Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy.
Unit of Clinical Psychology, Santi Paolo e Carlo Hospital, 20142 Milan, Italy.
Int J Environ Res Public Health. 2021 Dec 19;18(24):13367. doi: 10.3390/ijerph182413367.
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.
新冠疫情给急诊和重症监护医生带来了前所未有的伦理挑战。本文旨在探讨医生在疫情期间经历的道德困境。采用扎根理论进行定性多中心研究。我们招募了来自意大利伦巴第地区的六家医院的 15 名急诊和重症监护医生，他们参与了关于其道德困境的专业经验的半结构化访谈。访谈于 2020 年 11 月至 2021 年 2 月进行（即疫情爆发一年后）。对转录本进行了开放式、轴向式和选择性编码的定性分析。道德困境模型围绕着“做一个好医生”的核心范畴展开。一些大流行压力源威胁到做一个好医生的感觉，导致道德困境。大流行压力源包括医疗资源有限、患者分诊加剧、选择标准变化、治疗/临床知识有限以及患者隔离。道德困境的情绪包括无力感、沮丧/愤怒和悲伤。医生采用不同的个体应对策略来应对道德困境，例如回避、默许、重新解释和反抗。这些个体反应产生了不同的道德后果，如道德残留、脱轨或道德正直。工作环境，特别是团队和组织文化，对于恢复或破坏道德正直至关重要。为了让医生成功地应对道德困境，重新解释很重要，即通过重新构建道德困境的情况来找到体现自己价值观的新方法，并感知到合作和支持性的工作环境。
