Moral distress amongst intensive care unit professions in the UK: A qualitative study

Abstract Background: Working in intensive care presents psychological challenges to healthcare professionals, including moral distress. Concerningly, moral distress is associated with burnout and a tendency to leave the profession. The COVID-19 pandemic has further highlighted the challenges to staff wellbeing and the importance of identifying and mitigating moral distress. However moral distress remains poorly studied in the UK. Our aim was to explore the experience and response to moral distress amongst intensive care professionals in the UK and identify interventions to support professionals and improve staff wellbeing. Methods: Prior to the COVID-19 pandemic, 15 interviews were performed with intensive care professionals from four units of varying size and specialty facilitates recruited from a pool of responders to a questionnaire survey. Participants were purposively sampled for hospital, profession, grade, and quantitative moral distress score. Transcripts were analysed using thematic analysis. Results: Participants included a range of intensive care professions, working experience, overall moral distress score, and were representative of the larger questionnaire sample. Moral distress occurred across all professions, levels of seniority, and in all units. Moral distress occurred in many situations, most commonly related to providing care against the patient’s wishes/interests, or resource constraints compromising care. Its experience resulted in multiple negative feelings and could lead to withdrawal from engaging with patients/families and avoiding a career in intensive care. Participants described a range of individualised coping strategies tailored to the situations faced. The most common and highly valued strategies were informal and relied on working within a supportive environment along with a close-knit team, although participants acknowledged there was a role for structured and formalised intervention. A lack of agency was central to the experience of moral distress. Conclusions: Moral distress is commonly encountered by UK intensive care professionals and can have an important negative impact on professional wellbeing and patient care. Interventions to support intensive care professionals should recognise the individualistic nature of coping with moral distress. Addressing moral distress may support a healthy and sustainable intensive care workforce. Achieving this requires a supportive environment and a close-knit supportive team which has implications for how intensive care services are organised.