‘Have They Talked About Us At All?’ The Moral Distress of Healthcare Social Workers during the COVID-19 Pandemic: A Qualitative Investigation in the State of Texas

ABSTRACT

Amid the ongoing pandemic, as overburdened and underfunded health systems are requiring health care social workers (HSWs) to assume responsibilities beyond their scope of practice, institutional constraints have undoubtedly heightened encounters of moral distress (MD). MD is the psychological disequilibrium that arises when institutional factors obligate an individual to carry out a task that violates their professional and/or personal ethics. Our qualitative study investigated HSWs' (n = 43) MD in Texas during the 2019 COVID-19 pandemic. Findings from our study indicate that MD occurs across five levels (i) patient care decisions;(ii) personal care decisions;(iii) team/unit decisions;(iv) organisational decisions;and (v) social justice decisions. MD is rooted in systems that disproportionately impact historically excluded populations, including social inequities such as financial instability, homelessness and substance use. Organisations need to explicitly consider social justice initiatives that seek to identify growing disparities in care that have been at the forefront of the pandemic;macro-level perspectives that expand MD must address social and health inequities that impede daily tasks of all health care workers. MD encounters that are rooted in social determinants of health can inform supervision, education and practice to ameliorate HSWs' value conflict. The pandemic has heightened encounters of moral distress (MD) among health care social workers (HSWs). MD occurs when institutional factors constrain an individual in performing a task that violates their professional and/or personal values. MD is a leading cause of burnout, job dissatisfaction, patient disengagement and turnover. Limited research on HSWs' MD during the pandemic indicates a need for evidence-based data to inform intervention strategies. This qualitative study aimed to identify the triggers of MD among a sample of HSWs in Texas during the COVID-19 pandemic. Findings from our study show that MD is rooted in (i) patient care decisions, including rushed and unsafe discharge plans and poor end-of-life practices;(ii) personal care decisions, including safety precautions that reduce care;(iii) team/unit considerations, including poor interdisciplinary collaboration and power imbalances;(iv) structural factors, including inconsistent visitation policies and unethical hierarchies;and (v) social injustice, including social inequities and the politicization of the pandemic. Importantly, as all health care workers are being impacted by macro-level constraints, health care organisations ought to explicitly consider incorporating social justice initiatives to enhance health and well-being. Our findings have implications for social work practice, education and supervision.