Moral distress and protective work environment for healthcare workers during public health emergencies.

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-10-01 DOI:10.1186/s12910-024-01098-w
K Bondjers, Alve K Glad, H Wøien, T Wentzel-Larsen, D Atar, S K Reitan, L A Rosseland, J A Zwart, G Dyb, S Ø Stensland
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Abstract

Background: Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors.

Objectives: The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic.

Methods: We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic.

Results: About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30-2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0-10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress.

Conclusions: Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs' work environment.

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突发公共卫生事件中医护人员的精神压力和保护性工作环境。
背景:公共卫生突发事件(如 Covid-19 大流行病)给世界各地的医护人员(HCW)带来了巨大压力,可能会增加遭遇伦理挑战情境(ECS)的风险。作为一名医护人员,在这种情况下经历伦理挑战可能是不可避免的,但有必要减轻其不利影响(如道德困扰),以降低长期负面后果的风险。减轻这些影响的一个可能途径是通过工作环境因素:本研究旨在探讨[方法:我们采用多元逻辑线性回归法,分析了在大流行期间,高危职业工作者中与 ECS 相关的风险因素[1]、不同职业因素(即职业、接触 Covid-19 患者的程度)下与 ECS 相关的精神痛苦强度,以及[3]工作环境因素对这种相关性的影响:我们采用多元逻辑和线性回归方法,对挪威四家医院的977名医护人员的自我报告数据进行了分析:在这项研究中,约有一半的医护人员在大流行期间经历过ECS,而与ECS相关的精神痛苦程度高于以往采用类似评估方法进行的研究。较年轻的年龄、女性性别、工作地区(挪威中北部)和职业(护士)都与较高的经历ECS几率(OR范围:1.30-2.59)相关,直接接触Covid-19患者也与较高的几率相关。在那些报告在大流行期间经历过 ECS 的参与者中,他们在回忆这些情况时的道德困扰程度为中等(0-10 分,平均值为 5.7)。男性的道德困扰程度略低(部分 eta 平方;ηp2 = 0.02)。报告工作量可控(ηp2 = 0.02)以及有更多机会按照最佳做法工作(ηp2 = 0.02)与较低的道德困扰水平相关:我们的研究结果表明,道德困扰有可能在组织层面上得到缓解,特别是通过重点确保可管理的工作量和按照最佳实践工作的能力。为了建立足以抵御未来公共卫生突发事件的可持续医疗保健系统,医疗保健组织应采取措施,为医护人员的工作环境提供这些方面的便利。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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