Understanding physicians’ moral distress in the Covid 19 pandemic

Year 2022, Volume: 39 Issue: 4, 958 - 965, 29.10.2022

Selin Keskin Kızıltepe , Asli Kurtgöz

Abstract

Moral distress is a significant problem for health care professionals, resulting in reduced job satisfaction, burnout and job retirement This study aims to explore the experiences of emergency physicians related to moral distress during the Covid 19 pandemic. We conducted in-depth semi-structured interviews of 25 physicians working in the emergency department to describe their experiences related to moral distress. Data were analyzed using thematic analysis through the six-step process. Three major themes were identified: (I) The impact of the Covid-19 pandemic on moral distress; (II) The effect of moral distress on physicians; (III) Suggestions to prevent/reduce moral distress. In the light of the results of our study, the moral distress experienced by physicians has been exacerbated due to the increase in the factors causing moral distress to be during the pandemic period as well.

Keywords

Covid 19, moral distress, pandemic, physicians.

References

• 1. An, Y., Yang, Y., Wang, A., Li, Y., Zhang, Q., Cheung, T., ... & Xiang, Y. T. (2020). Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. Journal of affective disorders, 276, 312-315. doi:10.1016/j.jad.2020.06.047
• 2. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.doi: 10.1191/1478088706qp063oa.
• 3. Borges, L. M., Barnes, S. M., Farnsworth, J. K., Bahraini, N. H., & Brenner, L. A. (2020). A commentary on moral injury among health care providers during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S138. doi: 0.1037/tra0000698
• 4. Forozeiya, D., Vanderspank-Wright, B., Bourbonnais, F. F., Moreau, D., & Wright, D. K. (2019). Coping with moral distress–The experiences of intensive care nurses: An interpretive descriptive study. Intensive and Critical Care Nursing, 53, 23-29.
• 5. Galehdar, N., Kamran, A., Toulabi, T., & Heydari, H. (2020). Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: A qualitative study. BMC psychiatry, 20(1), 1-9. 9 doi:10.1186/s12888-020-02898-1
• 6. Haller, M., Norman, S. B., Davis, B. C., Capone, C., Browne, K., & Allard, C. B. (2020). A model for treating COVID-19–related guilt, shame, and moral injury. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S174. doi:10.1037/tra0000742
• 7. Helmers, A., Palmer, K. D., & Greenberg, R. A. (2020). Moral distress: Developing strategies from experience. Nursing Ethics, 27(4), 1147-1156.doi: 10.1177/0969733020906593
• 8. Hesselink, G., Straten, L., Gallée, L., Brants, A., Holkenborg, J., Barten, D. G., & Schoon, Y. (2021). Holding the frontline: a cross-sectional survey of emergency department staff well-being and psychological distress in the course of the COVID-19 outbreak. BMC health services research, 21(1), 1-10. doi:10.1186/s12913-021-06555-5
• 9. Hines, S. E., Chin, K. H., Glick, D. R., & Wickwire, E. M. (2021). Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(2), 488. doi:10.3390/ijerph18020488
• 10. Kherbache, A., Mertens, E., & Denier, Y. (2021). Moral distress in medicine: An ethical analysis. Journal of Health Psychology, 13591053211014586. doi:10.1177/13591053211014586
• 11. Lincoln, Y., Guba, EG.(1985). Naturalistic Inquiry. California, CA: Sage Publication.
• 12. Laurs, L., Blaževičienė, A., Capezuti, E., & Milonas, D. (2020). Moral distress and intention to leave the profession: Lithuanian nurses in municipal hospitals. Journal of Nursing Scholarship, 52(2), 201-209. doi:10.1111/jnu.12536
• 13. Maftei, A., & Holman, A. C. (2021). The prevalence of exposure to potentially morally injurious events among physicians during the COVID-19 pandemic. European Journal of Psychotraumatology, 12(1), 1898791. doi: 10.1080/20008198.2021.1898791
• 14. Maguen, S., & Price, M. A. (2020). Moral injury in the wake of coronavirus: Attending to the psychological impact of the pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S131. doi:10.1037/tra0000780
