Another Pandemic
How moral distress affected Polish and Lithuanian clinicians
DOI:
https://doi.org/10.3384/de-ethica.2001-8819.23723Keywords:
SARS-CoV-2 pandemic, toxic sociomoral atmosphere, healthcare ecology, moral distress, differences in levels of moral distress between Polish and Lithuanian medical workers, resiliencyAbstract
The SARS-CoV-2 pandemic has transgressed biomedical categories. According to Horton, it turned out to be a 'syndrome' that infected virtually all spheres of social life. The pandemic has created toxic social atmosphere highly unfavorable to clinical and clinic-ethical decision making. Constraints and pressures related to micro-, meso-, exo- and macro-environments framing doctors, nurses, and medical students in training were identified. These factors exacerbated moral distress (moral injury) amongst clinicians. In a joint Polish-Lithuanian project (IDUB 2020-2022) we examined predictors of moral distress in pandemic clinical contexts. A survey-based, real-time, correlational and comparative study was conducted in Poland and Lithuania after the first year of pandemic with N=227 participants. Unexpected differences on regular and pandemic-type moral distress levels were found between the two national samples. Polish participants showed significantly higher moral distress levels than their Lithuanian counterparts. The following article discusses these findings and recommends the reinforcement of resilient medical decision making.
References
Abbasi, Safura, Somayeh Ghafari, Mohsen Shahriari and Nahid Shahgholian. ‘Effect of moral empowerment program on moral distress in intensive care unit nurses’, Nursing Ethics 26:5 (2019), pp. 1494-1504. https://doi.org/10.1177/0969733018766576. Accessed 20 June 2021.
De Araújo, Luís Fernando S. C., Paulo Delgalarrondo, Cláudio E. M. Banzato. ‘On the notion of causality in medicine: addressing Austin Bradford Hill and John Leslie Mackie’, Archives of Clinical Psychiatry (Sao Paulo) 41:2 (March-April 2014).
Austin, Cindy L., Robert Saylor and Philip J. Finley. ‘Moral distress in physicians and nurses: impact on professional quality of life and turnover’, Psychological Trauma Theory Research, Practice and Policy 9 (2017), pp. 399-406.
Baldwin, P. J., M Dodd and RM Wrate. ‘Young doctors’ health – I. How do working conditions affect attitudes, health and performance’, Social Sciences & Medicine 45 (1997), pp. 35-40.
Bandura, Albert. ‘Social cognitive theory, in: Annals of child development. Six theories of child development, Vol. 6, edited by R. Vasta. Greenwich, CT: JAI Press, 1989, pp. 1-60.
Berrios, German E. ‘Historical development of ideas about psychiatric aetiology’, in: New Oxford textbook of psychiatry, edited by M. Gelder et al. New York: Oxford University Press, 2009.
Bell, Robert et al. ‘Unmet expectations for care and the patient?physician relationship’, Journal of General Internal Medicine 17:11 (2002), pp. 817-824.
Borges, Lauren M., Sean M. Barnes, Jacob K. Farnsworth et al. ‘A commentary on moral injury among health care providers during the COVID-19 pandemic’, Psychological Trauma 12 (2020), S138-S140.
Borkowska, Natalia, Bartosz Borkowski and Tomasz Gaszy?ski. ‘Moral distress, resilience and burnout in nurse anaesthetists and critical care nurses’, Anestezjologia & Ratownictwo 13 (2019), pp. 97-103.
Bronfenbrenner, Urie. ‘Toward an experimental ecology of human development’, American Psychologist 32 (1977), pp. 513-531.
Buchelt, Beata and Iwona Kowalska-Bobko. UEK Report. Center of Public Policies, 2020. URL: https://pulsmedycyny.pl/raport-po-pandemii-15-proc-lekarzy-zamierza-odejsc-z-rynku-pracy-1006274.
Bursztajn, Harold J., Thomas G. Gutheil, and Archie Brodsky. ‘Ethics and the triage model in managed care hospital psychiatry’, Psychiatric Times 15:9 (1998), pp. 33-40.
