ICU Nurse's Moral Distress as an Occupational Hazard Threatening Professional Quality of Life in the Time of Pandemic COVID 19

Abstract

Background: Moral distress is an unpleasant feeling that arises when one is forced to behave in such a way that it violates one’s personal beliefs and values about what is right and what is wrong. Moral distress, unlike other forms of distress, contains an incompatible conflict between one’s personal moral limitations and the acts that accompany it. Objective: to investigate moral distress and its effects on the ICU nursing staff, their professional quality of life as well as, related factors. Methods: The total sample of this cross-sectional study comprised of 258 ICU nurses working in reference hospitals for COVID 19 recruited online using google forms. The study tools are: a) “Measure of Moral Distress for Healthcare Professionals (MMD-HP)” to assess intensity and frequency of moral distress b) “Professional Quality of Life Scale (ProQOL-5)” to assess professional quality of life. Data were analyzed using IBM SPSS Statistics 25,0 (IBM Analytics, IBM Software Group Statistical Package). Results: Overall MMD-HP score ranged from 3 to 262 with a mean score of 116.52 (SD= 68.56). Distress score ranged from 5 to 79 with a mean score of 43.67 (SD=17.44) while intensity score ranged from 3 to 108 with a mean score 52.04 (SD=22.69). Bivariate analysis showed there is a statistically significant positive correlation between the intensity of moral distress and overall moral distress score with years of service in ICU and age. Nurses’ Assistants (m=48.1 p=0.021) scored higher than Registered nurses in distress and intensity score (m=54.1 p=0.020) while female also scored higher in overall MMD-HP (m=121.2 p=0.049). Multivariate logistic regression analysis, showed that secondary trauma scale was independently associated with a higher distress scale score and a higher MMD-HP. Conclusion: Educational support that provide information about dealing with moral distress during the coronavirus pandemic and how ICU nurses should deal with ethical issues that may confront in the everyday professional life is essential. Hospitals should monitor moral distress and there should be workshops that could build moral resilience and maintain high professional quality of life.

Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses’ Relational Practice During the Coronavirus Pandemic

“…The literature is clear in that such circumstances during the COVID-19 pandemic have created moral distress for nurses ( Akram, 2021 ; Malliarou et al, 2021 ; Morley et al, 2020 ; Wiener et al, 2021 ). Morley and colleagues (2020) highlight that nurses’ relationships with patients and their families during COVID-19 have been drastically impacted at end of life, tasking nurses to “temper these potentially dehumanizing scenarios of people dying alone in isolation of their loved ones” (p. 37).…”

Moral distress and alcohol use among nurses during COVID-19

“…However, results of this survey differed from another measure of intensive care nurse moral distress during the COVID-19 pandemic who reported a mean moral distress of 116.52. [27] The lower results were from a sample of nurses in Greece and the higher of United States nurses, which may indicate that nurses in different countries were differently distressed. These differences may have been caused by other factors in the nurse samples, thus more research is needed to fully understand the effect of the COVID-19 pandemic on nurse moral distress.…”

Spanish psychometric properties of the moral distress scale—revised: a study in healthcare professionals treating COVID-19 patients

“…In a second step, and as relationships between moral distress and professional quality of life have been previously stated (i.e., Austin et al [ 31 ]), we hypothesized and tested a structural equation model, in which a factor formed by the 11 items of the Spanish version of the Moral Distress Scale – Revised predicted a factor of professional quality of life, formed by the three dimensions of the Short ProQOL. The model was based on Austin et al (2017) and Malliarou et al’s [ 44 ] results, and therefore it posited an impact of moral distress on professional quality of life, which was expected to be negative. In order to evaluate the model’s fit, criteria stated above were used.…”

“…Indeed, moral distress was negatively related to age [ 40 ], work experience [ 41 ], effective communication [ 42 , 43 ] and compassion satisfaction [ 31 ], whereas it showed a positive relation with burnout and compassion fatigue [ 38 ]. More recently, Malliarou et al [ 44 ] have delved into these relationships, again with evidence pointing a negative relation between moral distress and professional quality of life (higher levels of burnout and compassion fatigue were related to higher scores in moral distress).…”