Dataset Information

Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study.

ABSTRACT:

Background

Palliative care professionals have had to adapt to rapidly changing COVID-19 restrictions with personal protective equipment and physical distancing measures impacting face-to-face communication with patients and relatives.

Aim

To explore the narratives of palliative care doctors working during the pandemic to understand their experiences at a personal and professional level.

Design

In-depth narrative interviews were carried out via video call. Interviews were transcribed verbatim and analysed using a joint paradigmatic and narrative approach to elucidate common themes and closely explore individual narratives.

Setting/participants

Eight palliative care doctors who had worked on a hospice inpatient unit in the UK before and during the pandemic were recruited from two hospices in Scotland.

Results

Three intersecting themes are described, the most significant being moral distress. Participants articulated a struggle to reconcile their moral convictions with the restrictions enforced, for example, wanting to provide support to patients through physical proximity but being unable to. To differing degrees, this resulted in internal conflict and emotional distress. Two further themes arose: the first concerned a loss of humanity in interaction and a striving to re-humanise communication through alternative means; the second being a change in staff morale as the pandemic progressed.

Conclusions

Restrictions had a considerable impact on palliative care doctors' ability to communicate with and comfort patients which led to moral distress and contributed to decreasing morale. Future research could explore moral distress in palliative care settings internationally during the pandemic with a view to compare the factors affecting how moral distress was experienced.

SUBMITTER: Fish EC

PROVIDER: S-EPMC9174577 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study.

Fish Ellis C EC Lloyd Anna A

Palliative medicine 20220512 6

<h4>Background</h4>Palliative care professionals have had to adapt to rapidly changing COVID-19 restrictions with personal protective equipment and physical distancing measures impacting face-to-face communication with patients and relatives.<h4>Aim</h4>To explore the narratives of palliative care doctors working during the pandemic to understand their experiences at a personal and professional level.<h4>Design</h4>In-depth narrative interviews were carried out via video call. Interviews were tr ...[more]

PMID: 35548937

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Project description:BackgroundMoral distress is a far-reaching problem for nurses in different settings as it threatens their health.AimThis study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress.Research designA qualitative interview study with reflexive thematic analysis was used.Participants and research contextWe conducted semi-structured interviews with 20 home-care nurses in Germany.Ethical considerationsThe study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health.FindingsTwenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one's health, extended responsibility for the entire care arrangement, work-privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient's territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels.ConclusionsIn cases of tension between the service and billing system and the understanding of these nurses' care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients' quality of care.

Project description:ObjectiveTo explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic.DesignCross-sectional survey in late 2020, employing quantitative and qualitative analyses.SettingSafety net practices in 20 US states.Participants2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes.MeasuresOrdinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress.ResultsWeighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported 'mild' or 'uncomfortable' levels and 26.8% characterised their moral distress as 'distressing', 'intense' or 'worst possible'. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress.ConclusionsDuring the pandemic's first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study's clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians' moral distress from witnessing inequities and other injustices for their patients and communities.

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Dataset Information

Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study.

Background

Aim

Design

Setting/participants

Results

Conclusions

Publications

Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study.

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