Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study.

PURPOSE: The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral distress as perceived by medical doctors working at emergency departments in Stockholm during the pandemic, with the purpose of investigating causes of moral distress and methods to manage moral distress. METHODS: Semi-structured interviews were conducted with twelve doctors working at two emergency departments. A questionnaire was developed based on previous research and the interviews were analysed qualitatively through thematic analysis. RESULTS: The themes "The factors that precipitated moral distress", "Experience of workplace support" and "Coping strategies" as well as seven subthemes and 15 codes were identified. The informants reported on various situations with different causes of moral distress. Common causes were resource depletion, such as hospital bed shortages, and following stricter triage criteria. Informants reported varying ways of managing moral distress. CONCLUSIONS: Informants experienced moral distress when faced with challenges such as resource depletion, rules and regulations, and colleagues' decisions. The informants who chose to seek support received it from their workplace, which helped them cope with their experiences. Some informants chose to not seek support.

"You treat what you have to treat, and you don't care as much if they understand or if they feel good about it": Communication barriers and perceptions of moral distress among doctors in emergency departments.

Doctors facing communication barriers when assessing patients in emergency departments (ED) is a frequent phenomenon, as the global prevalence of dementia and migration have increased. This study aims to explore how communication barriers influence moral distress as perceived by medical doctors working at emergency departments. Twelve doctors at 2 different EDs in Stockholm, Sweden, participated. Answers on communication barriers were collected from an interview guide on moral distress. Informants' responses were analyzed using qualitative thematic analysis. The results suggest that doctors experience moral distress when assessing patients with communication barriers due to an inability to mediate calm and safety and understand their patients, and due an increased need of resources and difficulties in obtaining consent before conducting examinations or interventions. In conclusion, communication barriers can be a cause of moral distress, which should be considered when developing tools and methods to mitigate and manage moral distress.

Medical Doctors' Perceptions of the Media Coverage during the Covid-19 Pandemic: A Case Study in Stockholm.

The strain on healthcare systems including emergency departments increased substantially during the Covid-19 pandemic,negatively affecting healthcare workers and their well-being. The emotional distress experienced by healthcare staff during the pandemic was worsened by confusion and conspiracy theories that circulated in the news and online media. Reports on the pandemic and general consumption of media intensified as the public's demand for information increased. There is limited research on how doctors perceived media coverage, and how they were affected in their work. This study aimed to explore how medical doctors in emergency departments perceived the media coverage during the Covid-19 pandemic. Twelve doctors at two different emergency departments in Stockholm, Sweden, participated. Interview questions on media were asked as part of a more extensive questionnaire. Informants' responses were analysed qualitatively. The results indicate that doctors to some extent used media as a source of information, due to limited access to knowledge about the virus. Results further suggest that media coverage triggered fear of infection, caused worry and job strain. The doctors percieved that the media coverage on Covid-19 affected patient-seeking behaviour as well as the doctor-patient relationship. The findings can be relevant in preparation for future pandemics and considered in development of policy for media and emergency departments.