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COVID 19: Learning About Nurses’ Moral Distress During Crisis Care

During the pandemic, nurses continue to deliver a crisis standard of care, which requires allocating and using scarce medical resources. This care, in the context of COVID-19, an infectious and potentially fatal illness, requires nurses to balance their duty to care for patients while protecting themselves and their families. Crisis standards of care cause high moral distress for clinicians. The lack of preparedness of U.S. hospitals to initiate crisis care standards is likely amplifying such distress. Could better leadership communication mitigate this distress and consequential poorer mental health?

In an article published in the Journal of Advanced Nursing, researchers at the University of Pennsylvania School of Nursing (Penn Nursing) share findings from their study that explored factors associated with nurses’ moral distress during the pandemic. By conceptualizing the sources of moral distress at three levels, the researchers were able to close the knowledge gaps about the types of and degree of moral distress experienced by nurses, the factors associated with moral distress during the COVID-19 pandemic, and its relation to longer-term mental health. COVID-19-specific situations were the most distressing, e.g., the transmission risk to nurses’ family members, caring for patients without family members present, and caring for patients dying without family or clergy present.

“We found that COVID-19 patient care volume and personal protective equipment (PPE) workarounds increased moral distress, while effective leadership communication decreased it and improved post-surge mental health,” says lead-author Eileen T. Lake, PhD, MSN, MA, BSN, FAAN, the Jessie M. Scott Endowed Term Chair in Nursing and Health Policy, Professor of Nursing and Sociology, and Associate Director of the Center for Health Outcomes and Policy Research. “Given the lingering negative effects on nurses suffering moral distress during a crisis, our findings should motivate and provide guidance for leaders in the ongoing COVID-19 pandemic and future crises.”

Co-authors of the article include Kathleen E. Fitzpatrick Rosenbaum, BSN, RNC-NIC, CCRN, Rachel French, PhD BSN RN, and Rebecca Clark, PhD, MSN, RN, CNM, WHNP-BC, all of Penn Nursing; Aliza Narva and Sara Holland, both of Penn Medicine; Jessica Smith of the University of Texas; Emily Cramer of the University of Kansas Medical Center; and Jeannette Rogowski of the Pennsylvania State University. This research was supported by the National Institute of Nursing Research, National Institutes of Health T32NR007104.