Moral Distress and Moral Resilience of Health Professionals in a Greek Public Hospital during the Second Wave of Pandemic
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Abstract
Healthcare professionals during the pandemic in the Greek public healthcare system have experienced increased psychological distress, fear and a greater intention to quit their jobs. This study analyzes the factors of moral distress and moral resilience of healthcare professionals employed during the second wave of the pandemic. The target group was the healthcare professionals (HP = 169) who served in the Evaggelismos General Hospital Covid-clinics and -ICU for 2022 and data were collected through life protocols.
Healthcare professionals believe that when faced with moral challenges, they are able to discern them and think clearly. They are especially stressed when they care for more patients than they can safely handle when they are involved in care that causes unnecessary suffering or does not adequately relieve pain or symptoms, and when they notice that patient care is getting worse. Also stressful are the situations, leading to the creation of possible moral distress, when they witness a violation of a standard of practice or moral code. Factors that lead or may lead healthcare professionals to moral distress are nursing safety, unnecessary and deteriorating patient care, and violation of medical confidentiality, violation of standards of practice or moral codes.
The score on the MMD-HP scale indicates low-to-moderate levels of moral distress. Based on the RMRS scale the moral resilience of healthcare professionals is characterized by moderate-to-high with the highest scores per statement seen when patient care is getting worse and feel pressured to ignore situations where patients have not been given adequate information. The healthcare professionals report that they have either left or have considered leaving their position in a clinic due to moral distress, although they are not currently thinking of leaving their position. The factors that increase the frequency of moral distress and decrease their moral resilience are feeling powerless anxiety, nursing/treatment errors, aggressive treatment, caring for more patients than they can handle, substandard patient care, and hierarchical teams.
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References
2. De Oliveira, SM, de Alcantara Sousa, LV, Vieira Gadelha, M, do Nascimento, VB. Prevention actions of burnout syndrome in nurses: An integrating literature review. Clinical Practice and Epidemiology in Mental Health. 2019; 15:64-73. doi.org/10.2174/ 1745017901915010064
3. Epstein B, Turner, M. The nursing code of ethics: Its value, its history. The Online Journal of Issues in Nursing. (2015); 31, 20(2):4. doi:10.3912/OJIN.Vol20No02Man04
4. Missouridou E, Mangoulia P, Pavlou V, Kritsotakis E, Stefanou E, Bibou P, Kelesi M, Fradelos EC. Wounded healers during the COVID-19 pandemic: Compassion fatigue and compassion satisfaction among nursing care providers in Greece. Perspectives in Psychiatric Care. (2021). doi:1–12. 10.1111/ ppc.12946
5. Van der Wath A, van Wyk N. A hermeneutic literature review to conceptualize altruism as a value in nursing. Scandinavian Journal of Caring Sciences. (2019); 34(3): 575-584. doi:10.1111/scs.12771
6. Virani S.B. Moral distress and covid-19: A frontline emergency nurse's perspective. Nursing. (2021); 51(12):39-43. doi.org/ 10.1097/01.nurse.0000800072.35132.c1
7. McCann MC, Beddoe E, McCormick K, Huggard P, Kedge S, Adamson C, Huggard J. Resilience in the health professions: Α review of recent literature. International Journal of Well-Being. (2013); 21(1):90-103
8. Kramer JB, Brown DE, Kopar PK. Ethics in the time of coronavirus: Recommendations in the covid-19 pandemic. Journal of the American College of Surgeons. (2020); 230(6):1114-1118. doi.org/10.1016/j.jamcollsurg.2020.04.004.
9. Kotrotsiou S, Theofanidis D, Malliarou M, Konstanti Z, Sarafis P, Tsioumanis G, Paralikas T. Investigating nurses stress response strategies during the covid-19 pandemic. Materia Sociomedica. (2021); 33(3):168-173. doi:10.5455/msm.2021.33.168-173
10. Morley J, Machado C, Burr C, Cowls J, Joshi I, Taddeo M, Floridi, L. The ethics of AI in health care: A mapping review. Social Science & Medicine. (2020); 1982, 260:113172. doi.org/10.1016/j.socscimed. 2020.113172
11. Malliarou M, Nikolentzos A, Papadopoulos D, Bekiari T, Sarafis, P. ICU nurse's moral distress as an occupational hazard threatening professional quality of life in the time of pandemic covid 19. Materia Sociomedica. (2021); 33(2):88-93. doi.org/ 10.5455/msm. 2021.33.88-93
12. Tingle J. Commentary on young A (2009). Review: The legal duty of care for nurses and other healthcare professionals. Journal of Clinical Nursing. (2010); 19(1-2):297-299. doi.org/10.1111/j.1365-2702.2009.03058.x
