ArticleBMJ open2022
Moral and exhausting distress working in the frontline of COVID-19: a Swedish survey during the first wave in four healthcare settings.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis.European journal of psychotraumatology · 2024Trial
- Assessing ethical competence and ethical climate: development and psychometric testing of the Clinical Ethics Support Measurement Instrument (CES-MI).BMC medical ethics · 2026Article
- Article
- Age and grit in prioritising intensive care: - a mixed-methods approach of normative challenges.BMC medical ethics · 2025Article
- Trying to create order in chaos-healthcare workers' perspective of COVID-19 intensive care (a qualitative study).BMJ open quality · 2025Article
- Moral distress among maternity and neonatal healthcare workers during the COVID-19 pandemic in Sweden: Results from the COPE staff longitudinal cohort study.Acta obstetricia et gynecologica Scandinavica · 2025Article
- Moral distress and protective work environment for healthcare workers during public health emergencies.BMC medical ethics · 2024Article
- Doctors' experience providing primary care for refugee women living with chronic pain: a qualitative study.BMC health services research · 2024Article
- Introducing Mechanically Assisted Cough for Patients With Progressive Neurological Disease: Patient-Physical Therapist Interaction and Physical Therapist Perspective.Physical therapy · 2024Article
- COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study.BMC primary care · 2023Article
- After the first lockdown due to the COVID-19 pandemic: Perceptions, experiences, and effects on well-being in Italian people.Frontiers in psychology · 2023Article
- Effects of work-family conflict on turnover intention among primary medical staff in Huaihai Economic Zone: a mediation model through burnout.Frontiers in psychiatry · 2023Article
- An Adaptive Healthcare Organization Can Effectively Respond to Medical Crises.International journal of public health · 2023Article
- Health care workers' need for support from managers during the initial phase of the COVID-19 pandemic.BMC health services research · 2022Article
- Practices and Strategies of Health Professionals during the COVID-19 Pandemic-Between Limitations and Opportunities.Healthcare (Basel, Switzerland) · 2022Article
- Professional and Psychological Influence of the COVID-19 Pandemic on the Training of Medical Residents.Journal of medical education and curricular developmentArticle
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo describe the prevalence and sources of experienced moral stress and anxiety by Swedish frontline healthcare staff in the early phase of COVID-19.
designCross-sectional survey, quantitative and qualitative. PARTICIPANTS AND
setting1074 healthcare professionals (75% nurses) in intensive, ward-based, primary and municipal care in one Swedish county. MEASURES: A study-specific closed-ended and an open-ended questionnaire about moral stress and the Generalised Anxiety Disorder 7-item scale measuring anxiety, followed by an open question about anxiety.
findingsMoral stress was experienced by 52% of respondents and anxiety by 40%. Moral stress in concern for others attributed to institutional constraints comprised experiences of being deprived of possibilities to respond to humane and professional responsibility. Staff experienced being restricted in fulfilling patients' and families' need for closeness and security as well as being compelled to provide substandard and inhumane care. Uncertainty about right and good, without blame, was also described. However, a burdensome guilt also emerged as a moral distress, blaming oneself. This comprised feeling complicit in the spread of COVID-19, inadequacy in care and carrying patients' suffering. Staff also experienced an exhausting distress as a self-concern in an uncontrollable work situation. This comprised a taxing insecurity by being in limbo, being alone and fear of failing, despair of being deprived control by not being heard; unable to influence; distrusting management; as well as an excessive workload.
conclusionsWe have not only contributed with knowledge about experiences of being in the frontline of COVID-19, but also with an understanding of a demarcation between moral stress/distress as a concern for patients and family, and exhausting distress in work situation as self-concern. A lesson for management is that ethics support should first include acknowledgement of self-concern and mitigation of guilt before any structured ethical reflection. Preventive measures for major events should focus on connectedness between all parties concerned, preventing inhumane care and burn-out.
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