Abstract
The COVID-19 pandemic has confronted emergency and critical care physicians with unprecedented ethically challenging situations. The aim of this paper was to explore physicians’ experience of moral distress during the pandemic. A qualitative multicenter study was conducted using grounded theory. We recruited 15 emergency and critical care physicians who worked in six hospitals from the Lombardy region of Italy. Semi-structured interviews about their professional experience of moral distress were conducted from November 2020–February 2021 (1 year after the pandemic outbreak). The transcripts were qualitatively analyzed following open, axial, and selective coding. A model of moral distress was generated around the core category of Being a Good Doctor. Several Pandemic Stressors threatened the sense of Being a Good Doctor, causing moral distress. Pandemic Stressors included limited healthcare resources, intensified patient triage, changeable selection criteria, limited therapeutic/clinical knowledge, and patient isolation. Emotions of Moral Distress included powerlessness, frustration/anger, and sadness. Physicians presented different Individual Responses to cope with moral distress, such as avoidance, acquiescence, reinterpretation, and resistance. These Individual Responses generated different Moral Outcomes, such as moral residue, disengagement, or moral integrity. The Working Environment, especially the team and organizational culture, was instrumental in restoring or disrupting moral integrity. In order for physicians to manage moral distress successfully, it was important to use reinterpretation, that is, to find new ways of enacting their own values by reframing morally distressing situations, and to perceive a cooperative and supportive Working Environment.
Highlights
The COVID-19 epidemic was declared by the World Health Organization [1] as a pandemic on 11 March 2020
The study was designed according to the principles of grounded theory, which is a qualitative, inductive methodology originally developed by Glaser and Strauss [19] to study psychosocial processes, and to generate theory originating from the data
The grounded theory methodology allowed for capturing the process of moral distress: the causes, the related emotions, the responses used by physicians to face it, and its outcomes
Summary
The COVID-19 epidemic was declared by the World Health Organization [1] as a pandemic on 11 March 2020. The rapid and unexpected evolution of the pandemic generated enormous pressure on the Italian healthcare system [2]. The imbalance between the healthcare needs and the available resources forced physicians to grapple with extremely difficult and unprecedented clinical choices [5]. Under these dramatic circumstances, the main guiding ethical principles—respect for autonomy, beneficence, non-maleficence, and distributive justice- were continuously utilized to guide decisions that balanced the benefits and harms of individual patients with that of the larger
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International journal of environmental research and public health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
