Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway

Abstract

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms.

The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study

“…Finally, our findings highlight the need to implement care policies for professionals in similar health crises and shocks in the future, such as establishing psychological intervention programs for professionals on the frontline of care, developing ethical organizational cultures, re-humanizing care for patients and families, and ensuring safe environments for patients and professionals [34,37]. Specifically, we believe that nurses and nursing assistants need to specialize further in critical care and that stable human resources policies should be promoted [64].…”

“…ICU professionals have also faced ethical dilemmas and conflicts arising from the need to establish more restrictive admission profiles and the inability to provide emotional support and information to families in person [7,32,58,[61][62][63]. To address this situation, a number of studies suggest the implementation of organizational coping strategies such as improving human resources policies, designing targeted psychological interventions for professionals, and having ethical guidelines for difficult decisions in place in ICUs [6,7,13,34,37,[64][65][66][67].…”

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

“…Studying frontline healthcare workers (FHCWs) during a coronavirus disease 2019 (COVID‐19) surge offers an opportunity to learn more about moral distress as potentially morally injurious events are unfolding (Huang et al, in press; Lu et al, 2020 ; Pereira‐Sanchez et al, 2020 ; Shanafelt et al, 2020 ; Shechter et al, 2020 ). Commentaries and surveys suggest that moral distress and moral injury are common during the pandemic, particularly among FHCWs treating COVID‐19 patients (Borges et al, 2020 ; Haller et al, 2020 ; Maguen & Price, 2020 ; Miljeteig et al, 2021 ). An exemplar of this was the pandemic surge in New York City in the spring of 2020, the first surge in the U.S. when little was known about the virus.…”

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students

“…Ethical dilemmas emerge due to a shortage of both medical and human resources. 10 Ethical dilemmas are described as situations that cannot be solved; decisions made between two options may be morally plausible, although equally problematic due to the circumstances. Furthermore, ethical conflicts arise when one is aware of the need for proper actions, however, one may have trouble exercising these actions because of certain internal or external factors.…”