Abstract
BackgroundGlobal health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs.MethodsA total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed.FindingsRespondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|].InterpretationElevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.
Highlights
Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events
Many HCWs have encountered potentially morally distressing events (PMDEs) over and above the stressors faced during their typical practice, such as risk of COVID-19 transmission to family members, caring for patients without family members present, triaging patients in the context of limited resources where the lack of treatment may result in death, and following directions that go against their professional standards or core values [7, 8]
31.8% (n = 291) reported that their work involved contact with patients diagnosed with COVID19. These respondents had similar length of time elapsed since the start of the pandemic to survey completion and similar distributions in terms of sex, race, income level, and past trauma exposure compared to those who had not been in contact with patients with COVID-19 (Table S1, all p > .050)
Summary
Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The COVID-19 pandemic has had major collateral effects on the global healthcare system creating sustained and unrelenting pressure to re-allocate scarce healthcare resources including HCWs. During the pandemic, many HCWs have encountered potentially morally distressing events (PMDEs) over and above the stressors faced during their typical practice, such as risk of COVID-19 transmission to family members, caring for patients without family members present, triaging patients in the context of limited resources where the lack of treatment may result in death, and following directions that go against their professional standards or core values [7, 8]
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