Campbell, Stephen M., Connie M. Ulrich and Christine Grady. ‘A broader understanding of moral distress’, in: Moral distress and the health professions, edited by Connie M. Ulrich and Christine Grady. Springer: Cham, 2018, pp. 59-77.
Card, Alan J. ‘Physician burnout: Resilience training is only part of the solution’, Annals of Family Medicine 16 (2016), pp. 267-270. doi.org/10.1370/afm.2223. Accessed on 2 Dec 2021.
Cartwright, Nancy. ‘Causal laws and effective strategies’, Noûs 13:4 (1979), pp. 419-437.
Castro de Araujo, L.F.S. ‘Weak causes and complex causal nets in psychiatry’, Revista Latinoamericana de Psicopatologia Fundamental 17:1 (2014), pp. 14-27.
Chapman, Gretchen B. and Frank A. Sonnenberg. Decision making in health care: theories, psychology and applications. Cambridge University Press, 2020.
Cioffi, Jane. ‘Decision making: Towards a holistic for the clinical context’, Academia Letters, August 2021. doi.org/10.20935/AL3325. Accessed on 14 March 2022.
Civinskas, Remogijus, Jaroslav Dvorak and Gintaras Šumskas. ‘Medikai ir socialini? paslaug? teik?jai – COVID-19 sukeltos kriz?s politik? priešakin?se linijose: darbo salygos, j? poveikis, elgsena’, Regional Formation and Development Studies 1:33 (2021), pp. 6-16. doi.org/10.15181/rfds.v33i1.2195. Accessed on 11 April 2022.
Crane, Monique F., Piers Bayl-Smith and John A. Cartmill. ‘A recommendation for expanding the definition of moral distress experienced in the workplace’, The Australia & New Zealand Journal of Organizational Psychology 6 (2013), pp. 1-9.
De Koning, Rozaline, Abdullah Egiz, Joe Kotecha et al. ‘Survey fatigue during the COVID-19 pandemic: an analysis of neurosurgery survey response rates’, Frontiers in Surgery (2021). doi.org/10.3389/fsurg.2021.690680. Accessed on 7 May 2022.
Delikat, Dariusz and Jacek Smereka. ‘Komunikacja z pacjentem w dobie COVID-19’ [Communicating with a patient during the COVID-19], in: Komunikowanie si? lekarza i pacjenta w medycynie rodzinnej, edited by Agnieszka Mastelarz-Migas, Aldona K. Jankowska and Jaros?aw Bara?ski. Edra Urban & Partner Editions: Wroclaw, 2021, pp. 105-113.
Dzau, Victor J., Darrel Kirch and Thomas Nasca. ‘Preventing a parallel pandemic – a national strategy to protect clinicians’ well-being’, New England Journal of Medicine 383 (2020), pp. 513-515.
Elpern Ellen H., Barbara Covert and Ruth Kleinpell. ‘Moral distress of staff nurses in a medical intensive care unit’, American Journal of Critical Care 6 (2005), pp. 523-530.
Elwin Glyn, Dominick Frosch, Richard Thomson et al. ‘Shared decision making: a model for clinical practice’, Journal of General Internal Medicine 27:10 (2012), pp. 1361-1367.
Epstein Elisabeth G., Phyllis B. Whitehead, Chuleeporn Prompahakul et al. ‘Enhancing understanding of moral distress: the Measure of Moral Distress for Health Care Professionals’, AJOB Empirical Bioethics 10:2 (2019), pp. 113-124. doi.org/10.1080/23294515.2019.1586008. Accessed 17 February 2021.
Epstein Elisabeth G. and Sarah Delgado. ‘Understanding and addressing moral distress’, OJIN The Online Journal of Issues in Nursing 15:3 (2010), Manuscript #1. https://doi.org/10.3912/OJIN.Vol. 15, no. 03, Man. 01. Accessed 11 November 2020.
Eriksson Malinn, Mehdi Ghazinour and Anne Hammarström. ‘Different uses of Bronfenbrenner’s ecological theory in public mental health research: what is their value for guiding public mental health policy and practice?’ Social Theory and Health 16 (2018), pp. 414-433.
