It’s important to talk about moral pressure in health care

Lack of care places and health care personnel, poor economy and austerity. During crises, the risk of suffering from moral distress increases. Not least because the Covid-19 pandemic has become a difficult test for many doctors, with the concept of ethical pressure becoming more and more audible.

Anne Liljas, Lecturer in Public Health Sciences at Karolinska Institutet, is the researcher responsible for an interdisciplinary research project on moral pressure in emergency departments. It started last summer and will run for three years. The researchers start from Professor Andrew Jamieton’s definition of moral pressure from 1984, that is, it is a feeling that arises when a person is prevented from doing what he knows is the right thing to do in a situation.

The project is managed by Clara Brun, an 11th semester medical student and PhD student.

She says that moral pressure is simply about not being able to act in line with what you believe is right.

Why is it important to study moral pressures?

Moral pressure is associated with secondary psychological consequences such as burnout, depression, mental illness in general, and high employee turnover. Therefore, it is important to study from an individual, workplace and patient perspective, says Clara Brun.

Anne Lilgas describes it as a domino effect: moral pressure or pressure of conscience can lead to burnout and a deteriorating social environment at work, which in turn can lead to patients being exposed to increased risks.

According to her, previous research shows that healthcare professionals are not particularly aware of what moral pressure means.

– The experience itself is familiar to many. But the fact that there was a concept for it only really came to fruition during the pandemic, she says.

Putting words to the unpleasant feeling and seeing it as a concept is important, according to the researchers.

– It means you saw. Then you can increase awareness and knowledge of the problem, which is the basis for treating it, says Anne Lilgas.

With increased knowledge and a better way to deal with moral pressure, the research group hopes to be able to prevent mental illness caused by moral pressure among emergency personnel, enhance the work environment and reduce employee turnover, as well as provide increased preparedness to deal with crises.

Researchers are currently sending questionnaires about moral stress to staff at two emergency departments. Staff will then be invited to workshops with researchers to discuss how to deal with ethical pressure, help develop an evidence-based support model, and interview department heads and others with personal responsibility about how they deal with the issue.

The model should be used in all emergency departments.

“We will develop support from the information we get from healthcare staff, but with support from previous scientific literature,” says Clara Brun.

Is there any previous support?

– Not real. They have tried some methods and conducted small-scale studies, but generally focusing more on pressure in general than on moral pressure. Clara Brun says there is no established evidence-based support and framework/methods for individuals to be able to cope with moral pressures.

However, there are initiatives in this area. For example, Stockholm Hospital introduced ethics tours during the Covid pandemic, which Lakartedningen has previously written about.

– It’s great and very important that we act, but to show that something works, you need evidence-based research as a foundation. This is what we want to highlight very early on,” says Anne Lilgas.

Completely removing moral pressures is not possible – or desirable.

– The idea is not to remove moral pressure as a concept, says Clara Brun and points to the research of KI doctoral student Martina Gustafsson on healthcare staff in disaster areas. She emphasizes that moral stress is a natural reaction to moral dilemmas, and therefore not something that should be sought to be eliminated. On the other hand, it is good to learn how to manage emotions and try to fix controllable problems that cause moral tension.

What do you think one should do when, as a physician, one finds oneself in a situation that creates ethical stress?

Bring it up with your manager or colleague instead of suppressing your feelings, says Anne Lilgas.

In addition to Anne Lillias, Johan von Schrepp, Professor of Global Disaster Medicine, Bo Borström, Professor of Social Medicine, and Niklas Guth, a university lecturer and lecturer in medical ethics at Karolinska Institutet, are also supervisors of doctoral student Clara. Bron.

Read also:
Now elected officials must work to reduce moral pressure
It is important to have tools to counter moral pressure during and after the pandemic
Moral pressure behind job dissatisfaction
Psychologist: Important to work with communication within the medical team

Lakartidningen.se 2023-10-10