• 15. Miljeteig, I., Forthun, I., Hufthammer, K. O., Engelund, I. E., Schanche, E., Schaufel, M., & Onarheim, K. H. (2021). Priority-setting dilemmas, moral distress, and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway. Nursing Ethics, 28(1), 66-81.doi: 10.1177/0969733020981748
• 16. Morley, G., Sese, D., Rajendram, P., & Horsburgh, C. C. (2020). Addressing caregiver moral distress during the COVID-19 pandemic. Cleveland Clinic journal of medicine. doi:10.3949/ccjm.87a.ccc047
• 17. Morley, G., Bradbury-Jones, C., & Ives, J. (2019). What is ‘moral distress in nursing? A feminist empirical bioethics study. Nursing Ethics, 27(5), 1297-1314. doi:10.1177/0969733019874492
• 18. Mosheva, M., Hertz‐Palmor, N., Dorman Ilan, S., Matalon, N., Pessach, I. M., Afek, A., ... & Gothelf, D. (2020). Anxiety, pandemic‐related stress, and resilience among physicians during the COVID‐19 pandemic. Depression and anxiety, 37(10), 965-971. doi: 10.1002/da.23085
• 19. Ness, M. M., Saylor, J., DiFusco, L. A., & Evans, K. (2021). Leadership, professional quality of life and moral distress during COVID‐19: A mixed‐methods approach. Journal of Nursing Management, 1-11. doı: 10.1111/jonm.13421
• 20. Norman, S. B., Feingold, J. H., Kaye‐Kauderer, H., Kaplan, C. A., Hurtado, A., Kachadourian, L., ... & Pietrzak, R. H. (2021). Moral distress in frontline healthcare workers in the initial epicenter of the COVID‐19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depression and Anxiety,38,1007-1017. doı: 10.1002/da.23205
• 21. O’Neal, L., Heisler, M., Mishori, R., & Haar, R. J. (2021). Protecting providers and patients: results of an Internet survey of health care workers’ risk perceptions and ethical concerns during the COVID-19 pandemic. International journal of emergency medicine, 14(1), 1-11. doi:10.1186/s12245-021-00341-0
• 22. Patterson, J. E., Edwards, T. M., Griffith, J. L., & Wright, S. (2021). Moral distress of medical family therapists and their physician colleagues during the transition to COVID‐19. Journal of Marital and Family Therapy, 47(2), 289-303. doi: 10.1111/jmft.12504
• 23. Rodriguez, R. M., Montoy, J. C. C., Hoth, K. F., Talan, D. A., Harland, K. K., Ten Eyck, P., ... & Weber, K. D. (2021). Symptoms of anxiety, burnout, and PTSD and the mitigation effect of serologic testing in emergency department personnel during the COVID-19 pandemic. Annals of emergency medicine, 78(1), 35-43. doi:10.1016/j.annemergmed.2021.01.028.
• 24. Rosenwohl-Mack, S., Dohan, D., Matthews, T., Batten, J. N., & Dzeng, E. (2021). Understanding experiences of moral distress in end-of-life care among US and UK physician trainees: A comparative qualitative study. Journal of general internal medicine, 36(7), 1890-1897. doi:10.1007/s11606-020-06314-y
• 25. Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., ... & Abdalla, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General hospital psychiatry, 66, 1-8.
• 26. Song, X., Fu, W., Liu, X., Luo, Z., Wang, R., Zhou, N., ... & Lv, C. (2020). Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China. Brain, behavior, and immunity, 88, 60-65. doi:10.1016/j.bbi.2020.06.002.
• 27. Sprung, C. L., Joynt, G. M., Christian, M. D., Truog, R. D., Rello, J., & Nates, J. L. (2020). Adult ICU triage during the coronavirus disease 2019 pandemic: who will live and who will die? Recommendations to improve survival. Critical care medicine, 48(8), 1196.doi: 10.1097/CCM.0000000000004410
• 28. Truog, R. D., Mitchell, C., & Daley, G. Q. (2020). The toughest triage—allocating ventilators in a pandemic. New England Journal of Medicine, 382(21), 1973-1975. Doi: 10.1056/NEJMp2005689
• 29. Wang, Z., Harold, K. G., Tong, Y., Wen, J., Sui, M., Liu, H., ... & Liu, G. (2021). Moral injury in Chinese health professionals during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, May,27. doi:/10.1037/tra0001026