Table 1
Descriptive characteristics.
| DESCRIPTIVE CHARACTERISTICS | |||
|---|---|---|---|
| CHARACTERISTIC | TOTAL | COVID-19 CARE, N (%) | |
| No | Yes | ||
| Age, years | |||
| <20 | 218 (1) | 134 (2) | 84 (1) |
| 20–30 | 1830 (12) | 862 (10) | 968 (14) |
| 31–40 | 3029 (19) | 1555 (17) | 1474 (21) |
| 41–50 | 4032 (25) | 2208 (25) | 1824 (26) |
| 51–65 | 6493 (41) | 4002 (45) | 2491 (36) |
| >65 | 233 (1) | 171 (2) | 62 (1) |
| Gender | |||
| Female | 13563 (85.4) | 7656 (85.4) | 5907 (85.4) |
| Male | 2276 (14.3) | 1281 (14.3) | 995 (14.4) |
| Other | 45 (0.3) | 30 (0.3) | 15 (0.2) |
| Occupational groups | |||
| Direct patient care | 12640 (79) | 6604 (73) | 6036 (87) |
| Managers | 470 (3) | 259 (3) | 211 (3) |
| Coordinators | 82 (1) | 55 (1) | 27 (0) |
| Indirect patient carea | 1219 (8) | 806 (9) | 413 (6) |
| Otherb | 1554(10) | 1277(14) | 277(4) |
| Months at workplace | |||
| <6 | 1480 (10) | 769 (9) | 711 (11) |
| 6–12 | 1542 (10) | 848 (10) | 694 (11) |
| 13–60 | 6217 (41) | 3431 (41) | 2786 (42) |
| 61–120 | 2570 (17) | 1470 (17) | 1100 (17) |
| 121–240 | 2100 (14) | 1237 (15) | 863 (13) |
| >240 | 1190 (8) | 736 (9) | 454 (7) |
[i] Note: Group totals differ due to incomplete survey responses.
a: Psychologists, dentists/dental nurses, physiotherapists/occupational therapists/dieticians, audiologists/speech therapists, pharmacists, radiology nurses/medical physicists, biomedical scientists/laboratory assistants, and chiropractors.
b: Other which is not specified in the above.
Table 2
Differences in the frequency of experiencing morally stressful situations.
| DIFFERENCES IN THE FREQUENCY OF EXPERIENCING MORALLY STRESSFUL SITUATIONS | |
|---|---|
| PREDICTOR | FREQUENCY OF MORALLY STRESSFUL SITUATIONS, OR [95% CI] (N = 14,935) |
| Age (×10 years) | 0.88 [0.86; 0.91]*** |
| Sex | |
| Male | 0.77 [0.71; 0.84]*** |
| Female (ref) | 1.00 |
| COVID care | |
| Yes | 2.37 [2.23; 2.51]*** |
| No (ref) | 1.00 |
| Occupational group | |
| Indirect patient care | 0.63 [0.57; 0.70]*** |
| Coordinators | 1.23 [0.84; 1.80] |
| Managers | 1.09 [0.93; 1.27] |
| Other | 0.74 [0.67; 0.82]*** |
| Direct patient care (ref) | 1.00 |
[i] Note: The outcome was assessed on a 5-point scale from Never to Very Often and treated as an ordinal variable in the analysis.
Figure 1
The extent of experiencing situations with moral stress. Participants involved in COVID-19 care reported a higher frequency of morally stressing situations (p < 0.001).
Table 3
Differences in ratings of severity of the stress associated with different types of morally stressful situations.
