“I felt like the angel of death”: role conflicts and moral distress among allied professionals employed by the US cardiovascular implantable electronic device industry
- First Online:
- 165 Downloads
This study aimed to identify themes associated with role conflicts and moral distress experienced by cardiovascular implantable electronic device (CIED) industry-employed allied professionals (IEAPs) in the clinical setting.
Focus groups were used to elicit perspectives from IEAPs who had deactivated a CIED.
Seventeen IEAPs (five women) reported increased clinical presence and work-related role conflicts and moral distress along several themes: (1) relationships with patients, (2) relationships with clinicians, (3) role ambiguity, (4) customer service to clinicians, and (5) CIED deactivation. Patients often misperceived IEAPs as physicians or nurses. Many physicians expected IEAPs to perform clinical duties. Customer service obligations exacerbated IEAP role conflicts and moral distress because of dual agency. IEAPs commonly received and carried out requests to deactivate CIEDs; doing so, however, generated considerable distress—particularly deactivations of pacemakers in pacemaker-dependent patients. Several described themselves as “angels of death.” IEAPs had recommendations for mitigating role conflicts and moral distress, including improving the deactivation process.
IEAPs experienced role conflicts and moral distress regarding their activities in the clinical setting and customer service obligations. Health care institutions should develop and enforce clear boundaries between IEAPs and clinicians in the clinical setting. Clinicians and IEAPs should adhere to these boundaries.
KeywordsDevice deactivation Device industry Ethics Industry-employed allied professional
Cardiovascular implantable electronic device
Heart Rhythm Society
Industry-employed allied professional
- 2.Wilkoff, B. L., Auricchio, A., Brugada, J., Cowie, M., Ellenbogen, K. A., Gillis, A. M., et al. (2008). HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): Description of techniques, indications, personnel, frequency and ethical considerations. Heart Rhythm, 5(6), 907–925.PubMedCrossRefGoogle Scholar
- 3.Mond, H. G., Irwin, M., Ector, H., & Proclemer, A. (2008). The world survey of cardiac pacing and cardioverter-defibrillators: calendar year 2005: An International Cardiac Pacing and Electrophysiology (ICPES) project. Pacing and Clinical Electrophysiology, 31(9), 1202–1212.PubMedCrossRefGoogle Scholar
- 7.Krueger, R. A. & Casey, M. A. (2009). Focus groups: a practical guide for applied research (4th ed.). Los Angeles: Sage.Google Scholar
- 8.Clarke, A. (2005). Situational analysis: grounded theory after the postmodern turn. Thousand Oaks: Sage.Google Scholar
- 9.Strauss, A. L. (1987). Qualitative analysis for social scientists. Cambridge: Cambridge University Press.Google Scholar
- 11.Lampert, R., Hayes, D. L., Annas, G. J., Farley, M. A., Goldstein, N. E., Hamilton, R. M., et al. (2010). HRS expert consensus statement on the management of cardiovascular implantable electronic devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm, 7(7), 1008–1026.PubMedCrossRefGoogle Scholar