Chronicling moral distress among healthcare providers during the COVID‐19 pandemic: A longitudinal analysis of mental health strain, burnout, and maladaptive coping behaviours

Abstract

The COVID‐19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020–December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross‐level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.

A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19

“…The association with depression is consistent with findings in military personnel [52][53][54]. One longitudinal study identified burnout as a predictor of MD [20]. This implies that persons with preexisting psychological problems are more vulnerable to MD than others.…”

“…The relative normativity of experiencing moral stressors [28] is in accordance with the fact that some of the COVID-19 studies report low and medium levels of MD [14][15][16]25], and by this, they do not differ from results of pre-COVID-19 studies in HCWs [32,61]. Nevertheless, many HCWs have continuously experienced morally stressful situations during the pandemic [15,20]. We consider this comparable to cumulative traumatization.…”

“…In the present studies, MI is associated with low well-being [10,20] and, with symptoms of posttraumatic stress disorder [79] and other psychological problems such as burnout [10,11,20]. Symptoms and comorbidities of MD include depression [79] and low selfcompassion [77].…”

“…Based on these operationalizations used in the quantitative studies, MD was moderate [15,16,25] or low [14]. However, in Norman and colleagues [15] 53-88% of HCWs reported having experienced moral distress and in Wilson and colleagues [20], respondents experienced MD 2-3 times a week [20]. Referring to the prevalence of MI in HCWs, three quantitative studies assessed the psychological impact of morally distressing events by using the MISS-HP [11].…”

“…Moral distress is a prominent phenomenon in healthcare professions [5][6][7][8][9] that has been studied across different aspects of healthcare provision, especially in nursing [5,6,8]. While there is not a unified definition of who constitutes a healthcare worker (HCW) across studies measuring MD and/or MI, other groups that have been studied in this context include physicians [10][11][12][13][14][15][16][17][18][19][20][21], mental health workers (e.g., psychologists and psychotherapists) [3,19,20,22,23], and chaplains [15]. In general, HCWs have been conceptualized as individuals who actively engage in the protection and the improvement of the health of society [24].…”