1
|
Abdollahimohammad A, Rahnama M, Firouzkouhi M. Experiences of family members when accompanying patients in intensive care units: A qualitative study. Nurs Crit Care 2024; 29:777-784. [PMID: 38459751 DOI: 10.1111/nicc.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Family members of Intensive Care Unit (ICU) patients encounter numerous challenges while providing companionship to their hospitalized loved ones. AIM This study aims to explore the experiences of family members with loved ones hospitalized in ICUs. STUDY DESIGN Qualitative research was conducted using a content analysis approach. Ten family members of ICU patients were recruited using purposive sampling. Data were collected through semi-structured, in-depth interviews and analysed following Graneheim and Lundman's suggested steps. FINDINGS Analysis of interviews with ten family members of ICU patients revealed a theme of "challenging companionship on an obscure path," encompassing four categories (1-4) and nine subcategories (a, b and c). These included (1) the interplay between the patient and the family: a. family affected by the patient's condition; b. patient affected by the family's condition; (2) mixed emotions of apprehension and anticipation regarding ICU admission: a. fear of ICU hospitalization; b. hope for ICU hospitalization; (3) unaddressed needs and concerns: a. pressure from the ICU's visiting limitations; b. lack of a resting room to settle; c. vague information about the patient's condition; (4) two-way care suffering for families a. direct suffering associated with companionship; b. indirect suffering while observing the patients' suffering. CONCLUSIONS Families of ICU patients encounter various challenges, revealing the complex interplay of emotions, needs and challenges within the ICU. This highlights the intricate dynamics in this critical health care environment. RELEVANCE TO CLINICAL PRACTICE A holistic and empathetic approach in clinical practice is crucial in ICU care, particularly during the challenging journey patients and their families undergo in this critical setting. Health care systems and providers should adapt ICU rules to address evolving needs, alleviate concerns and enhance the overall family experience during their loved one's hospitalization in the ICU.
Collapse
Affiliation(s)
| | - Mozhgan Rahnama
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammadreza Firouzkouhi
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| |
Collapse
|
2
|
Grönlund CF, Isaksson U, Brännström M. Moral distress thermometer: Swedish translation, cultural adaptation and validation. Nurs Ethics 2024; 31:461-471. [PMID: 37755115 PMCID: PMC11308259 DOI: 10.1177/09697330231197707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. AIM The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. RESEARCH DESIGN The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version. PARTICIPANTS AND RESEARCH CONTEXT 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch's ANOVA, Games-Howell post-hoc test and Pearson's correlation analysis were done. ETHICAL CONSIDERATIONS The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. RESULTS The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. CONCLUSION The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context.
Collapse
|
3
|
Rodriguez-Ruiz E, van Mol MMC, Latour JM, Fuest K. Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety. Med Intensiva 2024:S2173-5727(24)00061-4. [PMID: 38594110 DOI: 10.1016/j.medine.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.
Collapse
Affiliation(s)
- Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Joseph Maria Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; Curtin School of Nursing, Curtin University, Perth, Australia; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kristina Fuest
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ismaninger Str. 22, 81675 Munich, Germany
| |
Collapse
|
4
|
Girela-Lopez E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, Lopez-Valero M, Romero-Saldaña M. Measuring moral distress in health professionals using the MMD-HP-SPA scale. BMC Med Ethics 2024; 25:41. [PMID: 38570759 PMCID: PMC10993501 DOI: 10.1186/s12910-024-01041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.
