记录 COVID-19 大流行期间医疗保健提供者的道德困境:心理健康压力、倦怠和适应不良应对行为的纵向分析。
Chronicling moral distress among healthcare providers during the COVID-19 pandemic: A longitudinal analysis of mental health strain, burnout, and maladaptive coping behaviours.
机构信息
Clemson University, Clemson, South Carolina, USA.
Furman University, Greenville, South Carolina, USA.
出版信息
Int J Ment Health Nurs. 2022 Feb;31(1):111-127. doi: 10.1111/inm.12942. Epub 2021 Oct 13.
The COVID-19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020-December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross-level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.
新冠疫情带来了许多新情况,加剧了医疗保健领域的道德困境。由于资源有限,医护人员无法保护自己免受病毒侵害,而且严格的安全规定改变了他们的工作方式,因此他们被迫从事违背自己职业道德和个人是非观的工作。虽然许多医护人员在工作场所经历了道德困境,但也有一些人在家中感到痛苦。一些医护人员在因限制而无法在疫情期间开放的设施中工作,这可能会导致他们感到无能为力和内疚。本研究评估了每周能否看到患者是否会影响员工的道德困境与其心理健康压力、倦怠和适应不良应对之间的关系。共有 378 名医护人员在 7 个月的时间内(2020 年 4 月至 2020 年 12 月)每周对调查做出回应。分层线性建模技术用于随时间检查研究变量。结果表明,即使控制了前一周的情况,道德困境仍能预测个人的心理健康压力和倦怠。然而,道德困境并不是适应不良应对的重要预测因素。有趣的是,能够和不能看到患者的医护人员的道德困境平均评分没有显著差异,这意味着两组人都经历了道德困境的症状。然而,跨层调节结果表明,随着时间的推移,看到患者的能力放大了道德困境与心理健康压力和倦怠之间的关系。讨论了结果的意义和如何在医护人员中解决道德困境的建议。