Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study

ABSTRACT

Purpose

The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral distress as perceived by medical doctors working at emergency departments in Stockholm during the pandemic, with the purpose of investigating causes of moral distress and methods to manage moral distress.

Methods

Semi-structured interviews were conducted with twelve doctors working at two emergency departments. A questionnaire was developed based on previous research and the interviews were analysed qualitatively through thematic analysis.

Results

The themes ”The factors that precipitated moral distress”, “Experience of workplace support” and “Coping strategies” as well as seven subthemes and 15 codes were identified. The informants reported on various situations with different causes of moral distress. Common causes were resource depletion, such as hospital bed shortages, and following stricter triage criteria. Informants reported varying ways of managing moral distress.

Conclusions

Informants experienced moral distress when faced with challenges such as resource depletion, rules and regulations, and colleagues’ decisions. The informants who chose to seek support received it from their workplace, which helped them cope with their experiences. Some informants chose to not seek support.

KEYWORDS:

• Moral distress
• moral stress
• emergency departments
• hospitals
• Covid-19

Acknowledgments

We would like to thank Martina Gustavsson who has been an important help through generously sharing the interview questions she has developed and used in previous studies on moral distress. We would also like to thank the informants for their time, helpfulness, and participation.

Authors contribution

CB, AL and BB designed the study. CB carried out the interviews. CB, AL and JA planned and conducted the analysis. All authors contributed to the interpretations of the findings. CB wrote the initial draft of the manuscript and AL contributed to subsequent versions. All authors reviewed, read and approved the final version before submission.

Data availability statement

Anonymized interview transcripts in the original language (Swedish) can be provided upon reasonable request by contacting the corresponding author.

Disclosure statement

No potential conflict of interest was reported by the authors.

Geolocation information

Stockholm, Sweden

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Notes on contributors

Clara Brune

Clara Brune Medical student and PhD student. My research focuses on moral distress among healthcare workers at emergency departments in Stockholm Region.

Janne Agerholm

Janne Agerholm Assistant professor. My research area is equity in health and health care. Particularly I have been looking at the effect of a health care reform on equity in health care, but also on the challenges with investigating equity in health care utilization in general; especially when using different types of quantitative data sources.

Bo Burström

Bo Burström Medical doctor, specialist in social medicine. Professor at Karolinska institutet, leader of the research group Equity and Health Policy. My main focus is on equity in health, health care and in the social and economic consequences of disease, and on health in disadvantaged groups.

Ann Liljas

Ann Liljas Assistant Professor in the research group Equity and Health Policy at the Department of Global Public Health. My research interests lie in the areas of ageing, health and social inequalities, and healthcare services and systems. I am also a lecturer and lead the course Applied Health Promotion and Prevention part of the Master programme in Public Health.