Majority of Clinicians in US Safety Net Practices Report ‘Moral Distress’ During COVID-19 Pandemic, Study Finds – ScienceDaily

The plight of doctors and nurses working in hospitals during the COVID-19 pandemic has received much attention in the media and academic research, including their moral distress witnessing so many deaths at times when they could offer if little. Much 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 health clinicians who work with low-income patients in welfare clinics, Donald Pathman, MD, MPH, of the ‘UNC School of Medicine, found that nearly 72 percent reported experiencing mild or intense levels of moral distress during the first year of the pandemic due to the limits of what they could do for their patients, witnesses the struggles of their patients and the challenges of their own work situations.

This analysis, published in BMJ openwas conducted using late 2020 data from practices in 20 states.

“Most people receive their health care in offices, and many clinicians who work there have experienced moral distress from how the pandemic has limited the care they could provide to patients and from having been witnesses to the effects of the pandemic on patients and colleagues,” said lead author Donald Pathman, MD. , MPH, professor in the Department of Family Medicine at UNC.

Moral distress was defined in the survey as witnessing or doing things that contradict deeply held moral and ethical beliefs and expectations. “Moral distress is a concept developed to understand the consequences of disruptive situations that nurses may experience in hospitals, but the concept of moral distress is probably just as useful in understanding a type of distress as clinicians of all disciplines and backgrounds. every workplace knows,” Pathman said.

Survey respondents were 2,073 clinicians who work in community health centers, mental health facilities and other types of safety net clinics that provide care to low-income patients who face barriers to receive care in the mainstream American healthcare system. Many of these patients are also members of ethnic minority groups.

Of the respondents, 28.4% reported no work-related moral distress during the pandemic. But 44.8% reported “mild” or “uncomfortable” levels of moral distress, and 26.8% described their moral distress as “distressing”, “intense” or “the worst possible”. These last two groups together represent 71.6% of respondents, a substantial majority.

Many office clinicians in this study reported moral distress from not being able to provide care to all patients – think of the practices closed at the start of the pandemic that later reopened but limited care to only the most vulnerable patients. sick – and not being able to provide the best care to their patients when care protocols changed to minimize infection of patients and staff within the office and virtual visits were required even when in-person office visits were better for their patients.

Other respondents felt moral distress seeing how the pandemic affected the health and lives of their patients, some of whom they had known for years. A nurse practitioner in the study in North Carolina noted moral distress seeing how the pandemic “impacted families in our clinic and felt powerless to make meaningful change.”

Other clinicians were morally distressed when their colleagues’ health was compromised or they lost their jobs. Respondents sometimes saw co-worker hardship as unavoidable during the pandemic, but sometimes as due to their employers’ lack of interest in the well-being of clinic staff. One dentist said: “All our manager and director seem to care about is making money and the number of patients we see. I had to balance being exposed to so many patients and then to go home to my family and potentially expose them.”

Some respondents reported moral distress from patients, clinic staff, and community members not wearing masks or following public health recommendations, as well as the politicization of the pandemic. As medical professionals, they knew these precautions worked, and when people did not follow them, they knew others would be infected unnecessarily.

Social inequalities and health disparities morally distressed some respondents, such as one respondent distressed at “seeing how my patient population has been disproportionately affected by illness and death due to socio-economic issues”. Pathman noted that, “given the type of individual who chooses to provide health care in low-income communities, it is not surprising that some are morally distressed to see the pandemic worsening the health and lives of their patients because of their limited resources”.

The consequences of moral distress are concerning. The article notes that moral distress is known to cause burnout, compassion fatigue, patient disengagement, and staff turnover for nurses in hospital settings and is likely to do so for clinicians in nursing homes as well. safety net practices.

The paper’s co-authors are Jeffrey Sonis, MD, MPH, associate professor in the departments of Social Medicine and Family Medicine at UNC; Thomas E. Rauner at the Nebraska Division of Public Health; Kristina Alton, MD, at Vanderbilt University Medical Center; Anna S. Headlee of the University of Nebraska-Lincoln and Jerry N. Harrison of New Mexico Health Resources.

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