ArticleInternational journal of environmental research and public health2021
Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study.
Article in International journal of environmental research and public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review.BMC health services research · 2024Pooled it
- Pooled it
- Moral distress of primary health care workers during the global pandemic.Scientific reports · 2026Article
- Coping with moral distress: a qualitative study exploring psychological strategies used by healthcare professionals.BMC psychology · 2025Article
- Psychometric properties of the Czech moral injury symptom scale.Scientific reports · 2025Article
- Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study.International journal of qualitative studies on health and well-being · 2024Article
- Innovation adoption, use and implementation in emergency departments during the COVID-19 pandemic.BMJ innovations · 2024Article
- From moral distress to resilient ethical climate among general practitioners: Fostering awareness. A qualitative pilot study.PloS one · 2024Article
- Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned.BMC medical ethics · 2023Article
- Physicians' Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions.International journal of environmental research and public health · 2023Article
- Difficulties and distress experienced by Japanese public health nurses specializing in quarantine services when dealing with COVID-19: A qualitative study in peri-urban municipality.AIMS public health · 2023Article
- Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources.International journal of environmental research and public health · 2022Article
- COVID-19 Outbreak: Understanding Moral-Distress Experiences Faced by Healthcare Workers in British Columbia, Canada.International journal of environmental research and public health · 2022Article
- Moral Distress Events and Emotional Trajectories in Nursing Narratives during the COVID-19 Pandemic.International journal of environmental research and public health · 2022Article
- The Moral Impact of the COVID-19 Pandemic on Nurses' Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic Psychological Needs.International journal of environmental research and public health · 2022Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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