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1.
BMC Med Ethics ; 22(1): 73, 2021 06 17.
Article in English | MEDLINE | ID: covidwho-1277937

ABSTRACT

BACKGROUND: The COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19. METHODS: An extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. RESULTS: Three hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. "Inadequate emotional support for patients and their families" was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect,  ethical awareness and support. "Culture of not avoiding end-of-life-decisions" and "Self-reflective and empowering leadership" received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior. CONCLUSION: Levels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care.


Subject(s)
COVID-19 , Attitude of Health Personnel , Critical Care , Humans , Intensive Care Units , Morals , Pandemics , SARS-CoV-2 , Stress, Psychological , Surveys and Questionnaires
2.
BMJ ; 373: n1543, 2021 Jun 16.
Article in English | MEDLINE | ID: covidwho-1276934
3.
BMC Health Serv Res ; 21(1): 525, 2021 May 29.
Article in English | MEDLINE | ID: covidwho-1247589

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak has been associated with stress and challenges for healthcare professionals, especially for those working in the front-line of treating COVID-19 patients. This study aimed to: 1) assess changes in well-being and perceived stress symptoms of Dutch emergency department (ED) staff in the course of the first COVID-19 wave, and 2) assess and explore stressors experienced by ED staff since the COVID-19 outbreak. METHODS: We conducted a cross-sectional study. An online questionnaire was administered during June-July 2020 to physicians, nurses and non-clinical staff of four EDs in the Netherlands. Well-being and stress symptoms (i.e., cognitive, emotional and physical) were scored for the periods pre, during and after the first COVID-19 wave using the World Health Organization Well-Being Index (WHO-5) and a 10-point Likert scale. Stressors were assessed and explored by rating experiences with specific situations (i.e., frequency and intensity of distress) and in free-text narratives. Quantitative data were analyzed with descriptive statistics and generalized estimating equations (GEE). Narratives were analyzed thematically. RESULTS: In total, 192 questionnaires were returned (39% response). Compared to pre-COVID-19, the mean WHO-5 index score (range: 0-100) decreased significantly with 14.1 points (p < 0.001) during the peak of the first wave and 3.7 points (< 0.001) after the first wave. Mean self-perceived stress symptom levels almost doubled during the peak of the first wave (≤0.005). Half of the respondents reported experiencing more moral distress in the ED since the COVID-19 outbreak. High levels of distress were primarily found in situations where the staff was unable to provide or facilitate necessary emotional support to a patient or family. Analysis of 51 free-texts revealed witnessing suffering, high work pressure, fear of contamination, inability to provide comfort and support, rapidly changing protocols regarding COVID-19 care and personal protection, and shortage of protection equipment as important stressors. CONCLUSIONS: The first COVID-19 wave took its toll on ED staff. Actions to limit drop-out and illness among staff resulting from psychological distress are vital to secure acute care for (non-)COVID-19 patients during future infection waves.


Subject(s)
COVID-19 , Psychological Distress , Cross-Sectional Studies , Disease Outbreaks , Emergency Service, Hospital , Humans , Netherlands/epidemiology , SARS-CoV-2
4.
Indian J Med Ethics ; V(4): 1-6, 2020.
Article in English | MEDLINE | ID: covidwho-1239246

ABSTRACT

Burnout is a major occupational problem among healthcare providers, especially during the Covid-19 pandemic. The frontline health workforce is experiencing a high workload and multiple psychosocial stressors which may affect their mental and emotional health, leading to burnout symptoms. Moreover, sleep deprivation and a critical lack of psychosocial support may aggravate such symptoms amidst Covid-19. From an ethical viewpoint, healthcare providers may experience moral distress while safeguarding patient welfare and autonomy. Moreover, social injustice and structural inequities may affect their emotional health while tackling a high volume of new cases and mortality. Global evidence indicates the need for adopting multipronged evidence-based approaches to address burnout during this pandemic, which may include increasing the awareness of work-related stress and burnout, promoting mindfulness and self-care practices for promoting mental wellbeing, ensuring optimal mental health services, using digital technologies to address workplace stress and deliver mental health interventions, and improving organisational policies and practices focusing on burnout among healthcare providers.


