Abstract
BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19.ResultsThree hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care.
Highlights
During a global health crisis, e.g. the COVID-19 pandemic, caregivers encounter ethical issues they usually do not experience in everyday healthcare [1, 2]
This study aims to compare the degree of moral distress during the COVID-19 outbreak with those of a cohort one year before the COVID-19 outbreak
Demographic data The extended Measurement of Moral Distress for Healthcare Professionals (MMD-HP) was completed by 41 intensivists (5.0%), 355 intensive care unit (ICU) nurses (9.3%), and 108 supporting staff, the extended Ethical Decision Making Climate Questionnaire (EDMCQ) by 40 intensivists (4.8%), 345 ICU nurses (9.1%), and 103 supporting staff
Summary
During a global health crisis, e.g. the COVID-19 pandemic, caregivers encounter ethical issues they usually do not experience in everyday healthcare [1, 2]. Health care professionals have to allocate limited resources fairly, whether they are medical (e.g., drugs, ventilators, testing capability, and hospital beds), Donkers et al BMC Med Ethics (2021) 22:73 structural (e.g., venue) or human (e.g., medical personnel) [4]. Restrictions such as isolation and quarantining of patients, their families and health care professionals may affect the delivery of health care [5]. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19
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