European Union. Health at Glance 2020. URL: https://ec.europa.eu/health/sites/default/files/state/docs/2020_healthatglance_rep_en.pdf. Accessed 21 March 2022.
Gallery Michael E., Theodore W. Whitley, Leah K. Klonis et al. ‘A study of occupational stress and depression among emergency physicians’, Annals of Emergency Medicine 21 (1992), pp. 58-64.
Garrett Laurie. ‘The art of medicine COVID-19: the medium is the message’, Lancet 395 (2020), pp. 942-943.
Gedminas M. Interview by K. Klikna, Medicas ptaruko, TV3, 2020. URL: https://www.tv3.lt/naujiena/video/medikas-pratruko-velniop-ta-hipokrato-priesaika-jeigu-tu-laiko-ir-ranku-neturi-padeti-tam-zmogui-n1072858. Accessed 7 August 2021.
Grady, Christine et al. ‘Reflections on moral distress and moral success,’ in: Connie Ulrich and Christine Grady (eds), Moral distress in the health professions. Springer: Cham 2018, pp. 159–171.
Grochal, Renata. ‘Koronawirusa mo?na pokona? testami, a nie prokuratur?’ [Coronavirus can be overcome by tests, not persecution]. Newsweek, 19 April 2020. https://www.newsweek.pl/opinie/ziobro-straszy-lekarzy-prokuratura/g6dhsj4. Accessed 14 August 2021.
Habermas, Jürgen. Responsibility and its role in the relationship between moral judgment and action, in: Carol Gilligan and Laurence Kohlberg (eds), Advanced seminar in research in moral development, 1981.
Hamric, Ann B. ‘Empirical research on moral distress: issues, challenges, and opportunities’, HEC Forum 24 (2012), pp. 39-49.
Hamric, Ann B., Walter S. Davis and Marcia Day Childress. ‘Moral distress in health care professionals’, Pharos 69:1 (2006), pp. 16-23.
Hong, Soo Jung. ‘I want an omnipotent doctor: North Korean defectors’ unmet expectations of South Korean medical providers’, The Qualitative Report 22:10 (2017), pp. 2612-2628. doi.org/10.46743/ 2160-3715/2017.2546.
Horton, Richard. ‘COVID-19 is not a pandemic’, The Lancet 396 (2020), p. 824.
IJntema, Richta C., Wilmar B. Schaufeli and Yvonne D. Burger. ’Resilience mechanisms at work: The psychological immunity-psychological elasticity (PI-PE) model of psychological resilience’, Current Psychology 2021, Springer. doi.org/10.1007/s12144-021-01813-5. Accessed 30 November 2021.
Jameton, Andrew. ‘Dilemmas of moral distress: moral responsibility and nursing practice. AWHONN’s Clinic’, Issues in Perinat & Women’s Health Nursing 4:4 (1993), pp. 542-551.
Jameton, Andrew. Nursing practice: the ethical issues. Prentice Hall, Englewood Cliffs, NJ, 1984.
Kälvemark, Sofia, Anna T Höglund, Mats G Hansson et al. ‘Living with conflicts-ethical dilemmas and moral distress in the health care system’, Social Sciences and Medicine 58:6 (2004), pp. 1075-1084.
Klinger, Klara and Patrycja Otto. Pierwsze donosy na lekarzy w prokuraturze, „Gazeta Prawna”, 8 April 2020. URL: prawo.gazetaprawna.pl.
Kristjánsson Kristjan. ‘Flourishing as the aim of education: towards an extended, ‘enchanted’ Aristotelian account’, Oxford Review of Education 42:6 (2016), pp. 707-720.
Kwak, Magdalena, Iwona Zaczyk and Ewa Wilczek-Ró?yczka. ‘Stres i style radzenia sobie z nim przez polskie piel?gniarki’, Medycyna Ogólna i Nauki o Zdrowiu 24:2 (2018), pp. 120-125. DOI: https://doi.org/10.26444/monz/91633.