Subject(s)
Burnout, Psychological/prevention & control , COVID-19/psychology , Health Personnel/psychology , Burnout, Psychological/epidemiology , Humans , SARS-CoV-2
5.
J Health Psychol ; 27(8): 1971-1990, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1211678

ABSTRACT

Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician's ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories: principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.


Subject(s)
Attitude of Health Personnel , COVID-19 , Ethical Analysis , Humans , Morals , Pandemics , Stress, Psychological/psychology , Surveys and Questionnaires
6.
Nurs Ethics ; 28(7-8): 1137-1164, 2021.
Article in English | MEDLINE | ID: covidwho-1207586

ABSTRACT

BACKGROUND: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. OBJECTIVE: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. RESEARCH DESIGN: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. ETHICAL CONSIDERATIONS: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. RESULTS: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. DISCUSSION/CONCLUSION: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses' moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences.


Subject(s)
COVID-19 , Humans , Morals , Pandemics , Qualitative Research , SARS-CoV-2
7.
Nurs Leadersh (Tor Ont) ; 34(1): 7-19, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1175770

ABSTRACT

BACKGROUND: The COVID-19 pandemic is placing unprecedented pressure on a nursing workforce that is already under considerable mental strain due to an overloaded system. Convergent evidence from the current and previous pandemics indicates that nurses experience the highest levels of psychological distress compared with other health professionals. Nurse leaders face particular challenges in mitigating risk and supporting nursing staff to negotiate moral distress and fatigue during large-scale, sustained crises. Synthesizing the burgeoning literature on COVID-19-related burnout and moral distress faced by nurses and identifying effective interventions to reduce poor mental health outcomes will enable nurse leaders to support the resilience of their teams. AIM: This paper aims to (1) synthesize existing literature on COVID-19-related burnout and moral distress among nurses and (2) identify recommendations for nurse leaders to support the psychological needs of nursing staff. METHODS: Comprehensive searches were conducted in Medline, Embase and PsycINFO (via Ovid); CINAHL (via EBSCOHost); and ERIC (via ProQUEST). The rapid review was completed in accordance with the World Health Organization Rapid Review Guide. KEY FINDINGS: Thematic analysis of selected studies suggests that nurses are at an increased risk for stress, burnout and depression during the ongoing COVID-19 pandemic. Younger female nurses with less clinical experience are more vulnerable to adverse mental health outcomes.


Subject(s)
Burnout, Professional , COVID-19/nursing , COVID-19/psychology , Morals , Nurses/psychology , Humans , Pandemics , SARS-CoV-2
8.
HEC Forum ; 33(4): 415-423, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1152054

ABSTRACT

Moral distress is defined as the inability to act according to one's own core values. During the COVID-19 pandemic, moral distress in medical personnel has gained attention, related to the impact of pandemic-associated factors, such as the uncertainty of treatment options for the virus and the accelerated pace of deaths. Measures to provide aid and mitigate the long-term pandemic effect on providers are starting to be designed. Yet, little has been said about the moral distress experienced by patients and the relational and additive effect on provider moral distress. Pandemic-associated factors affecting moral distress in patients include the constraining effects of isolation on spiritual and religious traditions as well as the intentional separation of patients from their families. This paper will explore the idea that patients are suffering their own moral distress and further how this impacts the intensity of moral distress experienced by the providers-nurses and physicians. The paucity of research in this area with the implications on patient's distress, decision making, and distress experienced by providers compels further investigation and analysis.


Subject(s)
COVID-19 , Health Personnel , Humans , Morals , Pandemics , SARS-CoV-2
9.
J Med Ethics ; 2021 Mar 24.
Article in English | MEDLINE | ID: covidwho-1150249

ABSTRACT

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.

