1
|
Buchbinder M, Browne A, Berlinger N, Jenkins T, Buchbinder L. Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-15. [PMID: 37347222 PMCID: PMC10758677 DOI: 10.1080/15265161.2023.2224270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic factors. We conclude by reflecting on how and why this conceptual clarity matters for improving clinicians' professional wellbeing, and offer preliminary pathways for intervention.
Collapse
Affiliation(s)
| | | | | | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA
| |
Collapse
|
2
|
de Moraes SHM, Cunha IPD, Lemos EF, Abastoflor LLL, Oshiro MDL, Bohrer RTDODA, Sarubbi V, Souza FBD, Nascimento DDGD, do Valle Leone de Oliveira SM. Prevalence and associated factors of mental health disorders among Brazilian healthcare workers in times of the COVID-19 pandemic: A web-based cross-sectional study. PLoS One 2023; 18:e0274927. [PMID: 37279233 DOI: 10.1371/journal.pone.0274927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
The COVID-19 pandemic in Brazil affected mental health among healthcare workers. To objective of this study was to evaluate the mental health of healthcare workers in in the central-west region of the Brazil, estimating the prevalence of mental health disorders, and investigating associated factors, perceptions of safety, and self-perceptions about mental health in times of the COVID-19 pandemic. The questionnaire was divided into two parts that included general information and perceptions about the work process and identified symptoms using the Depression Anxiety Stress Scale-21 (DASS-21), and multiple linear regression analysis was conducted. A total of 1,522 healthcare workers participated in the survey. Overall prevalence of symptoms was calculated for depression (58.7%), anxiety (59.7%), and stress (61.7%). Physicians had 3.75 times greater risk of depression (1.59-8.85, 95% CI). Independent variables associated with depression symptoms were not feeling safe with the way services were organized (1.12:1.03-1.21, 95% CI) and self-perception of poor mental health (8.06: 4.03-16.10% CI). Working in management was protective, and married professionals had 12% lower risk of exhibiting symptoms of depression (0.79-0.99, 95% CI). Participants with self-perception of poor mental health had 4.63 greater risk for symptoms of anxiety (2.58-8.31, 95% CI). Protective factors were not having sought support for mental health (0.90: 0.82-0.99, 95% CI), having a graduate degree (0.71: 0.54-0.94, 95% CI), and not having been diagnosed with COVID-19 (0.90: 0.83-0.98, 95% CI). Perception of poor mental health was associated with 6.95-fold greater chance of developing stress symptoms. Protective factors from stress were having a degree in dentistry (0.81: 0.68-0.97, 95% CI), residing in Mato Grosso do Sul (0.91: 0.85-0.98, 95% CI), and not having sought mental health support services (0.88: 0.82-0.95, 95% CI). The prevalence of mental health disorders is high among healthcare workers, and is associated with professional category, organization of services provided, and self-perception of poor mental health, reinforcing the need for preventative measures.
Collapse
Affiliation(s)
| | - Inara Pereira da Cunha
- Escola de Saúde Pública Dr. Jorge David Nasser, Campo Grande, Mato Grosso do Sul, Brasil
| | | | - Lesly Lidiane Ledezma Abastoflor
- Fiocruz Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
| | | | | | - Vicente Sarubbi
- Universidade Estadual de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
| | | | | | | |
Collapse
|
3
|
Escher C, Nagy E, Creutzfeldt J, Dahl O, Ruiz M, Ericson M, Osika W, Meurling L. Fear of making a mistake: a prominent cause of stress for COVID-19 ICU staff-a mixed-methods study. BMJ Open Qual 2023; 12:e002009. [PMID: 36697055 PMCID: PMC9884924 DOI: 10.1136/bmjoq-2022-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs. METHOD A survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline. RESULTS Staff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported 'making a mistake' as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified 'lack of knowledge and large responsibility', 'workload and work environment', 'uncertainty', 'ethical stress' and 'organization and teamwork' as major causes of stress. CONCLUSION Despite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor.
Collapse
Affiliation(s)
- Cecilia Escher
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Department of Anesthesia and Intensive Care, Norrtälje Hospital, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Nagy
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Oili Dahl
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mini Ruiz
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Mats Ericson
- Division of Ergonomics, Royal Institute of Technology, Stockholm, Sweden
| | - Walter Osika
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Lisbet Meurling
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
4
|
Miner SA, Berkman BE, Altiery de Jesus V, Jamal L, Grady C. Navigating Pandemic Moral Distress at Home and at Work: Frontline Workers' Experiences. AJOB Empir Bioeth 2022; 13:215-225. [PMID: 35472000 DOI: 10.1080/23294515.2022.2064000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: During the COVID-19 pandemic, frontline workers faced a series of challenges balancing family and work responsibilities. These challenges included making decisions about how to reduce COVID-19 exposure to their families while still carrying out their employment duties and caring for their children. We sought to understand how frontline workers made these decisions and how these decisions impacted their experiences.Methods: Between October 2020 and May 2021, we conducted 61 semi-structured interviews in English or Spanish, with individuals who continued to work outside of the home during the pandemic and had children living at home. Interviews were recorded, transcribed verbatim, and analyzed using abductive methods.Results: Frontline workers experienced moral distress, the inability to act in accordance with their values and obligations because of internal or external constraints. Their moral distress was a result of the tensions they felt as workers and parents, which sometimes led them to feel like they had to compromise on either or both responsibilities. Individuals felt morally conflicted because 1) their COVID-19 work exposures presented risk that often jeopardized their family's health; 2) their work hours often conflicted with their increased childcare responsibilities; and 3) they felt a duty to their colleagues, patients/customers, and communities to continue to show-up to work.Conclusions: Our findings point to a need to expand the concept of moral distress to include the perspectives of frontline workers outside of the healthcare professions and the fraught decisions that workers make outside of work that may impact their moral distress. Expanding the concept of moral distress also allows for a justice-based framing that can focus attention on the disparities inherent in much frontline work and can justify programmatic recommendations, like increasing paid childcare opportunities, to alleviate moral distress.
Collapse
Affiliation(s)
- S A Miner
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA.,Department of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - B E Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - V Altiery de Jesus
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA.,John Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - L Jamal
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
5
|
Aymerich C, Pedruzo B, Pérez JL, Laborda M, Herrero J, Blanco J, Mancebo G, Andrés L, Estévez O, Fernandez M, Salazar de Pablo G, Catalan A, González-Torres MÁ. COVID-19 PANDEMIC EFFECTS ON HEALTH WORKERS’ MENTAL HEALTH: SYSTEMATIC REVIEW AND META-ANALYSIS. Eur Psychiatry 2022; 65:e10. [PMID: 35060458 PMCID: PMC8828390 DOI: 10.1192/j.eurpsy.2022.1] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|