But for overworked nurses, watching patients die alone has been identified as one of the most significant sources of moral distress affecting nurses, according to a new qualitative study led by Elizabeth Peter, Professor at the Lawrence Bloomberg Faculty of Nursing.
Peter along with team members Shan Mohammed lecturer, U of T Nursing, Tieghan Killackey PhD student U of T Nursing, Jane MacIver, Adjunct Professor U of T Nursing, Caroline Variath, PhD student, U of T Nursing, & Conor Chiasson, undergraduate student Arts & Science, were awarded funding for this study as part of the University’s Toronto Covid-19 Action Fund supporting high-impact research that contributes to the global fight against SARS-CoV-2.
The study also identified additional sources of moral distress. Many nurses continue to be fearful of infecting others, and this was especially true in the early stages of the first wave when Personal Protective Equipment (PPE) was in short supply. Others felt unprepared or not sufficiently informed in how to provide care for Covid-19 patients as hospitals scrambled to create capacity in ICU wards.
In response, Peter and her research team have provided 11 recommendations for nurse leaders to implement, to help reduce these instances of moral distress.
“This is important because long-term, moral distress can be really damaging, and has the potential to have a real impact on quality of care,” says Peter. “We have to be thinking about what we are exposing nurses to repetitively in terms of their psychological health. Who will they be a year from now, will they even want to stay in nursing?”
Peter and her research team conducted virtual interviews with close to 30 registered nurses from across the health care spectrum, including, critical care, pediatrics, obstetrics and more, to ensure a diverse range of perspectives.
Those who worked as community health nurses identified different sources of distress stemming from a lack of resources inhibiting their ability to provide appropriate support to their clients, many of whom experience homelessness.
According to Peter, a source of common concern identified in the study was the sudden media focus labelling nurses as heroes.
“There was a real sense of ambivalence around being called a hero from our participants, and the majority of the nurses we spoke with were reluctant to embrace this narrative,” says Peter.
Pot banging and clapping sessions are, on the surface, kind gestures but many of the nurses surveyed said that that they wondered if anyone was going to recognize and value nurses once the pandemic was over.
“There were a lot of mixed feelings about this from our participants, especially those that have been working with infectious diseases for a while, because much of their work is unchanged” says Peter.
While there has been previous research done on sources of moral distress in health care workers, there has not yet been a cohesive set of recommendations to mitigate them, which is what makes Peter’s study so integral for nurses, though she cautions that there is no quick intervention to deal with moral distress.
“It is not as simple as meditating for 5 minutes, a lot of the changes are structural and harder to realize in practice,” says Peter. “There are no magic bullets.”
With the pandemic still in full swing it will be difficult to prevent all sources of distress, but Peter points to leadership among health care workers as key.
“Seeing their leaders physically visit ICU units to understand what nurses are experiencing, was something study participants said was especially helpful in reducing distress as is the support they are receiving from their colleagues,” says Peter.
Some of the key recommendations from the study include engaging nurses in collective and transparent decision making, providing educational opportunities related to Covid-19, offering professional mental health support, and recognizing nurses at the policy level so distress can be acted upon.
Moving forward, Peter will be entering the second phase of her funded study collecting qualitative data from nurses working in long-term care throughout the second wave. Upon disseminating the results, Peter is hoping a policy brief aimed at decision makers will help change practices for nurses quickly and in a meaningful way.
“Moral distress has always been around, but it is currently affecting our health care workers with a constancy and magnitude we have not seen before,” says Peter. “It is why these recommendations are needed to help not only our nurses but ultimately patient care.”