Moral distress in frontline healthcare workers in the initial epicenter of the COVID‐19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning

Abstract

Introduction Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID‐19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID‐19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID‐19‐related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties. Method Data were collected in spring 2020, through an anonymous survey delivered to a purposively‐selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID‐19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample. Results The majority of the sample (52.7%–87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID‐19 moral distress: negative impact on family, fear of infecting others, and work‐related concerns. All three factors were significantly associated with severity and positive screen for COVID‐19‐related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes. Conclusion Moral distress is prevalent in FHCWs and includes family‐, infection‐, and work‐related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.

Morally Distressing Experiences, Moral Injury, and Burnout in Florida Healthcare Providers during the COVID-19 Pandemic

“…As hypothesized and similar to previous findings [ 21 ], we found that MI was related to burnout. We also found that MI was associated with higher levels of psychiatric symptoms including depression, anxiety, and PTSD, a finding that is consistent with prior research focused on HCPs [ 3 , 15 ] and military samples [ 42 ]. In our sample, providers who reported Others MI were almost three times more likely to score above the clinical cutoff for depression, while those reporting Self MI were over two times more likely to score above the clinical cutoff for depression, over four times more likely to score above the clinical cutoff for anxiety, and over 6 times more likely to score above the clinical cutoff for PTSD.…”

“…Our finding requires further research to better understand the characteristics of leadership that are the most important contributors to reducing burnout. Strengthening the suggestion that leadership support mitigates a poor work environment [ 3 ], our findings suggest that in healthcare settings, leadership quality and style are critical factors that contribute to the wellbeing of employees. Hospital administrators and other supervisors in a healthcare setting should be aware of the importance of providing support to the HCPs they supervise, particularly those who may be at greatest risk of MI and burnout.…”

“…Even prior to the events of the global health emergency caused by COVID-19, workplace burnout, which is recognized in the ICD-11 as a diagnosable condition [ 1 ] has been a problem of increasing concern among healthcare providers [ 2 ]. Since the start of the pandemic, health care providers (HCPs) have experienced increased psychological and physical stress due to the burden of caring for very ill patients, often in the context of fear of contracting COVID-19 and spreading the virus to friends and family [ 3 , 4 ].…”

“…When compared to other morally distressing events, inadequate care was most reported and suggestive of moral injury in over 80% of 6026 frontline healthcare workers. The feelings of inadequacy of care and incompetency of their work abilities was also highly related to work difficulties, being another indicator of burnout [ 3 ]. Recognizing the specific HDMEs that contribute most to MI can be helpful at identifying appropriate coping factors or support systems.…”

Experience of General Practice Residents Caring for Dependent Elderly during the First COVID-19 Lockdown—A Qualitative Study

“…Moral distress is “psychological harm that occurs when people are forced to make or witness decisions or actions that contradict their fundamental moral values” [ 1 ]. The 2019 Coronavirus disease pandemic (COVID-19) has had an impact on health care workers around the world [ 2 ] and caused psychosocial risks [ 3 ].…”