10.
J Perinatol ; 41(5): 1177-1179, 2021 05.
Article in English | MEDLINE | ID: covidwho-1091505

ABSTRACT

Family-centered care (FCC) has become the normative practice in Neonatal ICUs across North America. Over the past 25 years, it has grown to impact clinician-parent collaborations broadly within children's hospitals as well as in the NICU and shaped their very culture. In the current COVID-19 pandemic, the gains made over the past decades have been challenged by "visitor" policies that have been implemented, making it difficult in many instances for more than one parent to be present and truly incorporated as members of their baby's team. Difficult access, interrupted bonding, and confusing messaging and information about what to expect for their newborn can still cause them stress. Similarly, NICU staff have experienced moral distress. In this perspective piece, we review those characteristics of FCC that have been disrupted or lost, and the many facets of rebuilding that are presently required.


Subject(s)
COVID-19 , Intensive Care Units, Neonatal , Parents/psychology , Power, Psychological , Humans , Infant, Newborn , Parent-Child Relations , Professional-Family Relations
11.
Nursing ; 51(2): 55-58, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1081763

ABSTRACT

ABSTRACT: Nurses and other healthcare professionals across the US have experienced and are still experiencing different types of moral anguish during the COVID-19 pandemic. This article discusses moral distress and the other forms of moral anguish that nurses experience, how the COVID-19 pandemic has exacerbated moral distress among nurses, and coping strategies.


Subject(s)
Adaptation, Psychological , COVID-19/nursing , Morals , Nurses/psychology , Psychological Distress , COVID-19/epidemiology , Humans
12.
Nurs Ethics ; 28(1): 66-81, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1024323

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.


Subject(s)
Attitude of Health Personnel , COVID-19/therapy , Decision Making , Psychological Distress , Adult , Bioethics , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Norway/epidemiology , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
13.
J Hum Rights Soc Work ; 6(1): 91-96, 2021.
Article in English | MEDLINE | ID: covidwho-935344

ABSTRACT

Healthcare professionals may experience moral distress when navigating difficult positions in which acting or providing for their patient's best interest may not be possible due to barriers outside of their control. This phenomenon has primarily been investigated within nursing and other clinical disciplines; however, experiences of moral distress have also been noted in the social work profession. Healthcare professionals, including social workers, may experience moral distress when witnessing violations of their patients' human rights. This article discusses research reporting on experiences of moral distress within the social work profession, a reality social work students may also face during their field placements. Understanding the causes and effects of moral distress within the social work profession is important when preparing social work students as they transition into the workforce. Future research investigating moral distress should include the perspectives of social work field students, as their experiences are understudied. This phenomenon is especially important to investigate, as the current COVID-19 pandemic is expected to exacerbate health challenges.

14.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 63(12): 1483-1490, 2020 Dec.
Article in German | MEDLINE | ID: covidwho-928411

ABSTRACT

BACKGROUND: The COVID-19 pandemic poses particular challenges for people working in the medical sector. Some of the medical students and young medical professionals who are starting their work in healthcare facilities during this time are confronted with extraordinary moral challenges. A portion of them does not yet have sufficient coping skills to adequately deal with these challenges. This can lead to so-called moral distress (MoD). Permanent or intensive exposure to MoD can have serious consequences. Appropriate support services have the potential to improve the handling of MoD. OBJECTIVE: This article aims to provide an overview of the current state of research on MoD among medical students and young medical professionals in order to sensitize lecturers with responsibility for education and training and doctors in leading positions to the problem. MAIN PART: This article presents the scientific concept of MoD, known triggers, and options for prevention and intervention. The topic is presented with reference to the changes in patient care in the context of the COVID-19 pandemic and research needs are presented. CONCLUSION: The article illustrates the necessity of a German-language, interdisciplinary discourse on MoD among medical students and young professionals.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Students, Medical , Betacoronavirus , COVID-19 , Germany , Humans , Morals , Pandemics/prevention & control , SARS-CoV-2
15.
J Bioeth Inq ; 17(4): 777-782, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-917140

