quality measures at the expense of patient care.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #23

  None
0 		 1  2  3 Very distressed
4
Level of distress

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24. Be required to care for patients who have unclear or inconsistent treatment plans or who lack goals of care.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #24

  None
0 		 1  2  3 Very distressed
4
Level of distress

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25. Work within power hierarchies in teams, units, and my institution that compromise patient care.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #25

  None
0 		 1  2  3 Very distressed
4
Level of distress

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26. Participate on a team that gives inconsistent messages to a patient/family.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #26

  None
0 		 1  2  3 Very distressed
4
Level of distress

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27. Work with team members who do not treat vulnerable or stigmatized patients with dignity and respect.

  Never
0 		 1  2  3 Very frequently
4
Frequency

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Level of distress you would feel or have felt as a result of #27

  None
0 		 1  2  3 Very distressed
4
Level of distress

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28. Other situation

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     How frequently have you experienced this?

  Never
0 		 1  2  3 Very frequently
4
Frequency

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     Level of distress you would feel or have felt

  None
0 		 1  2  3 Very distressed
4
Level of distress

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29. Other situation

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     How frequently have you experienced this?

  Never
0 		 1  2  3 Very frequently
4
Frequency

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     Level of distress you would feel or have felt

  None
0 		 1  2  3 Very distressed
4
Level of distress

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Have you ever considered leaving your position because of moral distress?

T