Moral distress among healthcare professionals working in intensive care units in Spain

E Rodriguez-Ruiz; M Campelo-Izquierdo; P B Veiras; M M Rodríguez; A Estany-Gestal; A B Hortas; M S Rodríguez-Calvo; A Rodríguez-Núñez

doi:10.1016/j.medin.2021.06.004

Moral distress among healthcare professionals working in intensive care units in Spain

Med Intensiva (Engl Ed). 2021 Jul 28:S0210-5691(21)00170-4. doi: 10.1016/j.medin.2021.06.004. Online ahead of print.

[Article in English, Spanish]

Authors

E Rodriguez-Ruiz¹, M Campelo-Izquierdo², P B Veiras², M M Rodríguez², A Estany-Gestal³, A B Hortas³, M S Rodríguez-Calvo⁴, A Rodríguez-Núñez⁵

Affiliations

¹ Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain. Electronic address: r.ruizemilio@gmail.com.
² Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain.
³ Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain.
⁴ Institute of Forensic Sciences, University of Santiago de Compostela, Spain.
⁵ Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain; Paediatric Intensive Care Unit, Department of Pediatrics, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain.

PMID: 34332793
DOI: 10.1016/j.medin.2021.06.004

Abstract

Objective: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs).

Design: Cross-sectional, prospective study.

Setting: ICUs in Spain.

Participants: HCPs currently working in Spanish ICUs.

Interventions: A 55-item questionnaire was electronically distributed.

Main variables: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS).

Results: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD.

Conclusions: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Keywords: Clima ético; Critical care; Critical care nursing; Cuidados intensivos; Desasosiego moral; Enfermería de cuidados intensivos; Ethical climate; Intensive care units; Moral distress; Unidad de cuidados intensivos.