13. Creswell J. Research in education: Designing, conducting and evaluating quantitative and qualitative research. (2012). 4th Edition. ISBN: 9780134519395
14. Heinze KE, Hanson G, Holtz H, Swoboda SM, Rushton CH. Measuring health care interprofessionals' moral resilience: Validation of the Rushton moral resilience scale. Journal of Palliative Medicine. (2021); 24(6):865-872. doi.org/10.1089/jpm.2020.0328
15. Rushton CH, Thomas TA, Antonsdottir IM, Nelson KE, Boyce D, Vioral A, Swavely D, Ley CD, Hanson GC. Moral injury and moral resilience in health care workers during covid-19 pandemic. Journal of Palliative Medicine. (2022); 25(5): 712-719. doi.org/10.1089/ jpm .2021.0076
16. Epstein EG, Whitehead PB, Prombahakul C, Thacker LR, Hamric AB. Enhancing understanding of moral distress: The measure of moral distress for health care professionals, AJOB Empirical Bioethics. (2019); 10(2):113-124. doi: 10.1080/23294515.2019.1586008
17. Tharenou P, Saks AM, Moore C. A review and critique of research on training and organizational-level outcomes. Human Resource Management Review. (2007); 17(3):251-273. doi.org/10.1016/j.hrmr.2007. 07.004
18. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis. (2010). 7th Edition, Prentice Hall, Upper Saddle River
19. Young PD, Rushton CH. A concept analysis of moral resilience. Nursing Outlook. (2017); 65(5):579-587. doi.org/10.1016/ j. outlook.2017.03.009
20. Salari N, Shohaimi S, Khaledi-Paveh B, Kazeminia M, Bazrafshan MR, Mohammadi M. The severity of moral distress in nurses: a systematic review and meta-analysis. Philosophy, Ethics, and Humanities in Medicine. (2022); 17(1):13. doi.org/10.1186/ s13010-022-00126-0
21. Shahriari M, Mohammadi E, Abbaszadeh A, Bahrami M, Fooladi MM. Perceived moral values by Iranian nurses. Nursing ethics. (2012); 19(1):30-44. doi.org/10.1177/ 0969733011408169
22. Musto LC, Rodney PA, Vanderheide R. Toward interventions to address moral distress: navigating structure and agency. Nursing Ethics. (2015); 22(1):91-102. doi.org/ 10.1177/0969733014534879
23. Bayat M, Shahriari M, Keshvari M. The relationship between moral distress in nurses and moral climate in selected hospitals of the Iranian social security organization. Journal of Medical Ethics and History of Medicine. (2019); 12:8. https://doi.org/10.18502/jmehm.v 12i8.1339
24. Haahr A, Norlyk A, Martinsen B, Dreyer, P. Nurses experiences of moral dilemmas: A review. Nursing Ethics. (2020); 27(1):258-272, doi.org/10.1177/0969733019832941
25. Arries-Kleyenstüber EJ. Moral resilience in nursing education: exploring undergraduate nursing student’s perceptions of resilience in relation to moral ideology. SAGE Open Nursing. (2021); 7. doi.org/10.1177/23779608211017798
26. Llop-Gironés A, Vračar A, Llop-Gironés G. et al. Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic? Human Resources for Health. (2021); 19:112 doi.org/10.1186/s12960-021-00651-7
27. Kim EY, Chang SO. Exploring nurse perceptions and experiences of resilience: a meta-synthesis study. BMC Nursing. (2022); 21:26. doi.org/10.1186/s12912-021-00803-z
28. Sarafis P, Rousaki E, Tsounis A, Malliarou M, Lahana L, Bamidis P, Niakas D, Papastavrou E. The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. BMC Nursing. (2016); 15(1):1-9
29. Park S, Elliott J, Berlin A. Strengthening the UK primary care response to COVID-19. BMJ. (2020). 370; m3691. doi.org/10.1136/ bmj.m3691
30. Rodger D, Blackshaw B, Young, A. Moral distress in healthcare assistants: A discussion with recommendations. Nursing Ethics. (2019); 26(7-8):2306-2313. doi.org/10.1177/ 0969733018791339
31. Lepidou M, Kadda O, Argyriou G, Nestor A, Marvaki K, Hassioti G, Nanas S. Moral dilemmas as a source of stress among doctors and nurses in the intensive care unit. Nosileftiki. (2012); 51:187-194
32. Tsironi S, Bovaretos N, Tsoumakas K, Giannakopoulou M, Matziou V. Factors affecting parental satisfaction in the neonatal intensive care unit. Journal of Neonatal Nursing. (2012). 18(5):183-192
33. Parpa E. Attitudes of health care professionals (physicians, nurses), relatives of advanced cancer patients and public towards euthanasia: a comparative study. National and Kapodistrian University of Athens, Medical and Health Sciences, (2015); 145
34. Sikaras C, Ilias I, Tselebis, A, Pachi A, Zyga S, Tsironi M, Rojas-Gil AP, Panagiotou A. Nursing staff fatigue and burnout during the covid-19 pandemic in Greece. AIMS Public Health. (2022). 9(1):94-105. doi:10.3934/ publichealth.2022008
35. Haikali S. Moral distress in Hellenic end-of-life care nurses. PhD Thesis, National and Kapodistrian University of Athens (EKPA). Faculty of Health Sciences. Department of Nursing. (2011); 364. doi:10.12681/eadd/ 26089.