Coping with moral distress: a qualitative study exploring psychological strategies used by healthcare professionals

Abstract

Background: Moral distress is a specific type of stress related to the moral dimension of clinical practice. Literature shows that moral distress is associated with depressive symptoms, job resignation and burnout. However, few studies have explored the psychological factors that can modulate moral distress. The aim of this qualitative study was to explore the range of psychological strategies employed by healthcare professionals (HPs) to cope with moral distress. Methods: Using a snowball sampling technique, a purposeful sample of interdisciplinary HPs working in a large public hospital in Milan (Italy) was recruited. Semi-structured interviews were conducted. HPs were asked to recall morally distressing situations and how they coped in their aftermath. The interviews were audio-recorded, transcribed and analyzed through content analysis to identify psychological strategies used to cope with moral distress. Results: We interviewed 20 HPs (11 physicians, seven nurses, one midwife and one physiotherapist; 15 females; mean age = 50.26; SD = 8.19). Eight strategies used to cope with morally distressing situations were identified: Reframing the situation, Trying to modify the situation, Limiting own involvement, Tolerating the situation, Meeting and sharing with colleagues, Rejecting and withdrawing from the situation, Searching for alternative actions, and Venting. Typically, HPs used more than one strategy (mean = 4.1; SD = 1.14) and recounted learning and adapting strategies over time. Conclusions: Our findings suggest that psychological strategies used to cope with moral distress seemed partially distinct from those used for emotional distress. Future research is needed to explore possible distinctions between general coping and moral coping. In the future, identifying strategies associated with different levels of moral distress could inform and guide the implementation of preventive interventions for HPs.