| DIFFERENCES IN RATINGS OF SEVERITY OF THE STRESS ASSOCIATED WITH DIFFERENT TYPES OF MORALLY STRESSFUL SITUATIONS | |||||
|---|---|---|---|---|---|
| PREDICTOR | TYPE OF SITUATION, OR [95% CI] | ||||
| ETHICAL DILEMMA (N = 10050) | UNALIGNED WITH MORAL VALUES (N = 10022) | OTHERS’ DECISIONS (N = 9988) | EXTERNAL OBSTACLES (N = 9979) | FEELINGS OF INSUFFICIENCY (N = 9972) | |
| Age (×10 years) | 0.93 [0.90; 0.96]*** | 0.93 [0.90; 0.96]*** | 0.89 [0.87; 0.92]*** | 0.85 [0.83; 0.88]*** | 0.88 [0.86; 0.91]*** |
| Sex | |||||
| Male | 1.01 [0.92; 1.11] | 0.92 [0.83; 1.01] | 0.96 [0.87; 1.06] | 0.82 [0.74; 0.90]*** | 0.81 [0.73; 0.89]*** |
| Female (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| COVID care | |||||
| Yes | 1.48 [1.38; 1.59]*** | 1.41 [1.31; 1.51]*** | 1.43 [1.34; 1.54]*** | 1.91 [1.78; 2.05]*** | 1.80 [1.68; 1.94]*** |
| No (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Occupational group | |||||
| Indirect patient care | 0.61 [0.53; 0.71]*** | 0.72 [0.63; 0.83]*** | 0.80 [0.70; 0.92]** | 0.66 [0.57; 0.75]*** | 0.68 [0.59; 0.77]*** |
| Coordinators | 1.00 [0.63; 1.58] | 1.37 [0.91; 2.05] | 1.08 [0.72; 1.60] | 0.58 [0.38; 0.86]** | 0.81 [0.50; 1.29] |
| Managers | 1.05 [0.87; 1.26] | 1.10 [0.91; 1.34] | 1.05 [0.85; 1.30] | 1.01 [0.82; 1.24] | 0.90 [0.74; 1.11] |
| Other | 0.81 [0.71; 0.92]** | 0.86 [0.75; 0.98]* | 0.84 [0.74; 0.96]* | 0.67 [0.58; 0.76]*** | 0.75 [0.66; 0.85]*** |
| Direct patient care (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
[i] Note: Moral stress was assessed on a 7-point scale from None to Extreme and treated as ordinal variables in the analyses.
Figure 2
Perceived moral stress after various types of situations. Participants involved in COVID-19 care reported higher levels of stress in all situations (all ps < 0.001).
Table 4
Differences in perceived causes of morally stressful situations.
| DIFFERENCES IN PERCEIVED CAUSES OF MORALLY STRESSFUL SITUATIONS | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| PREDICTOR | PERCEIVED CAUSE. OR [95% CI] | ||||||||
| RESOURCE CONSTRAINTS (N = 9210) | CLASH BETWEEN OWN/OTHERS’ MORAL VALUES (N = 9196) | FORCED ACT OUTSIDE OF COMPETENCE (N = 9193) | CULTURAL, SOCIAL AND POLITICAL ASPECTS(N = 9188) | LEADERSHIP, TEAM STRUCTURES (N = 9186) | COLLEAGUES BEHAVIORS/DECISIONS (N = 9188) | OWN SAFETY BEFORE PATIENT CARE (N = 9176) | PATIENT ISOLATION HINDERING VISITS (N = 9170) | DIFFICULTIES IN END-OF-LIFE CARE (N = 9164) | |
| Age (×10 years) | 0.87 [0.84; 0.89]*** | 1.01 [0.98; 1.04] | 0.83 [0.81; 0.86]*** | 0.97 [0.94; 1.00]* | 0.97 [0.94; 1.00] | 0.91 [0.89; 0.94]*** | 0.93 [0.90; 0.96]*** | 0.92 [0.89; 0.95]*** | 0.93 [0.90; 0.96]*** |
| Sex | |||||||||
| Male | 0.73 [0.66; 0.81]*** | 0.91 [0.82; 1.01] | 0.92 [0.84; 1.02] | 0.99 [0.89; 1.10] | 0.90 [0.81; 1.00]* | 0.94 [0.85; 1.05] | 0.83 [0.75; 0.92]*** | 0.69 [0.63; 0.77]*** | 0.71 [0.64; 0.79]*** |
| Female (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| COVID care | |||||||||
