Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy

Abstract

During the COVID-19 health emergency, healthcare professionals faced several ethical demanding job stressors, becoming at particular risk of moral distress. To date, only a few scales have been developed to evaluate moral distress among frontline professionals working in contact with COVID-19 patients. Moreover, although many healthcare professionals from various disciplines were converted to COVID-19 patient care, no study has yet analyzed whether the resulting change in duties might represent a risk factor for moral distress. Thus, this study aimed to investigate how and when the change in duties during the emergency would be related to healthcare professionals’ psycho-physical malaise. To this aim, a first Italian adaptation of the Stress of Conscience Questionnaire (SCQ) was provided. In total, 272 Italian healthcare professionals participated in this cross-sectional study. Healthcare professionals who had to perform tasks outside their usual clinical duties were more likely to experience moral distress and then psycho-physical malaise. This was particularly likely for those who were extremely concerned about becoming infected with the virus. The results also indicated that the Italian adaptation of the SCQ had a one-factor solution composed of six items. This study provides the first Italian adaptation of SCQ and practical suggestions on how supporting professionals’ well-being during emergencies.

Burnout and Moral Distress among Health Care Personnel in the Decline of COVID-19 Pandemic

“…Interestingly, both doctors and nurses believe that MD is promoted by insufficient training to provide necessary treatment and support (35,7% and 30,6% respectively, Table 2) and that more training would alleviate the risk of MD (38,9% and 39,8% respectively, Table 3). Our data are supported by the Maffoni's results that showed that appropriate training decreased the levels of MD [4].…”

“…In the early phase of the pandemic, it has been reported that doctors experienced higher levels of MD compared to the nurses [4]. This difference was explained by the inclusion of a cohort of doctors who had to perform tasks outside their usual range clinical duties (e.g., dermatologists and pediatricians redeployed to treat Covid-19 infected patients).…”

“…Access was denied to families to see their dying relatives in violation of values around death, dying and bereavement [3]. Medical staff experienced a lack of agency/power to make correct decisions for patients, and some were allocated to care of patients outside of their specialty without adequate training or experience [4]. Fear of becoming infected themselves and transmitting the infection to family, relatives, and colleagues put enormous ethical dilemmas both on physicians and nurses [4,5].…”

Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review

“…This reflects the contingencies of the COVID-19 pandemic, which forced residents of nursing homes to remain in their own rooms [ 70 ]. Therefore, at the overall level, it seems that nurses adopted the pre-pandemic patterns of prioritisation (e.g., failing in ensuring fundamental care) with the intent of reducing exposure in patients’ rooms for an extended period and to avoid the source of contagion [ 71 ], and/or due to the fatigue caused by the personal protective equipment worn (e.g., [ 72 ]). The rationed nursing activities did not turn out to be very different from those of the pre-pandemic period (e.g., [ 2 , 73 ]), as also emerged in those studies that included comparative studies [ 35 , 38 ].…”

How and When May Technostress Impact Workers’ Psycho-Physical Health and Work-Family Interface? A Study during the COVID-19 Pandemic in Italy

“…Future studies should also investigate the role of personality traits that were found to be precursors of workaholism (e.g., neuroticism) [121]). More research is also needed to identify other personal and environmental resources (e.g., professional self-efficacy; managerial support) [122]) that could buffer the detrimental effects of technostress on workers' well-being. Moreover, selection bias cannot be ruled out because of the nonprobability convenience sampling strategy.…”