Lachman, Vicki D. ‘Strategies necessary for moral courage’, OJIN The Online Journal of Issues in Nursing 15:3 (2010), Manuscript #3.
Lachman, Vicki D. ‘Moral courage in action: case studies’, Medsurg Nurs 15:4 (2007a), pp. 275-277.
Lachman, Vicki D. ‘Moral courage: a virtue in need of development?’ Medsurg. Nurs J 16:2 (2007b), pp. 131-133.
Lin, Gabrielle. Frustrating the state: surveillance, public health, and the role of civil society. Research Report – Watching the Watchers – Surveillance & Privacy Policy. McGill’s Centre for Media, Technology and Democracy, 2020. Accessed 14 October 2021.
Lind Georg. ‘Moral regression in medical students and their learning environment’, Revista Bras de Edu Med 24:3 (2000), pp. 24-33.
Löwy, Ilana. ‘The unknown known: the SARS past of COVID-19’, Medical Anthropology Quarterly Rapid Response (2020). URL: http://medanthroquarterly.org/?p=480. Accessed 30 March 2022.
Maaz, Hans-Joachim, Dietmar Czycholl and Aaron B. Czycholl (eds). Corona – Angst – Was mit unserer Psyche geschieht. Verlag Frank & Timme, 2021.
Mackie, John L. ‘Causes and conditions’, American Philosophical Quarterly 2 (1965), pp. 245-264.
Mackie, John L. ‘The concept of causation – conditional analyses’, in: idem, The cement of the universe: a study of causation. New York: Oxford Univ. Press, 1980.
Martinez, William, Sigall K. Bell, Jason M. Etchegaray et al. ‘Measuring moral courage for interns and residents: scale development and initial psychometrics’, Academic Medicine 91:10 (2016), pp. 1431-1438.
Milliken, Aimee. ‘Refining moral agency: insights from moral psychology and moral philosophy’, Nursing Philosophy 1:1 (2018). DOI:10.1111/nup.12185. Accessed 11 February 2022.
Morley, Georgina, Jonathan Ives, Caroline Bradbury-Jones et al. ‘What is ‘moral distress’? A narrative synthesis of the literature’, Nursing Ethics 26:3 (2019), pp. 646-662.
Murray, John S. ‘Moral courage in healthcare: acting ethically even in the presence of risk’, OJIN The Online Journal on Issues in Nursing 15(3) (2010), Manuscript #2.
Nash, Linda. Inescapable ecologies. Berkeley, Los Angeles, London: University of California Press, 2006.
Nielsen, Karina and Johan Simonsen Abildgaard. ‘Organizational interventions: a research-based framework for the evaluation of both process and effects’, Work & Stress 27:3 (2013), pp. 287-297. doi.org/10.1080/02678373.2013.812358. Accessed on 7 May 2022.
O’Byrne, Lorcan, Blánaid Davin and Fiona McNicholas. ‘Medical students and COVID-19: the need for pandemic preparedness’, Journal of Medical Ethics 0 (2020), pp. 1-4. doi:10.1136/medethics-2020-106353. Accessed on 5 May 2022.
O’Byrne, Lorcan, Blánaid Davin, Dimitrios Adamis et al. ‘Levels of stress in medical students due to COVID-19’, Journal of Medical Ethics 47 (2021), pp. 383-388. doi: https://10.1136/medethics-2020-107155. Accessed on 11 March 2022.
O’Donnell, Patricia, Adrienne Farrar, Karlynn Brintzenhofeszoc, Ann Conrad et al. ‘Predictors of ethical stress, moral action and job satisfaction in health care social workers’, Social Work in Health Care 46:3 (2008), pp. 29-51.
Omrane, Khaled, Daouda Kamissoko, Frederick Benaben, Christopher Zobel and Bruno Barroca. ‘Decision-making in the field of resilience: literature review’, HAL Archives-Ouvertes.fr, Open Science, 2020. ID hal-02894823.
Oser, Fritz K. and Roland Reichenbach. ‘Moral resilience – the unhappy moralist’, in: Morality in context, edited by W. Edelstein and Gertrude Nunner-Winkler. Elsevier, 2005, pp. 204-224.