| Yes | 1.99 [1.84; 2.14]*** | 1.45 [1.34; 1.56]*** | 1.76 [1.63; 1.90]*** | 1.42 [1.32; 1.53]*** | 1.37 [1.28; 1.48]*** | 1.22 [1.14; 1.32]*** | 1.85 [1.71; 1.99]*** | 2.40 [2.23; 2.59]*** | 3.07 [2.84; 3.32]*** |
| No (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Occupational group | |||||||||
| Indirect patient care | 0.65 [0.56; 0.76]*** | 0.77 [0.67; 0.90]** | 0.69 [0.60; 0.80]*** | 0.72 [0.62; 0.83]*** | 0.81 [0.70; 0.93]** | 0.57 [0.49; 0.66]*** | 0.63 [0.55; 0.73]*** | 0.48 [0.42; 0.56]*** | 0.44 [0.37; 0.52]*** |
| Coordinators | 0.88 [0.57; 1.38] | 0.88 [0.58; 1.33] | 1.02 [0.62; 1.66] | 1.26 [0.80; 2.00] | 0.77 [0.48; 1.24] | 1.19 [0.76; 1.86] | 0.86 [0.58; 1.27] | 0.68 [0.45; 1.03] | 1.15 [0.69; 1.92] |
| Managers | 1.32 [1.07; 1.62]** | 0.81 [0.66; 1.00] | 1.18 [0.97; 1.43] | 1.02 [0.84; 1.24] | 0.78 [0.64; 0.94]** | 0.81 [0.67; 0.98]* | 0.38 [0.31; 0.47]*** | 0.68 [0.55; 0.84]*** | 0.57 [0.46; 0.72]*** |
| Other | 0.66 [0.57; 0.76]*** | 0.87 [0.76; 1.00] | 0.90 [0.79; 1.04] | 0.89 [0.77; 1.03] | 0.88 [0.76; 1.02] | 0.86 [0.75; 0.99]* | 0.73 [0.63; 0.85]*** | 0.51 [0.44; 0.59]*** | 0.39 [0.33; 0.46]*** |
| Direct patient care (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
[i] Note: Each outcome was assessed on a 7-point scale from Disagree to Fully Agree and treated as ordinal variables in the analyses.
Table 5
Differences in the perceived availability and usefulness of sources of support for moral stress.
| DIFFERENCES IN THE PERCEIVED AVAILABILITY AND USEFULNESS OF SOURCES OF SUPPORT FOR MORAL STRESS | ||||
|---|---|---|---|---|
| PREDICTOR | SOURCES OF SUPPORT, OR [95% CI] | |||
| OWN SOLUTION/IDEAS, FINDING OWN SUPPORT (N = 8741) | WORKPLACE SUPPORT, REFLECTION GROUPS ETC. (N = 8730) | PSYCHOLOGIST/COUNSELLOR, OCCUPATIONAL HEALTH CARE, LEADERSHIP SUPPORT (N = 8727) | INFORMAL SUPPORT; COLLEAGUES, FRIENDS/FAMILY (N = 8721) | |
| Age (×10 years) | 0.98 [0.95; 1.01] | 1.08 [1.04; 1.11]*** | 1.05 [1.02; 1.09]** | 0.94 [0.91; 0.97]*** |
| Sex | ||||
| Male | 1.17 [1.06; 1.29]** | 1.26 [1.14; 1.40]*** | 1.17 [1.06; 1.30]** | 0.86 [0.78; 0.95]** |
| Female (ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| COVID care | ||||
| Yes | 1.44 [1.34; 1.55]*** | 1.16 [1.07; 1.25]*** | 1.37 [1.27; 1.48]*** | 1.62 [1.50; 1.74]*** |
| No (ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Occupational group | ||||
| Indirect patient care | 1.03 [0.89; 1.20] | 0.91 [0.79; 1.06] | 0.97 [0.82; 1.13] | 1.18 [1.01; 1.37]* |
| Coordinators | 0.66 [0.39; 1.12] | 1.48 [1.01; 2.16]* | 1.51 [0.93; 2.45] | 1.23 [0.74; 2.03] |
| Managers | 1.44 [1.18; 1.77]*** | 1.31 [1.07; 1.62]** | 1.91 [1.58; 2.32]*** | 2.09 [1.73; 2.54]*** |
| Other | 0.89 [0.77; 1.04] | 1.10 [0.95; 1.27] | 1.21 [1.05; 1.39]** | 0.95 [0.82; 1.10] |
| Direct patient care (ref) | 1.00 | 1.00 | 1.00 | 1.00 |
[i] Note: Each outcome was assessed on a 7-point scale from Disagree to Fully Agree and treated as ordinal variables in the analyses.