Collapse
Affiliation(s)
- Eloy Girela-Lopez
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Lopez-Valero
- Dispositivo de Cuidados Críticos y Urgencias, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy. Faculty of Medicine and Nursing, University of Cordoba, Córdoba, Spain
| |
Collapse
|
5
|
Gamvrouli M, Karanikola MNK, Paschali A, Giannakopoulou M. Reliability of Moral Distress Scale, Secondary Traumatic Stress Scale, and Jefferson Scale of Empathy Among Greek Nurses: A Pilot Study. J Nurs Meas 2024; 32:18-27. [PMID: 37348889 DOI: 10.1891/jnm-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: Moral distress (MD), secondary traumatic stress (STS), and empathy are of particular interest to the nursing profession. The availability of validated tools for the assessment of these parameters is of high importance. The primary aim of this pilot study was to evaluate the reliability of the Greek version of the MD Scale or the revised version (MDS-R), the Jefferson Scale of Empathy for Health Professionals (JSE-HP), and the STS Scale (STSS) in Greek nurses working in open and psychiatric wards. Methods: To assess the reliability of scales, internal consistency (coefficient alphas) and test-retest (interclass correlation coefficients [ICCs]) were calculated. Results: A total of 38 nurses took part in the study. All scales and subscales presented excellent stability (.876 ≤ ICC ≤ .963, p < .0001) and acceptable to excellent internal consistency reliability (first measurement, .796 ≤ coefficient alpha ≤ .959; second measurement, .794 ≤ coefficient alpha ≤ .956). Conclusions: The Greek version of MDS-R, STSS, and JSE-HP may be proposed for the assessment of relevant variables in Greek nursing staff.
Collapse
Affiliation(s)
- Maria Gamvrouli
- General Hospital of Nikaia-Piraeus "Agios Panteleimon" 20, Nikaia, Attica, Greece
| | - Maria N K Karanikola
- Associate Professor in Mental Health Nursing, Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Antonia Paschali
- Associate Professor in Health Psychology, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Margarita Giannakopoulou
- Professor in Fundamentals of Nursing, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Jacobs BB. An alternate explanation for the 2023 Match: Emergency medicine physicians endure repeated workplace moral distress and our students are watching. Acad Emerg Med 2023; 30:1176-1178. [PMID: 37285078 DOI: 10.1111/acem.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/28/2023] [Accepted: 06/03/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Breanne B Jacobs
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
7
|
Fischer-Grönlund C, Brännström M, Isaksson U. Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Med Ethics 2023; 24:35. [PMID: 37254086 DOI: 10.1186/s12910-023-00916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). METHODS Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole. RESULTS The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912). CONCLUSIONS We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.
Collapse
Affiliation(s)
| | - Margareta Brännström
- Department of Nursing, Umeå University, Campus Skellefteå, 93187, Skellefteå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Linnaeus v 9, 90736, Umeå, Sweden
| |
Collapse
|
8
|
Rodriguez-Ruiz E, Rodríguez-Núñez A. How Can We Balance Demands and Rewards to Transform Moral Distress Into Moral Resilience in the Stressful ICU Environment? Chest 2023; 163:1005-1006. [PMID: 37164567 DOI: 10.1016/j.chest.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Antonio Rodríguez-Núñez
- Department of Pediatrics, Paediatric Intensive, Intermediate and Palliative Care Unit, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
9
|
Hinzmann D, Schütte-Nütgen K, Büssing A, Boenisch O, Busch HJ, Dodt C, Friederich P, Kochanek M, Michels G, Frick E. Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:333. [PMID: 36612657 PMCID: PMC9819312 DOI: 10.3390/ijerph20010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.
