
11 May 2023
Moral distress during the pandemic affected health among critical care nurses
Critical care nurses experienced high moral distress during the COVID-19 pandemic, such as caring for seriously ill patients on ventilators without direct contact with their relatives. The long-term exceptional work situation led to sleep difficulties, declining health, and thoughts of leaving their job. Researchers have investigated various aspects of intensive care during the pandemic, providing lessons for sustainable healthcare in the future.
“Moral distress comes with situations that go against one's ethical compass. As a critical care nurse during the pandemic, it could mean that you, for various reasons, are not able to provide the care you are trained for,” says Åsa Engström, Professor of nursing at Luleå University of Technology and one of the researchers in the project.
In a series of studies, researchers from Luleå University of Technology, Karlstad University, the Swedish Red Cross University and Region Värmland, in a project funded by Region Värmland and Karlstad University, have investigated how people within intensive care have been affected by the pandemic – staff, patients and relatives.
Thoughts of leaving job
The latest scientific article shows that moral distress among critical care nurses during the pandemic can be linked to sleep problems, low-rated health, and thoughts of leaving their job. The study included 220 critical care nurses who worked at 15 different Swedish intensive care units during the pandemic. Of these, 21 percent had thoughts of leaving their job, and four percent expressed symptoms of exhaustion.
The critical care nurses in the study experienced high moral distress during the extraordinary situations during the pandemic, for example having to perform care that was not perceived as meaningful. This could include performing life-saving measures on a patient with no chance of survival. Lack of organization and lack of competence among colleagues also caused high moral distress.
“Good teamwork entails that critical care nurses want to stay at their workplace to a greater extent. During the pandemic, many had to take responsibility for more patients, for new colleagues and supervise students. Not knowing the competence of colleagues in critical situations caused stress,” says Maria Andersson, Senior Lecturer at the Swedish Red Cross University.
Objectification of patiens in the absence of relatives
A recurring problem, that the researchers noticed in several of the studies, was the difficulties in communicating with patients, and that relatives were not allowed to enter the intensive care units. In an international perspective, Swedish intensive care nurses seem to have been particularly negatively affected by the objectification of patients that resulted from the physical absence of relatives.
“A seriously ill patient in an intensive care unit cannot communicate. For the nurses in the intensive care units, therefore relatives are very important for the patient to become a person. Thanks to them, the nurse can understand the patient's wishes, preferences and provide good care. In Sweden, we have a tradition of working with person-centered care. Our nurses are trained in this and during the pandemic one of the most important prerequisites was taken away, the relatives,” says Åsa Engström.
“The isolation has been particularly tough during the pandemic, from everyone's perspective. The patient who is not allowed to have anyone at the bedside, the relatives who are at home without the possibility to visit their loved ones, and intensive care nurses with long work shifts away from their own family,” says Maria Andersson.
Conclutions for sustainable situation at work
From the studies, the researchers draw conclusions of importance for the future. One of them is that leadership and the organization have a large impact on moral distress and thus for whether critical care nurses want to stay at their work. Other conclusions include the importance of being prepared and coordination, as well as the importance of returning to what worked well before the pandemic.
“Reducing moral distress will result in a more sustainable situation at work and better health for the nurses. Now we need to take time to reflect on what has happened. It is also important to go back to things that were lost during the pandemic, for example the contact with relatives,” says Åsa Engström.
Previously published articles
https://journals.sagepub.com/doi/10.1177/23779608221103627 External link, opens in new window.
https://pubmed.ncbi.nlm.nih.gov/36338349/ External link, opens in new window.
https://journals.sagepub.com/doi/10.1177/10497323211050048 External link, opens in new window.
Contact
Åsa Engström
- Professor and Head of Subject
- 0920-493875
- asa.engstrom@ltu.se
- Åsa Engström
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