Nearly one in eight report report high levels of moral distress, study finds
Hospitals and other health care organizations can build loyalty and reduce burnout among clinicians during the COVID-19 pandemic by demonstrating support through actions such as providing them with personal protective equipment (PPE).
That is one of the findings to emerge from two recent studies examining the pandemic’s impact on doctors’ mental health. Both studies are based on results of a 2020 national online survey of internists who are members of the American College of Physicians.
One of the studies set out to identify health care organizations’ policies and actions associated, either positively or negatively, with “perceived organizational support” (POS)—the belief among doctors that their employer values them and cares about their well-being-- and to measure the association between POS and adverse mental health outcomes, burnout and intention to quit practice.
After controlling for all other support policies and potential confounders, the researchers found three policies that were positively associated with POS: offering opportunities to discuss ethical questions that arise when caring for COVID-19 patients, access to adequate PPE, and ensuring that leadership listens to employees’ concerns regarding COVID-19 generally.
Conversely, warning or sanctioning employees who refused pandemic-related assignments or spoke out about safety issues, was associated with lower POS.
“The COVID-19 pandemic has unleashed a flood of moral dilemmas for frontline clinicians,” Jeffrey Sonis, MD, MPH, associate professor of family medicine at the University of North Carolina-Chapel Hill and the study’s lead author said in an accompanying news release. “It’s not surprising that offering opportunities to discuss ethical concerns was strongly related to internists’ perceptions that their organization supported them.”
The goal of the other study was to determine the predictors, intensity and outcomes of moral distress, which the authors define as “the discomfort that health workers feel when they are prevented by persons, institutions or situations from doing what they believe is morally right.” Among health care workers, it is associated with anxiety and guilt, depression, and burnout and job attrition. The study’s main findings were:
The authors say their findings demonstrate that health care organizations need to focus on identifying doctors with moderate and high levels of moral distress. “Moral distress of any severity is concerning but low levels are associated only weakly with anxiety but no other outcomes while high levels are associated with dramatically increased odds of all adverse outcomes,” they write.
The study “Effects of Healthcare Organization Actions and Policies Related to COVID-19 on Perceived Organizational Support Among U.S. Internists” appears in the May/June 2022 issue of the Journal of Healthcare Management. “A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic” appears in the journal PLOS ONE.