Collapse
Affiliation(s)
- Dominik Hinzmann
- Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 München, Germany
| | | | - Arndt Büssing
- Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Boenisch
- Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Christoph Dodt
- Emergency Department, München Klinik, 81925 Munich, Germany
| | | | - Matthias Kochanek
- Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
| | - Guido Michels
- Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
| | - Eckhard Frick
- School of Medicine, Technical University of Munich, 80333 München, Germany
- Spiritual Care and Psychosomatic Health, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, 80539 Munich, Germany
| |
Collapse
|
10
|
Girela-López E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, García-Linares M, Llergo-Muñoz A, Romero-Saldaña M. Study of the Psychometric Properties of the Spanish Version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15649. [PMID: 36497724 PMCID: PMC9735761 DOI: 10.3390/ijerph192315649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND The early detection of moral distress requires a validated and reliable instrument. The aim of this study was to carry out an advanced analysis of the psychometric properties of the moral distress scale for health professionals (MMD-HP-SPA) by performing a validation of the construct and its internal and external reliability. METHODS We performed a multicentre cross-sectional study in health professionals belonging to the Andalusian public health system. Construct validity was performed by exploratory (n = 300) and confirmatory (n = 275) factor analysis (EFA/CFA) in different subgroups; we also analysed the internal consistency and temporal reliability of the scale. RESULTS 384 doctors and 191 nurses took part in the survey. The overall mean for moral distress was 128.5 (SD = 70.9), 95% CI [122.7-134.3], and it was higher in nurses at 140.5 (SD = 74.9) than in doctors at 122.5 (SD = 68.1), F = 8.37 p < 0.01. The EFA produced a model of five components which accounted for 54.8% of the variance of the model. The CFA achieved a goodness of fit of Chi2 = 972.4; AIC = 1144.3; RMSEA = 0.086; CFI = 0.844; TLI = 0.828; NFI = 0.785. CONCLUSIONS The MMD-HP-SPA scale has solid construct validity, excellent internal consistency, optimal temporal reliability, and underlying dimensions which effectively explore the causes of moral distress in health professionals, thus guaranteeing its use in hospital and community settings.
Collapse
Affiliation(s)
- Eloy Girela-López
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Cordoba, Spain
| | - Cristina M. Beltran-Aroca
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Cordoba, Spain
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
| | | | | | - Miguel García-Linares
- Equipo de Soporte Domiciliario de Cuidados Paliativos, Distrito Sevilla Norte-Aljarafe, 41008 Sevilla, Spain
| | - Antonio Llergo-Muñoz
- UGC Cuidados Paliativos, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Cordoba, Spain
- Grupo Asociado GA-16 Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Cordoba, Spain
| |
Collapse
|
11
|
Impact of the Coronavirus Disease 2019 Pandemic on Moral Distress Among Nurses and Physicians in Spanish ICUs. Crit Care Med 2021; 50:e487-e497. [PMID: 34966088 DOI: 10.1097/ccm.0000000000005434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of COVID-19 pandemic on moral distress (MD) among healthcare professionals (HCPs) (physicians and nurses) in Spanish ICUs. DESIGN Cross-sectional, prospective study. SETTING ICUs in Spain. PARTICIPANTS HCPs currently working in Spanish ICUs. INTERVENTIONS Data were collected via electronic survey with the use of a 50-item questionnaire in two different periods: prepandemic (October-December 2019) and during the second wave of COVID-19 (September-November 2020). MEASUREMENTS AND MAIN RESULTS During the prepandemic and pandemic periods, 1,065 (57.1% nurses) and 1,115 (58.5% nurses) HCPs completed the questionnaire, respectively. Higher MD levels were reported during COVID-19 pandemic, particularly among ICU nurses, when compared with the prepandemic period. Before COVID-19, physicians reported significantly higher levels of MD than ICU nurses (80.0 [interquartile range {IQR}, 40.0-135.0] vs 61.0 [IQR, 35.0-133.0]; p = 0.026). These differences disappeared during the pandemic period (81.0 [IQR, 39.0-138.5] vs 74.0 [IQR, 41.0-143.0]; p = 0.837). During the pandemic, younger and less experienced HCPs working in hospital areas that were converted in ICU or in ICUs with multiple occupancy rooms reported higher MD levels. In addition, HCPs who were off work for psychologic burden reported higher MD levels (108.0 [IQR, 66.0-139.0] vs 76.0 [IQR, 40.0-141.0]; p < 0.05). In the prepandemic period, patient-level root causes were the most morally distressing for nurses, whereas physicians reported higher MD on system-level root causes. During the pandemic, both groups reported higher MD on system-level root causes. During COVID-19, significantly more HCPs considered leaving their job due to MD. CONCLUSIONS MD has increased among ICU HCPs in Spain during COVID-19 pandemic. Physicians reported higher MD levels than nurses in the prepandemic period, whereas both HCPs groups reported similar MD levels in the pandemic period. Strategies are needed and should be implemented to mitigate MD among HCPs.
Collapse
|