Critical Care Providers’ Moral Distress: Frequency, Burden, and Potential Resources

Dominik Hinzmann, Katharina Schütte-Nütgen, Arndt Büssing, Olaf Boenisch, Hans-Jörg Busch, Christoph Dodt, Patrick Friederich, Matthias Kochanek, Guido Michels and Eckhard Frick ()
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Dominik Hinzmann: Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
Katharina Schütte-Nütgen: Department of Palliative Care, University Hospital Freiburg, 79106 Freiburg, Germany
Arndt Büssing: Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
Olaf Boenisch: Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
Hans-Jörg Busch: Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
Christoph Dodt: Emergency Department, München Klinik, 81925 Munich, Germany
Patrick Friederich: Department of Intensive Care, München Klinik, 81925 Munich, Germany
Matthias Kochanek: Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
Guido Michels: Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
Eckhard Frick: School of Medicine, Technical University of Munich, 80333 München, Germany

IJERPH, 2022, vol. 20, issue 1, 1-14

Abstract: Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). Aim: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. Methods: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). Results: Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants’ spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants’ experience in ICU/ED, and being of the male gender are further predictors of MD burden. Conclusions: MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.

Keywords: moral distress; moral suffering; emergency department; intensive care unit; spirituality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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