HJNO Jan/Feb 2022

HEALTHCARE JOURNAL OF NEW ORLEANS  I  JAN / FEB 2022 55 Jan Kasofsky, PhD Senior Vice President of Behavioral Health & Human Services Access Health Louisiana feelings of distress, compassion fatigue, depression, anxiety, guilt, shame, anger and potentially even disgust in carrying out their responsibility in a manner that they disagree with. It has implications for satisfaction, recruitment and retention of healthcare providers and implications for the delivery of safe and competent quality patient care. A key element in moral distress is the individual’s sense of powerlessness in re- sponse to their inability to carry out the action perceived as ethically appropriate. They may comply with a directive to which they disagree out of fear of losing their job, their own self-doubt or concern about creating conflict. Within a team, individu- als may be concerned about disrupting a power hierarchy, pressure to conform to policies, legal action or lack of administra- tive support. Because of the inordinate and unimag- ined amount of human suffering and death healthcare providers are being exposed to, it is even more critical now that healthcare leaders and administrators mitigate the negative effects of moral distress. By first acknowledging how policies can lead to moral distress, leaders can be proactive by obtaining input from caregivers prior to implementation. This step can not only lead to better ideas and fuller relation- ships, but also address the isolation and sense of powerlessness at the center of moral distress. In 2009, researchers Epstein and Ham- ric recommended strategies that included: encouraging providers to raise concerns to leadership with the authority to make changes in the policies and the delivery environment, connecting colleagues who are experiencing similar situations and encouraging them to work together for support and to create change, identifying root causes of problems that span the sys- tem and advocating for lasting change that crosses disciplines in the system, and ed- ucating other providers about what moral distress is and how to improve policies and environments to prevent it. It is increasingly important for health- care leaders and managers to recognize situations that can lead to moral distress. They must know how to be supportive and address the ethical conflicts that can arise in the delivery of patient-centered care, especially during the pandemic. This in- cludes establishing real opportunities for caregivers to express their concerns and for their suggestions to be seriously con- sidered to create needed organizational change. While it may be true that many sit- uations within the healthcare delivery sys- tem can create moral distress, it would be a huge mistake to dismiss its impact. Our “healthcare heroes” deserve the same level of empathy, respect and support they give to each of us as their patients. n potential risk to one’s own safety and that of a loved one. Extended work hours and shifts left providers exhausted. And, newly developed treatment protocols were nec- essarily and rapidly implemented without the typical practice trials and training. Ev- eryone was faced with making decisions about the use of limited resources. Another aspect of the pandemic that created moral distress was the quarantin- ing of hospital patients. Clearly, this was done to prevent infecting staff and family members, but it was a strain on providers seeing critically ill patients isolated from their loved ones even though providers tried their best to fill that void. Due to the sheer volume of infected patients, hospi- tal and clinic staff had to follow policies that delayed treatment for patients with non-COVID-related health problems. Treatment staff had to care for patients in ways that they might not have considered optimal in the context of pre-pandemic patient care. Healthcare providers experience mor- al distress when they must make difficult choices between following what health- care systems permit or following their conscience. The need to make such diffi- cult decisions feels inconsistent with the core values of many healthcare profes- sionals who want to deliver patient-cen- tered care. Typical emotional responses to moral distress include burnout and