Study shows excessive patient loads were the greatest cause of moral distress among health personnel during pandemic

Being a woman, a nursing professional, and working in the community sphere increased the risk of moral distress (MD), according to a study by the University of Cordoba carried out among more than 500 professionals with the Public Health Service of Andalusia in a period immediately after the COVID-19 pandemic.

Moral distress is the psychological harm that arises when people are forced to witness or perform actions that clash with their moral values. It is a problem that affects health care professionals, who are often exposed to hardships, long shifts, stress, and high levels of responsibility. During the pandemic, while society saw them as heroes, these professionals suffered high levels of moral distress.

"Worryingly high" levels of moral stress are recorded in the recent work published by Eloy Girela, Cristina Beltrán and Manuel Romero, researchers at the University of Cordoba who evaluated the prevalence of this problem among professionals in different areas of the Public Health Service of Andalusia during the early post-pandemic period.

The study is published in the journal BMC Medical Ethics.

"Our most significant findings were that women, nurses and those who work in the community sphere (primary care and emergency community services) face a higher risk of moral stress," explained Eloy Girela, a researcher in the Legal and Forensic Medicine Area.

The study was carried out with a sample of 566 professionals spanning Primary Care, Palliative Care, Intensive Care, Internal Medicine, Pulmonology and ER, services that apparently "featured more moral conflicts during the pandemic because there was a scarcity of resources to care for patients, so they had to make decisions entailing great responsibility," says Girela.

To evaluate the level of moral stress suffered by these professionals, and obtain the predictors associated with this problem, the team validated and used the MMD-HP-SPA (Measure of Moral Distress for Health care Professionals), developed in 2019 and which has 27 items corresponding to situations experienced by these workers.

"We obtained a significantly higher level of moral distress than in other similar studies, an aspect that we found worrisome," said Manuel Romero, a researcher with the Department of Nursing, Pharmacology and Physiotherapy.

Being a woman, working in Nursing, and being dedicated to community services increases the risk of suffering from it, but so does a lack of health care resources.

"Having to care for more patients than I can, safely," "a lack of resources, equipment, or beds," and "seeing patient care suffer from a lack of continuous care" were the three factors that generated the most moral distress in participants, according to the study.

This situation not only affects the physical and mental health of health personnel, but also that of patients as well. "The institutional response is fundamental," say the authors of this study, who see institutional organization and greater funding for services as solutions to the situations of excessive patient loads and scant resources suffered by the health personnel.

"Training, the existence of protocols, a more ethical climate, work-life balance strategies, and actions more focused on each service," proposes Legal and Forensic Medicine researcher Cristina Beltrán.

With this study, almost simultaneously with another published by a Galician team (Rodríguez-Ruiz et al. 2022), the MMD-HP-SPA scale was validated in Spain.

Ascertaining why being a woman is a risk factor, and the relationship between moral distress and burnout, are among the lines of study that the research team will explore to address this problem affecting society's health.