Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study

Donkers, Moniek A.; Gilissen, Vincent J. H. S.; Candel, Math J. J. M.; Dijk, Nathalie M. van; Kling, Hans-Willi; Heijnen-Panis, Ruth; Pragt, Elien; Horst, Iwan van der; Pronk, Sebastiaan A; Mook, Walther N. K. A. van

doi:10.1186/s12910-021-00641-3

Cited by 108 publications

(209 citation statements)

References 49 publications

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“…Mental health HCWs reported blurred roles when colleagues became clients [23]. In a study from the Netherlands, the most evident moral stressor was insufficient emotional support for patients and relatives [16]. Experiences of stress for all groups of HCWs included the inability to provide emotional support to patients when they or their relatives were anxious and stressed as well as the inability to provide a dignified death for the patient's relatives [16].…”

Section: Moral Stressors During Covid-19mentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Riedel

Kreh

Kulcar

et al. 2022

IJERPH

125

134

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Ethical dilemmas for healthcare workers (HCWs) during pandemics highlight the centrality of moral stressors and moral distress (MD) as well as potentially morally injurious events (PMIEs) and moral injury (MI). These constructs offer a novel approach to understanding workplace stressors in healthcare settings, especially in the demanding times of COVID-19, but they so far lack clear identification of causes and consequences. A scoping review of moral stressors, moral distress, PMIEs, and MI of healthcare workers during COVID-19 was conducted using the databases Web of Science Core Collection and PsycINFO based on articles published up to October 2021. Studies were selected based on the following inclusion criteria: (1) the measurement of either moral stress, MD, PMIEs, or MI among HCWs; (2) original research using qualitative or quantitative methods; and (3) the availability of the peer-reviewed original article in English or German. The initial search revealed n = 149,394 studies from Web of Science and n = 34 studies from EBSCOhost. Nineteen studies were included in the review. Conditions representing moral stressors and PMIEs as well as MD and MI as their potential outcomes in healthcare contexts during COVID-19 are presented and discussed. Highlighting MD and MI in HCWs during COVID-19 brings attention to the need for conceptualizing the impact of moral stressors of any degree. Therefore, the development of a common, theoretically founded model of MD and MI is desirable.

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Section: Moral Stressors During Covid-19mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Riedel

Kreh

Kulcar

et al. 2022

IJERPH

125

134

View full text Add to dashboard Cite

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“…Researchers have found that moral distress ratings have varied due to an individual's occupation (Donkers et al . 2021 ; Dryden‐Palmer et al . 2020 ; Kok et al .…”

Section: Introductionmentioning

confidence: 99%

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

Wilson

Metwally

Heavner

et al. 2021

Int J Mental Health Nurs

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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.

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“…During Coronavirus Disease (COVID-19) Pandemic, problems such as the increased stress, faster care, use of personal protective equipment, not allowing patients' families to visit due to their risk of infection, and many other factors make the situation more critical in addition to previous stressors (20). Moreover, working in unfamiliar environments, participating in unknown processes, workforce shortages, existing more the patients in need of the urgent care at the same time, fear of infection, new waves of the disease, deadly nature, and disease disability are challenged the nurses' decision-making between doing what is morally right and doing what is cost-effective (20,21).…”

Section: Abbaszadeh Et Al Indicated the Moderate Moral Distress Of The Nurses In Different Wardsmentioning

confidence: 99%

Moral distress among nurses working in Covid-19 wards: a cross-sectional study in 2021

Pooresmaeil

Aghamohammadi

2021

Preprint

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Background Covid-19 is an emerging disease, which has confronted nurses with new moral distress. This study aims to determine the moral distress and its related factors among nurses working in the covid-19 wards of Ardabil city in Iran. Methods This cross-sectional descriptive study evaluated 159 nurses working in the covid-19 wards of Imam Khomeini hospital -as the only hospitalization center for the patients with covid-19 in Ardabil, 2021. The instruments used included a personal-occupational information form and Corley's moral distress scale. Data analysis was performed using descriptive and inferential statistics (Pearson correlation coefficient, independent t-test and one-way analysis of variance) in SPSS v22. Results The mean and standard deviation of the frequency and intensity of the nurses' moral distress were estimated 52.28 ± 5.24 and 51.54 ± 5.86, respectively, which indicated the moderate level of moral distress in the both dimensions. The item "I hesitate to tell the patient or the patient's family about his condition and treatment" (4.74 ± 0.75) showed the most moral distress based on the intensity and the phrase "too much work reduces the quality of my work” (4.81 ± 0.55) caused the most moral distress in the frequency dimension. The results indicated a significant relationship between the intensity and frequency of moral distress with the type of nurses' employment (P < 0.05). Moreover, a significant relationship was observed between the nurses’ position and the frequency (P = 0.04), and the nurses’ work experience and the intensity of moral distress (P = 0.02). Conclusions It seems that providing the necessary training for how to deal with the moral distress in new waves of the disease and using the experiences of the experienced nurses in this field are essential due to observing the moderate level of moral distress among nurses working in covid-19 wards.

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Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study

Cited by 108 publications

References 49 publications

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

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

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

Moral distress among nurses working in Covid-19 wards: a cross-sectional study in 2021

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