Moral Distress and Perceived Community Views Are Associated With Mental Health Symptoms in Frontline Health Workers During the COVID-19 Pandemic

Abstract

Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%) or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with an increased risk of adverse mental health outcomes. Feeling appreciated by the community mitigated this risk in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

COVID‐19 infection and the broader impacts of the pandemic on healthcare workers

“…In addition to poor mental health, many HCWs have experienced moral distress during the COVID‐19 pandemic 80–83 . Moral distress, also referred to as ‘moral injury’, is defined as ‘ perpetrating, failing to prevent, bearing witness to or learning about acts that transgress deeply held moral beliefs and expectations ’ 84 .…”

“…Importantly, reporting these indicators of moral distress was associated with an increased risk of experiencing anxiety, depression, post‐traumatic stress disorder and burnout. By contrast, HCWs who felt appreciated by the community were less likely to endorse indicators of moral distress 83 . Such public initiatives to demonstrate community appreciation and gratitude for HCWs have been popular throughout the COVID‐19 pandemic.…”

“…50,51,66,69 In addition to poor mental health, many HCWs have experienced moral distress during the COVID-19 pandemic. [80][81][82][83] Moral distress, also referred to as 'moral injury', is defined as 'perpetrating, failing to prevent, bearing witness to or learning about acts that transgress deeply held moral beliefs and expectations'. 84 Moral distress can arise when HCWs cannot deliver usual 'best practice' patient care (e.g., due to scarcity of resources), or perceive that they have failed to meet patients' needs or are unable to prevent harm or death.…”

“…[88][89][90] During the COVID-19 pandemic, HCWs have commonly reported concerns regarding the inability of healthcare services to respond to increased caseloads of patients (both with and without COVID-19), 82 resource scarcity, excluding families from patients' bedsides and fears of letting co-workers down if they became infected with COVID-19. 82,83 Importantly, reporting these indicators of moral distress was associated with an increased risk of experiencing anxiety, depression, post-traumatic stress disorder and burnout. By contrast, HCWs who felt appreciated by the community were less likely to endorse indicators of moral distress.…”

“…By contrast, HCWs who felt appreciated by the community were less likely to endorse indicators of moral distress. 83 Such public initiatives to demonstrate community appreciation and gratitude for HCWs have been popular throughout the COVID-19 pandemic.…”