Location
Virtual
Start Date
1-3-2024 12:40 PM
End Date
1-3-2024 12:55 PM
Keywords:
washington; california; covid-19; pshmc; burbank
Description
Background:
The most common framework for ethical decision-making in healthcare is principalism which is founded on three ethical traditions: utilitarianism, achieving the most good for the most people; deontology, upholding moral obligations to individuals; and virtue ethics, doing what is virtuous regardless of the consequences. Principalism is further guided by four principles: 1) respect for autonomy; 2) beneficence, the duty to do good; 3) nonmaleficence, the duty to do no harm; and 3) justice, the duty to treat similar cases similarly. Patient-facing healthcare professionals (HCPs) commonly expect all moral values will be considered when decisions are made that impact patients and care delivery. During the COVID-19 crisis, changes to policies and practices were implemented quickly without HCP or patient input that may have conflicted with HCPs moral values, yet literature exploring this phenomenon is sparse.
Purpose:
To explore if policies and practices implemented during the COVID-19 pandemic contributed to perceived moral distress among patient-facing HCPs.
Methods
A qualitative, descriptive parent study was conducted with patient-facing HCPs from multiple sites across Providence to explore how they use chaplains to relieve stress. Data was analyzed using the Transactional Model of Stress and Coping as a sensitizing concept. That study found HCPs sought chaplain care to relieve stress of a moral nature (moral distress). Much of that moral distress reflected altered care practices implemented as a part of the crisis response to COVID-19. This discursive discussion with supporting data from the parent study argues policies intended to achieve the most good for the most people (utilitarianism) contributed to significant moral distress among patient-facing HCPs charged with implementing them.
Results
Data from 33 interviews was reviewed to determine if utilitarian policies implemented during the pandemic conflicted with HCPs’ moral obligations. We found those policies led to heavier workloads, restrictive visitation policies, and patients dying alone - all sources of moral distress among participants which contributed to suffering of both their patients and the HCPs themselves, as one nurse lamented “I’ve done a lot of harm to a lot of people”.
Conclusion
Decisions made during the COVID-19 pandemic in attempts to "do the most good for the most people" led to policies that were perceived to violate the moral values and obligations of patient-facing HCPs. Our study participants described a desire to uphold individual moral obligations despite the consequences. Such moral conflicts, though arguably justifiable, contributed to moral distress among our sample. Further research is needed to inform ways to alleviate such moral distress among HCPs.
Implications for Practice
Ethical decision-making in healthcare must take the multiple moral perspectives of all HCPs into consideration. When differing moral frameworks underpin ethical decision-making in patient care delivery, what is ethical from one perspective may be perceived as controversial by another. While applied principalism intended to limit harm during the COVID-19 pandemic, it may have contributed to significant moral distress among patient-facing HCPs. Healthcare leaders should provide resources to support HCPs who may be experiencing moral distress, particularly during times when policies and procedures are changed without patient or HCP input.
Recommended Citation
Sumner, Sarah; Colorafi, Karen; and Rangel, Teresa, "Perceived moral distress among patient-facing healthcare professionals during the COVID-19 pandemic" (2024). Providence Nursing Research Conference 2023 – Present. 22.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/podiums/22
Clinical Institute
Mental Health
Department
Behavioral Health
Department
Infectious Diseases
Department
Nursing
Perceived moral distress among patient-facing healthcare professionals during the COVID-19 pandemic
Virtual
Background:
The most common framework for ethical decision-making in healthcare is principalism which is founded on three ethical traditions: utilitarianism, achieving the most good for the most people; deontology, upholding moral obligations to individuals; and virtue ethics, doing what is virtuous regardless of the consequences. Principalism is further guided by four principles: 1) respect for autonomy; 2) beneficence, the duty to do good; 3) nonmaleficence, the duty to do no harm; and 3) justice, the duty to treat similar cases similarly. Patient-facing healthcare professionals (HCPs) commonly expect all moral values will be considered when decisions are made that impact patients and care delivery. During the COVID-19 crisis, changes to policies and practices were implemented quickly without HCP or patient input that may have conflicted with HCPs moral values, yet literature exploring this phenomenon is sparse.
Purpose:
To explore if policies and practices implemented during the COVID-19 pandemic contributed to perceived moral distress among patient-facing HCPs.
Methods
A qualitative, descriptive parent study was conducted with patient-facing HCPs from multiple sites across Providence to explore how they use chaplains to relieve stress. Data was analyzed using the Transactional Model of Stress and Coping as a sensitizing concept. That study found HCPs sought chaplain care to relieve stress of a moral nature (moral distress). Much of that moral distress reflected altered care practices implemented as a part of the crisis response to COVID-19. This discursive discussion with supporting data from the parent study argues policies intended to achieve the most good for the most people (utilitarianism) contributed to significant moral distress among patient-facing HCPs charged with implementing them.
Results
Data from 33 interviews was reviewed to determine if utilitarian policies implemented during the pandemic conflicted with HCPs’ moral obligations. We found those policies led to heavier workloads, restrictive visitation policies, and patients dying alone - all sources of moral distress among participants which contributed to suffering of both their patients and the HCPs themselves, as one nurse lamented “I’ve done a lot of harm to a lot of people”.
Conclusion
Decisions made during the COVID-19 pandemic in attempts to "do the most good for the most people" led to policies that were perceived to violate the moral values and obligations of patient-facing HCPs. Our study participants described a desire to uphold individual moral obligations despite the consequences. Such moral conflicts, though arguably justifiable, contributed to moral distress among our sample. Further research is needed to inform ways to alleviate such moral distress among HCPs.
Implications for Practice
Ethical decision-making in healthcare must take the multiple moral perspectives of all HCPs into consideration. When differing moral frameworks underpin ethical decision-making in patient care delivery, what is ethical from one perspective may be perceived as controversial by another. While applied principalism intended to limit harm during the COVID-19 pandemic, it may have contributed to significant moral distress among patient-facing HCPs. Healthcare leaders should provide resources to support HCPs who may be experiencing moral distress, particularly during times when policies and procedures are changed without patient or HCP input.
