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Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study.
Donkers, Moniek A; Gilissen, Vincent J H S; Candel, Math J J M; van Dijk, Nathalie M; Kling, Hans; Heijnen-Panis, Ruth; Pragt, Elien; van der Horst, Iwan; Pronk, Sebastiaan A; van Mook, Walther N K A.
  • Donkers MA; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. m.donkers@student.maastrichtuniversity.nl.
  • Gilissen VJHS; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
  • Candel MJJM; Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
  • van Dijk NM; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
  • Kling H; Department of Spiritual Care Services, Maastricht University Medical Center+, Maastricht, The Netherlands.
  • Heijnen-Panis R; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
  • Pragt E; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
  • van der Horst I; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
  • Pronk SA; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
  • van Mook WNKA; Department of Intensive Care, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
BMC Med Ethics ; 22(1): 73, 2021 06 17.
Article in English | MEDLINE | ID: covidwho-1277937
Semantic information from SemMedBD (by NLM)
1. Challenge TREATS professional occupation status
Subject
Challenge
Predicate
TREATS
Object
professional occupation status
2. intensive care unit LOCATION_OF Study
Subject
intensive care unit
Predicate
LOCATION_OF
Object
Study
3. Moral distress PROCESS_OF Nurses
Subject
Moral distress
Predicate
PROCESS_OF
Object
Nurses
4. Emotional support TREATS Family
Subject
Emotional support
Predicate
TREATS
Object
Family
5. Emotional support TREATS Patients
Subject
Emotional support
Predicate
TREATS
Object
Patients
6. History of previous events PROCESS_OF Control Groups
Subject
History of previous events
Predicate
PROCESS_OF
Object
Control Groups
7. Challenge TREATS professional occupation status
Subject
Challenge
Predicate
TREATS
Object
professional occupation status
8. intensive care unit LOCATION_OF Study
Subject
intensive care unit
Predicate
LOCATION_OF
Object
Study
9. Moral distress PROCESS_OF Nurses
Subject
Moral distress
Predicate
PROCESS_OF
Object
Nurses
10. Emotional support TREATS Family
Subject
Emotional support
Predicate
TREATS
Object
Family
11. Emotional support TREATS Patients
Subject
Emotional support
Predicate
TREATS
Object
Patients
12. History of previous events PROCESS_OF Control Groups
Subject
History of previous events
Predicate
PROCESS_OF
Object
Control Groups
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)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: BMC Med Ethics Journal subject: Ethics Year: 2021 Document Type: Article Affiliation country: S12910-021-00641-3

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: BMC Med Ethics Journal subject: Ethics Year: 2021 Document Type: Article Affiliation country: S12910-021-00641-3