From her in the British Journal of General Practice (BJGP) to her new appointment as Assistant Professor in the Institute of Health Sciences Education (IHSE) at 苹果淫院, Monica Molinaro, PhD, has had a hectic Fall semester.
Since her arrival, she has been co-teaching Advanced Qualitative Research: Philosophical and Theoretical Foundations with Elizabeth Anne Kinsella, Director of the IHSE 鈥 a course that Prof. Molinaro herself took as a PhD candidate at Western University.
At the IHSE, she also continues her research into one of the most urgent issues in health sciences education 鈥 moral distress among healthcare providers.
Moral distress has been defined as when an individual knows the right thing to do, but institutional or other constraints 鈥 such as staffing shortages, increased workload and issues related to remuneration 鈥 make it almost impossible to pursue the right course of action.
Prof. Molinaro鈥檚 latest research focuses on the experience of moral distress among family physicians, specifically those who care for patients experiencing health needs related to social inequity (e.g. precarious housing, poverty, racism, substance use, or mental ill health).
The study found that family physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system.
Prof. Molinaro also appeared on the podcast and the journal鈥檚 to discuss the findings 鈥 some of the first that shed light into moral distress experiences in family medicine.
鈥淩esearch into moral distress is rife with potential for understanding our healthcare system, how that system is structured, how healthcare is delivered, and how we can ensure our healthcare providers do not experience moral distress as a result of structural deficits,鈥 Prof. Molinaro says. 鈥淯ltimately, moral distress not only affects them, but it also affects how, or if, patients receive care.鈥
Moral distress rooted in structural issues
Prof. Molinaro first explored moral distress in her PhD thesis, which examined experiences of the phenomenon among pediatric oncology nurses. Looking back at her interviews with the nurses, she recalls that moral distress was reflected 鈥渋n every single thing the nurses told me.鈥
Although those interviews took place as the COVID-19 pandemic hit, Prof. Molinaro notes the nurses鈥 experiences of moral distress were frequently, 鈥渞ooted in historical, structural issues in relation to payment, staffing, workload, and the incongruency between the realities of practice versus their education.鈥
鈥淲ith COVID, these historical issues became much worse,鈥 she adds. 鈥淭hey were exacerbated by the pandemic, so healthcare providers were operating in a very urgent, stressful situation that broke open many cracks in the healthcare system.鈥
From there, Prof. Molinaro built upon her expertise, using narrative and other qualitative methodologies to examine experiences of moral distress in other healthcare contexts. She explored provision of morally and ethically complex health care during her research assistantship at Western University鈥檚 Centre for Education Research and Innovation (CERI) and in her Banting post-doctoral research fellowship at McMaster, where she now holds an appointment as a McMaster Education Research, Innovation and Theory (MERIT) Scholar.
Interest in moral distress has grown exponentially in recent years, but Prof. Molinaro cautions against conflating it with general stress or anxiety. She adds that scholarship that understands moral distress as a phenomenon related to structural issues 鈥 rather than difficulties that an individual experiences 鈥 can pose crucial questions about healthcare policy and health sciences education.
鈥淢oral distress has been understood as an individual issue 鈥 the idea that people experience moral distress when they have bad coping skills, or are not resilient enough,鈥 she explains. 鈥淭hat鈥檚 not okay, because we鈥檙e pushing responsibility for structural issues onto the individual. It鈥檚 up to those responsible for making these broader decisions with downstream effects like moral distress to make decisions that ultimately benefit our healthcare providers.鈥
鈥淲hat benefits healthcare providers鈥 well-being and their conduciveness to staying in the profession is what benefits the people receiving care from them,鈥 she adds.
Hopes to never stop learning
Prof. Molinaro is excited about what lies ahead at the IHSE. In the new year, she鈥檒l be releasing a podcast: Narrative Remedies: Re-Scripting Care, which will share stories from the health care practitioners documented in her dissertation and act as a resource for health care researchers and clinicians, graduate students, and general audiences to hear about the inner workings and benefits of critical narrative research. She鈥檒l also be writing up the results of another study examining moral distress experiences in family medicine and critical care during the COVID-19 pandemic.
About the IHSE, she says: 鈥淭his is an environment that is so supportive and conducive to everyone鈥檚 success, in a way that I think is quite rare in many academic contexts. They aren鈥檛 just investing in me as an academic, they are investing in me as a person.鈥
鈥淢y hope is that I鈥檓 never going to stop learning in some way,鈥 she adds. 鈥淗ere, I feel reassured that learning will always be taking place for me, whether it鈥檚 methodologically, philosophically, theoretically or foundationally.鈥
Elizabeth Anne Kinsella, PhD, Director of the IHSE, says the Institute is thrilled to welcome Prof. Molinaro, adding that she 鈥渄raws on a fresh set of conceptual and methodological perspectives to tackle some of the most pressing challenges facing healthcare practitioners, educators and healthcare systems.鈥
鈥淗er research is already making an impact, gaining international attention, and helping us to think about how we can design education, structure practice, develop policy and create healthcare systems that better support health professions students and practitioners.鈥