Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study

Giulia Lamiani, Davide Biscardi, Elaine C. Meyer, Alberto Giannini and Elena Vegni
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Giulia Lamiani: Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
Davide Biscardi: Unit of Clinical Psychology, Santi Paolo e Carlo Hospital, 20142 Milan, Italy
Elaine C. Meyer: Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
Alberto Giannini: Pediatric Intensive Care Unit, Spedali Civili di Brescia Hospital, 25123 Brescia, Italy
Elena Vegni: Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy

IJERPH, 2021, vol. 18, issue 24, 1-10

Abstract: The COVID-19 pandemic has confronted emergency and critical care physicians with unprecedented ethically challenging situations. The aim of this paper was to explore physicians’ experience of moral distress during the pandemic. A qualitative multicenter study was conducted using grounded theory. We recruited 15 emergency and critical care physicians who worked in six hospitals from the Lombardy region of Italy. Semi-structured interviews about their professional experience of moral distress were conducted from November 2020–February 2021 (1 year after the pandemic outbreak). The transcripts were qualitatively analyzed following open, axial, and selective coding. A model of moral distress was generated around the core category of Being a Good Doctor. Several Pandemic Stressors threatened the sense of Being a Good Doctor, causing moral distress. Pandemic Stressors included limited healthcare resources, intensified patient triage, changeable selection criteria, limited therapeutic/clinical knowledge, and patient isolation. Emotions of Moral Distress included powerlessness, frustration/anger, and sadness. Physicians presented different Individual Responses to cope with moral distress, such as avoidance, acquiescence, reinterpretation, and resistance. These Individual Responses generated different Moral Outcomes, such as moral residue, disengagement, or moral integrity. The Working Environment, especially the team and organizational culture, was instrumental in restoring or disrupting moral integrity. In order for physicians to manage moral distress successfully, it was important to use reinterpretation, that is, to find new ways of enacting their own values by reframing morally distressing situations, and to perceive a cooperative and supportive Working Environment.

Keywords: COVID-19; psychological stress; ethics; moral distress; intensive care; emergency medicine; grounded theory (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (4)

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