Moral distress in healthcare workers working in maternity, delivery or neonatal care - a sub-study of the COPE Staff cohort

Research problem and specific questionsMoral distress occurs when external factors prevent healthcare workers from doing what they think is best for the patient.

The aim is to determine moral distress and its impact on wellbeing in employees working at antenatal, labour and birth, and neonatal care units. The COVID-19 pandemic exemplifies strained circumstances transferrable to other vulnerable situations.

Underlying organisational work environment factors that can predict or affect levels of moral distress will be identified.Research questions:To what extent have healthcare workers experienced moral distress during the COVID-19 pandemic?Which organisational work environment factors affects the levels of moral distress during the COVID-19 pandemic?Which organisational work environment factors affects the level of moral distress over time?Is there an association between moral distress and intention to leave the occupation, impaired employee wellbeing (post-traumatic stress or burnout) and reduced patient safety?What personal strategies do healthcare employees adapt to mediate adverse organisational prerequisites to reduce their moral distress?Data and methodThe study uses measures moral distress (Moral Distress Scale-Revised), organisational work environment factors, employee wellbeing and patient safety using validated instruments.

The cohort comprises 1250 participants and additional recruitment take place annually. A Baseline measurement (January-April 2021) a follow-up (January-February 2022) have been conducted. Annual follow-up measurements qualitative interviews will be carried out.

Plan for project realisationThe job-demand resources model is used to study the association between organisational work environment, the level of moral distress and health effects among the study participants.

Research questions 1-4 will be answered by statistical analyses of questionnaire data deriving from the first two measurements (questions 1-2) combined with the annual follow-ups (questions 3-4).Research question 5 will be answered by qualitative focus group interviews based on the findings from questions 1 and 2.

RelevanceOur baseline data show that 26% of the midwives and 10% of the physicians were currently contemplating changing position due to moral distress, highlighting the impact of moral distress in securing the future workforce. The findings will be used to identify preventive factors for moral distress that could reduce employee.