Moral Distress in Canadian Intensivists: A Complex Interplay of Contextual and Relational Factors.
critical care
moral distress
physicians
stress
well-being
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
12
08
2022
revised:
18
11
2022
accepted:
08
12
2022
medline:
12
5
2023
pubmed:
28
12
2022
entrez:
27
12
2022
Statut:
ppublish
Résumé
Health care professionals experience moral distress when they cannot act based on their moral beliefs because of perceived constraints. Moral distress prevalence is high among critical care (ICU) clinicians, but varies significantly between and within professions. How can the interindividual variability in moral distress of Canadian ICU physicians be explained to inform future system-based interventions? We analyzed 135 free-text comments written by 83 of the 225 ICU physicians who participated in an online cross-sectional wellness survey. An interdisciplinary team of five investigators completed the thematic analysis of anonymized survey comments according to published guidelines. Physicians identified contextual and relational factors that contributed to moral distress and work-related stress. Combined sources of distress created high work-related demands that were not always matched by equally high resources or mitigated by work-related rewards. An imbalance between demands and rewards could lead to undesirable individual and collective consequences. Moral distress is experienced variably by ICU physicians and is linked to contextual and relational factors. Future studies should evaluate modifiable factors such as team interactions and the role of professional rewards as mitigators of distress to bring new insights into strategies to improve ICU clinician wellness and patient care.
Sections du résumé
BACKGROUND
Health care professionals experience moral distress when they cannot act based on their moral beliefs because of perceived constraints. Moral distress prevalence is high among critical care (ICU) clinicians, but varies significantly between and within professions.
RESEARCH QUESTION
How can the interindividual variability in moral distress of Canadian ICU physicians be explained to inform future system-based interventions?
STUDY DESIGN AND METHODS
We analyzed 135 free-text comments written by 83 of the 225 ICU physicians who participated in an online cross-sectional wellness survey. An interdisciplinary team of five investigators completed the thematic analysis of anonymized survey comments according to published guidelines.
RESULTS
Physicians identified contextual and relational factors that contributed to moral distress and work-related stress. Combined sources of distress created high work-related demands that were not always matched by equally high resources or mitigated by work-related rewards. An imbalance between demands and rewards could lead to undesirable individual and collective consequences.
INTERPRETATION
Moral distress is experienced variably by ICU physicians and is linked to contextual and relational factors. Future studies should evaluate modifiable factors such as team interactions and the role of professional rewards as mitigators of distress to bring new insights into strategies to improve ICU clinician wellness and patient care.
Identifiants
pubmed: 36574927
pii: S0012-3692(22)04343-4
doi: 10.1016/j.chest.2022.12.022
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1101-1108Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.