Patel, Rikinkumar S., Ramya Bachu, Archana Adikey, Meryem Malik and Mansi Shah. ‘Factors related to physician burnout and its consequences: a review’, Behavioral Sciences 8 (2018), 98 pp. 1-7.
Phillips, Carl V. and Karen Jean Goodman. ‘The missed lessons of Sir Austin Bradford Hill’, Epidemiologic Perspectives and Innovations 1:1 (2004), p. 3.
Piš?alkait?, Karolina and Olga Riklikien?. ‘Slaugytoj? profesinio streso paplitimas, priežastys ir raiška per koronaviruso pandemij?. Slaugos mokslas ir praktika: išš?kiai ir galimyb?s’, in: Respublikin?s mokslin?s praktin?s konferencijos santrauk? leidinys. Kaunas: Kauno Kolegija, 2021, pp. 33-34.
Rice, Elisabeth M., Mohamed Y. Rady, Arreta Hamrick, Joseph L. Verheijde and Debra K. Pendergast. ‘Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital’, Journal of Nursing Management 16 (2008), pp. 360-373.
Rothbaum, Jon and Adam Bee. ‘Coronavirus infects surveys, too: survey nonresponse bias and the Coronavirus pandemic’, The U.S. Census Bureau Report, 2021.
Rosenbaum, Lisa. ‘Facing Covid-19 in Italy: ethics, logistics, band therapeutics on the epidemic’s front line’, The New England Journal of Medicine 382:20 (2020), pp. 1873-1875.
Schillinger, Marcia. Learning environment and moral development. Aachen: Shaker, 2006.
Siedlecka, Ewa. Lekarz pope?ni? samobójstwo przez hejt? Epidemia budzi z?e instynkty [Doctor performs suicide? Epidemic wakes ill instincts], „Polityka”, 19 March 2020. URL: https://www.polityka.pl/tygodnikpolityka/spoleczenstwo/1947916,1,lekarz-popelnil-samobojstwo-przez-hejt-epidemia-budzi-zle-instynkty.read.
Susser, Mervyn. ‘What is a cause and how do we know one? A grammar for pragmatic epidemiology’, American Journal of Epidemiology 133:7 (1991), pp. 635-648.
Szewieczek, Jan and Jan Dulawa (eds). ?wiczenia z chorób wewn?trznych i piel?gniarstwa internistycznego. Katowice: Silesian Medical Univ. Press, 2008.
Terris, Milton. ‘Epidemiology and the public health movement’, Journal of Public Health Policy 8:3 (1987), pp. 315-329.
Thomas, Tessy A. and Laurence B. McCullough. ‘A philosophical taxonomy of ethically significant moral distress’, Journal of Medicine and Philosophy 40:1 (2015). pp. 102-120.
Wald Priscilla. Contagious: cultures, carriers, and the outbreak narrative. Durham - London: Duke Univ. Press, 2008.
Walston, Kenneth A. and Barbara Strudler Walston. ‘Who is responsible for your health? The construct of health locus and control’, in Social psychology of health and illness, edited by Glenn S. Sanders and Jerry Suls. Hillsdale, NJ: Lawrence Erlbaum, 1982, pp. 65-98.
Wiggins, Andrea and John Wilbanks. ‘The rise of citizen science in health and biomedical research’, American Journal of Bioethics 19:8 (2019), pp. 3-14.
Williamson, Victoria, Dominic Murphy and Neil Greenberg. ‘COVID-19 and experiences of moral injury in front-line key workers’, Occupational Medicine (London), 2 April 2020. https://doi:10.1093/occmed/kqaa052.
Wöhlke, Sabine and Claudia Wiesemann. ‚Moral distress im Pflegealltag und seine Bedeutung für die Implementierung von Advance Care Planning‘, Pflegewissenschaft 18 (2016), pp. 280-287.
Zajonc, Robert. ‘Feeling and thinking: preferences need no inferences’, American Psychologist 35 (1980), pp. 151-175.
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