ABSTRACT

COVID-19 has truly affected most of the world over the past many months, perhaps more than any other event in recent history. In the wake of this pandemic are patients, family members, and various types of care providers, all of whom share different levels of moral distress. Moral conflict occurs in disputes when individuals or groups have differences over, or are unable to translate to each other, deeply held beliefs, knowledge, and values. Such conflicts can seriously affect healthcare providers and cause distress during disastrous situations such as pandemics when medical and human resources are stretched to the point of exhaustion. In the current pandemic, most hospitals and healthcare institutions in the United States have not allowed visitors to come to the hospitals to see their family or loved ones, even when the patient is dying. The moral conflict and moral distress (being constrained from doing what you think is right) among care providers when they see their patients dying alone can be unbearable and lead to ongoing grief and sadness. This paper will explore the concepts of moral distress and conflict among hospital staff and how a system-wide provider wellness programme can make a difference in healing and health.


Subject(s)
COVID-19 , Conflict, Psychological , Death , Morals , Patient Isolation/ethics , Humans , Pandemics , United States
16.
Int J Nurs Stud ; 113: 103781, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-808702

ABSTRACT

BACKGROUND: The acute nature of COVID-19 and its effects on society in terms of social distancing and quarantine regulations affect the provision of palliative care for people with dementia who live in long-term care facilities. The current COVID-19 pandemic poses a challenge to nursing staff, who are in a key position to provide high-quality palliative care for people with dementia and their families. OBJECTIVE: To formulate practice recommendations for nursing staff with regard to providing palliative dementia care in times of COVID-19. DESIGN AND METHOD: A rapid scoping review following guidelines from the Joanna Briggs Institute. Eligible papers focused on COVID-19 in combination with palliative care for older people or people with dementia and informed practical nursing recommendations for long-term care facilities. After data extraction, we formulated recommendations covering essential domains in palliative care adapted from the National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care. DATA SOURCES: We searched the bibliographic databases of PubMed, CINAHL and PsycINFO for academic publications. We searched for grey literature using the search engine Google. Moreover, we included relevant letters and editorials, guidelines, web articles and policy papers published by knowledge and professional institutes or associations in dementia and palliative care. RESULTS: In total, 23 documents (7 (special) articles in peer-reviewed journals, 6 guides, 4 letters to editors, 2 web articles (blogs), 2 reports, a correspondence paper and a position paper) were included. The highest number of papers informed recommendations under the domains 'advance care planning' and 'psychological aspects of care'. The lowest number of papers informed the domains 'ethical care', 'care of the dying', 'spiritual care' and 'bereavement care'. We found no papers that informed the 'cultural aspects of care' domain. CONCLUSION: Literature that focuses specifically on palliative care for people with dementia in long-term care facilities during the COVID-19 pandemic is still largely lacking. Particular challenges that need addressing involve care of the dying and the bereaved, and ethical, cultural and spiritual aspects of care. Moreover, we must acknowledge grief and moral distress among nursing staff. Nursing leadership is needed to safeguard the quality of care and nursing staff should work together within an interprofessional care team to initiate advance care planning conversations in a timely manner, to review and document advance care plans, and to adapt goals of care as they may change due to the COVID-19 situation. Tweetable abstract: The current COVID-19 pandemic affects people living with dementia, their families and their professional caregivers. This rapid scoping review searched for academic and grey literature to formulate practical recommendations for nursing staff working in long-term care facilities on how to provide palliative care for people with dementia in times of COVID-19. There is a particular need for grief and bereavement support and we must acknowledge grief and moral distress among nursing staff. This review exposes practice and knowledge gaps in the response to COVID-19 that reflect the longstanding neglect and weaknesses of palliative care in the long-term care sector. Nursing leadership is needed to safeguard the quality of palliative care, interprofessional collaboration and peer support among nursing staff.


