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

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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
    Boston Children’s Hospital, 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
    Unit of Clinical Psychology, Santi Paolo e Carlo Hospital, 20142 Milan, Italy)

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.

Suggested Citation

  • Giulia Lamiani & Davide Biscardi & Elaine C. Meyer & Alberto Giannini & Elena Vegni, 2021. "Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study," IJERPH, MDPI, vol. 18(24), pages 1-10, December.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:24:p:13367-:d:705910
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    References listed on IDEAS

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    1. Natasha Smallwood & Amy Pascoe & Leila Karimi & Karen Willis, 2021. "Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(16), pages 1-15, August.
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    Cited by:

    1. Mihaela Alexandra Gherman & Laura Arhiri & Andrei Corneliu Holman & Camelia Soponaru, 2022. "The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic P," IJERPH, MDPI, vol. 19(13), pages 1-22, June.
    2. Daniela Lemmo & Roberta Vitale & Carmela Girardi & Roberta Salsano & Ersilia Auriemma, 2022. "Moral Distress Events and Emotional Trajectories in Nursing Narratives during the COVID-19 Pandemic," IJERPH, MDPI, vol. 19(14), pages 1-12, July.
    3. Dominik Hinzmann & Katharina Schütte-Nütgen & Arndt Büssing & Olaf Boenisch & Hans-Jörg Busch & Christoph Dodt & Patrick Friederich & Matthias Kochanek & Guido Michels & Eckhard Frick, 2022. "Critical Care Providers’ Moral Distress: Frequency, Burden, and Potential Resources," IJERPH, MDPI, vol. 20(1), pages 1-14, December.
    4. Davis Cooper-Bribiesca & Dulce María Rascón-Martínez & José Adan Miguel-Puga & María Karen Juárez-Carreón & Luis Alejandro Sánchez-Hurtado & Tania Colin-Martinez & Juan Carlos Anda-Garay & Eliseo Espi, 2023. "Physicians’ Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions," IJERPH, MDPI, vol. 20(5), pages 1-19, February.

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