Donald Pathman, MD, MPH of the UNC School of Medicine found that most health care providers experienced mild or severe moral distress in the first year of the pandemic due to issues related to patient care and the workplace. Did.
Chapel Hill, N.C. – The suffering of doctors and nurses working in hospitals during the COVID-19 pandemic has received significant attention in news media and academic research. Less attention has been paid to the moral distress of clinicians working in other settings during the pandemic.
Using data from a survey of more than 2,000 primary care, dental, and behavioral therapy clinicians who work with low-income patients in safety net clinics, Donald Passman, MD, UNC School of Medicine, found that nearly 72% In the mild or first year of the pandemic, I experienced intense levels of moral distress witnessing the hardships of my patients and the challenges of my own work situation due to the restrictions on what I could do for them.
This analysis BMJ Openconducted from late 2020 data from practices in 20 states.
“Most people receive health care in an office environment, and many clinicians working there have experienced first-hand how the pandemic has limited the care they can provide to their patients and the impact it has had on patients and colleagues. experienced moral pain,” said lead author Donald Passman, M.D. , MPH, Professor of Family Medicine, UNC.
In this study, moral distress was defined as witnessing or doing something that violates deeply held moral and ethical beliefs and expectations. “Although moral distress is a concept developed to help nurses understand the consequences of disturbing situations that nurses may experience in hospitals, the concept of moral distress can be applied to any field or work experience. “It may help us understand the types of distress clinicians in our community,” Pathman said.
Survey respondents were 2,073 clinicians who work in community health centers, mental health facilities, and other types of safety net clinics, and who face barriers to receiving care in the US mainstream health care system. Provides care to income patients. Many of these patients are also members of racial and ethnic minority groups.
28.4% of respondents reported no moral distress related to work during the pandemic. However, 44.8% reported ‘mild’ or ‘uncomfortable’ levels of moral distress, and 26.8% described moral distress as ‘painful’, ‘severe’ or ‘worst’. Her latter two groups combined account for 71.6% of respondents, a sizable majority.
Many of the office-based clinicians in this study reported moral distress from not being able to provide care to all patients.Care protocols were modified to minimize infection to patients and staff within the office. and care for patients when virtual visits become necessary, even when in-office face-to-face visits are better for patients.
Other respondents felt moral pain seeing how the pandemic affected the health and lives of patients. A research nurse in North Carolina said she felt moral pain watching the pandemic “affect families in our clinic and feel powerless to make meaningful change.” rice field.
Other clinicians suffered morally when their colleagues’ health was endangered or they lost their jobs. Others attributed it to employers’ lack of concern for the health of clinic staff. One dentist reported: We had to balance exposure to so many patients with returning to their families and their potential exposure. “
Some respondents reported moral distress from patients, clinic staff, and community members for not wearing masks or following public health recommendations, and the politicization of the pandemic. As healthcare professionals, they knew that these precautions worked, and that if people didn’t follow them, others would be unnecessarily infected.
Social inequalities and health disparities left some respondents morally distressed. For example, a respondent distressed by “seeing how my patient population is disproportionately affected by illness and death due to socioeconomic problems.” “Given the types of individuals who choose to provide health care in low-income communities, it is morally distressing to see the pandemic worsen the health and lives of patients due to limited resources,” Passman said. I wouldn’t be surprised if there are people.”
The consequences of moral suffering are alarming. The article notes that moral distress is known to cause burnout, compassion fatigue, patient withdrawal, and turnover among nurses in hospital settings, and likely for clinicians in safety net practices. says.
This article was co-authored by Jeffrey Sonis, MD, MPH, associate professor in the UNC Department of Social and Family Medicine. His Thomas E. Rauner of the Nebraska Public Health Service. Christina Alton, MD, Vanderbilt University Medical Center. Anna S. Headley, University of Nebraska-Lincoln, and Jerry N. Harrison, New Mexico Health Resources.