Subject(s)
COVID-19/epidemiology , Dementia/nursing , Nursing Homes/organization & administration , Nursing, Practical , Palliative Care/organization & administration , Aged , COVID-19/virology , Humans , Long-Term Care , SARS-CoV-2/isolation & purification
17.
JAMA Oncol ; 6(9): 1429-1433, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-807051

ABSTRACT

Importance: The coronavirus disease 2019 (COVID-19) pandemic has forced oncology clinicians and administrators in the United States to set priorities for cancer care owing to resource constraints. As oncology practices adapt to a contracted health care system, expertise gained from partnerships in low-resource settings can be used for guidance. This article provides a primer on priority setting in oncology and ethical guidance based on lessons learned from experience with cancer care priority setting in low-resource settings. Observations: Lessons learned from real-world experiences are myriad. First, in the setting of limited resources, a utilitarian approach to maximizing survival benefit should guide decision-making. Second, conflicting principles will often arise among stakeholders and decision makers. Third, fair decision-making procedures should be established to ensure moral legitimacy and accountability. Fourth, proactive safeguards must be implemented to protect vulnerable individuals, or disparities in cancer treatment and outcomes will only widen further. Fifth, communication with patients and families about priority setting decisions should be intentional and standardized. Sixth, moral distress among clinicians must be addressed to avoid burnout during a time when resilience is critical. Conclusions and Relevance: Although the need to triage cancer care may be new to those who underwent training and now practice oncology in high-resource settings, it is familiar for those who practice in low- and middle-income countries. Oncologists in the United States facing unprecedented decisions about prioritization can draw on ethical frameworks and lessons learned from real-world cancer care priority setting in resource-constrained environments.


Subject(s)
Coronavirus Infections/epidemiology , Neoplasms/epidemiology , Oncology Service, Hospital , Pandemics , Pneumonia, Viral/epidemiology , Betacoronavirus/pathogenicity , COVID-19 , Communication , Coronavirus Infections/complications , Coronavirus Infections/virology , Decision Making , Health Resources , Humans , Neoplasms/complications , Neoplasms/virology , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2 , United States/epidemiology
18.
Dev World Bioeth ; 21(4): 187-192, 2021 12.
Article in English | MEDLINE | ID: covidwho-780818

ABSTRACT

The COVID-19 pandemic has shaken the world through its first wave, and we have yet to experience the second wave. Even resourceful countries have failed to adequately prevent epidemics in their country, and for countries like Bangladesh, which already has strained an ineffective healthcare system, the challenges to contain the SARS-CoV-2 virus are that much more severe. Due to the scarcity of resources and systematic failures the Bangladeshi people deeply mistrust the healthcare system. The mistrust is further magnified as healthcare providers are hesitant to treat the patients because of the lack of proper protective gear. Physicians have a moral obligation to serve and treat patients; however, they have a moral obligation to protect their families. This dilemma places healthcare providers in situations where they experience moral distress. This article specifically discusses the importance of interpersonal relationships in driving change, using the framework of Responsiveness, while stating the need for complementary systematic change in order to rebuild trust in the Bangladeshi healthcare system.


Subject(s)
COVID-19 , Bangladesh , Health Personnel , Humans , Moral Obligations , Pandemics , SARS-CoV-2
20.
Cleve Clin J Med ; 2020 Jun 09.
Article in English | MEDLINE | ID: covidwho-592513

ABSTRACT

Moral distress is the psychological distress that is experienced in relation to a morally challenging situation or event. Although it was first observed within nursing, caregivers across all disciplines-including physicians, respiratory therapists, social workers and chaplains-experience moral distress. In this consult, we discuss 5 types of moral distress using examples of changes to clinical practice that have occurred due to COVID-19. We also provide suggestions for responding to moral distress and outline the resources available at Cleveland Clinic.

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