Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses

Abstract

Background Healthcare professionals often experience moral distress while providing end-of-life care. This study explored how physicians and nurses experienced moral distress when they cared for critically and terminally ill patients in tertiary hospitals in South Korea. Methods This study used semi-structured in-depth interviews. A total of 22 people in two tertiary hospitals were interviewed, nine (40.9%) of which were physicians and 13 (59.1%) were nurses. The recorded interview files and memos were analyzed using grounded theory. Results Most physicians and nurses encountered similar feelings of anger, helplessness, and burden owing to a lack of appropriate resources for end-of-life care. However, the factors and contexts of their moral distress differed. Nurses mainly addressed poorly organized end-of-life care, intensive labor conditions without support for nurses, and providing care without participation in decision-making. Meanwhile, physicians addressed the prevailing misperceptions on end-of-life care, communication failure between physicians owing to hierarchy and fragmented disciplines, the burden of responsibility in making difficult decisions, and the burden of resource allocation. Conclusion Differences in moral distress between physicians and nurses leave them isolated and can affect communication regarding healthcare. Mutual understanding between job disciplines will enhance their communication and help resolve conflicts in end-of-life care.

Stress Factors for the Paediatric and Adult Palliative Care Multidisciplinary Team and Workplace Wellbeing Solutions

“…Moreover, 55.4% of respondents identified emotionally difficult tasks as one of the main sources of stress in their work in paediatric palliative care. This is in line with the complexity and sensitivity of the field and with other authors who have analysed the emotional difficulties [31,35,36,49] and moral distress in paediatric palliative care [23,27,28].…”

“…The finding that a high workload (57.1%) was considered one of the main causes of stress highlights the high pressures and demands associated with working in paediatric palliative care in Romania [52,53], where professionals are often faced with multiple and complex tasks, tight deadlines, and a high volume of responsibilities. Physical exhaustion has been associated with a dynamic and prolonged duration of care [4,23,32,33].…”

“…We developed our questionnaire based on our knowledge of the Romanian context [52,53] and the results of the studies in the literature on the causes and effects of stress perceived by palliative healthcare professionals at work [4,9,14,[17][18][19][20][22][23][24]27,28,30,39,46] (Table 1), the impact of the COVID-19 pandemic on stress and burnout in palliative care [36,37,39,[46][47][48], and expectations and solutions for improving the workplace [4,14,18,[34][35][36]49,50,55,[57][58][59]. All this formed the theoretical basis of this study and contributed to the identification of the issues, the development of the hypothesis and the items of the questionnaire, and the overall aim of the research.…”

“…Doctors mentioned misconceptions about end-of-life care, the lack of communication due to fragmented hierarchies and disciplines, the burden of responsibility for making difficult decisions, and the pressure of allocating resources. The article pointed out the importance of mutual understanding through improved communication [23].…”