Being prevented from providing good care : a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic
Author: Gustavsson, Martina E; von Schreeb, Johan; Arnberg, Filip K; Juth, Niklas
Department: Inst för global folkhälsa / Dept of Global Public Health
View/ Open:
Version of Record (920.8Kb)
Supplementary material 1 (209.8Kb)
Supplementary material 2 (211.0Kb)
Abstract
Background Health care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis.
Methods: Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis.
Results: Three themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/ inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,”and (3) “The pandemic hindered us; pandemic-related obstacles. ”The three themes correspond to the main theme, “Being prevented from providing good care.”
Discussion: The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions.
Conclusions: On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon.
Methods: Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis.
Results: Three themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/ inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,”and (3) “The pandemic hindered us; pandemic-related obstacles. ”The three themes correspond to the main theme, “Being prevented from providing good care.”
Discussion: The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions.
Conclusions: On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon.
Institution:
- Global Disaster Medicine – Health Needs and Response, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Centre for Research ethics and Bioethics (CRB), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
Citation: BMC Med Ethics. 2023 Dec 9;24(1):110.
Citation DOI: 10.1186/s12910-023-00993-y
Citation PMID: 38071309
Citation ISI: 001117681100001
Publishing journal: BMC medical ethics
Eprint status: Peer Reviewed
Version: Published
Issue date: 2024-01-31
Sponsorship:
- Swedish National Board of Health and Welfare
- Uppsala University Hospital, grant no. 942431
- Karolinska Institutet Faculty Fund
Rights:
CC BY 4.0
Publication year: 2023
Statistics
Total Visits
Views | |
---|---|
Being ... | 75 |
Total Visits Per Month
January 2024 | February 2024 | March 2024 | April 2024 | May 2024 | June 2024 | July 2024 | |
---|---|---|---|---|---|---|---|
Being ... | 5 | 21 | 25 | 10 | 8 | 6 | 0 |
File Visits
Views | |
---|---|
Study 4, supplementary material 2.pdf | 45 |
Study 4.pdf | 42 |
Study 4, supplementary material 1.pdf | 32 |
Top country views
Views | |
---|---|
United States | 26 |
Sweden | 14 |
China | 6 |
Ireland | 5 |
Germany | 4 |
South Korea | 4 |
Canada | 2 |
Russia | 2 |
Bulgaria | 1 |
France | 1 |
Top cities views
Views | |
---|---|
Ashburn | 5 |
Boardman | 5 |
Norrköping | 5 |
Dublin | 2 |
Linköping | 2 |
Barrie | 1 |
Beijing | 1 |
Chengdu | 1 |
Clifton | 1 |
Düsseldorf | 1 |