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'Moral distress' significantly link with burnout in ICU clinicians during COVID-19

While clinicians working in the ICU experienced burnout symptoms during COVID-19, several were significantly associated with "moral distress," such as scarcity of resources and not working with qualified colleagues, found a Dutch study.

Niek Kok, a PhD candidate at Radboud Institute for Health Sciences in Nijmegen, the Netherlands, found in a stud presented at the Society of Critical Care Medicine (SCCM) virtual Critical Care Congress that while odds for nurses to have burn-out symptoms were more than 2.5 times greater than for physicians, incidence of burnout among physicians rose significantly during the COVID-19 pandemic.

Kok noted while several studies measured prevalence of burnout among healthcare workers during COVID-19, none had a baseline measurement, allowing a "before/after" picture of clinician symptoms.

"Simple prevalence estimates don't tell us anything about how burnout symptoms develop in ICU professionals over time," he said. "We cannot predict a disruptive event like the COVID-19 pandemic, so it's hard to time a baseline measurement like this."

Fortunately, Kok's group had a baseline measurement, as they surveyed ICU professionals about burnout in December 2019, just before the pandemic hit. They then followed up with a survey in May-June 2020 of the same ICU professionals to see how "burnout symptoms develop over time," Kok said.

Researchers measured burnout symptoms with the Maslach Burnout Inventory and moral distress with the Moral Distress Scale Revised.

Overall, 252 ICU professionals in a university medical centre and a large teaching hospital in the Netherlands responded to the survey in December, and 233 in June, for a response rate above 50% each time, with 153 overlapping. Of these, 21% were physicians and 79% were nurses. In June, 56% of respondents said they worked overtime, and 88% said they worked in a COVID unit.

Not surprisingly, 36% of respondents said they experienced burnout symptoms in June 2020 versus 23% in December 2019. Interestingly, the prevalence of burnout symptoms increased, with the percentage more than doubling among physicians from December to June (13.2% vs 28.6%, respectively).

Incidence of burnout also increased dramatically with 26.6% of physicians who did not report burnout symptoms in December reporting them in June. This incidence was higher than in nurses (21.7%).

The authors also measured "moral distress," which Kok defined as "where professionals know the right thing to do, but are prevented from doing so."

Among those surveyed, scarcity of time, personnel, and resources was the most morally distressing situation in June. When compared with December, there were significant increases among those who thought a colleague was perceived as not skilled enough and a colleague believed to act unsafe.

"We believe this has to do with recruitment of personnel from outside ICU wards because of the shortage of ICU nurses," Kok said.

Kok said moral distress clearly plays a role in the development of burnout symptoms, so it is "highly important" to address it through peer supports and ethics committees, though more research is needed to assess this issue as the pandemic continues to progress, he noted.


Study details
Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals: A Longitudinal Cohort Study

Kok, Niek; van Gurp, Jelle; Teerenstra, Steven; van der Hoeven, Hans; Fuchs, Malaika; Hoedemaekers, Cornelia; Zegers, Marieke

Published in Critical Care Medicine on 28 January 2021

ICU professionals are at risk of developing burnout due to coronavirus disease 2019. This study assesses the prevalence and incidence of burnout symptoms and moral distress in ICU professionals before and during the coronavirus disease 2019 crisis.
This is a longitudinal open cohort study.
Five ICUs based in a single university medical center plus another adult ICU based on a separate teaching hospital in the Netherlands.
All ICU professionals were sent a baseline survey in October–December 2019 (252 respondents, response rate: 53%), and a follow-up survey was sent in May–June 2020 (233 respondents, response rate: 50%).
Measurements and Main Results:
Burnout symptoms and moral distress measured with the Maslach Burnout Inventory and the Moral Distress Scale, respectively. The prevalence of burnout symptoms was 23.0% before coronavirus disease 2019 and 36.1% at postpeak time, with higher rates in nurses (38.0%) than in physicians (28.6%). Reversely, the incidence rate of new burnout cases among physicians was higher (26.7%) than nurses (21.9%). Higher prevalence of burnout symptoms was observed in the postpeak coronavirus disease 2019 period (odds ratio, 1.83; 95% CI, 1.32–2.53), for nurses (odds ratio, 1.77; 95% CI, 1.03–3.04), for professionals working overtime (odds ratio 2.11; 95% CI, 1.48–3.02), and for professionals directly engaged with care for coronavirus disease 2019 patients (odds ratio, 1.87; 95% CI, 1.35–2.60). Physicians were more likely than nurses to develop burnout symptoms due to coronavirus disease 2019 (odds ratio, 3.56; 95% CI, 1.06–12.21).
This study shows that overburdening of ICU professionals during an extended period of time leads to symptoms of burnout. Working long hours and under conditions of scarcity of staff, time, and resources comes at the prize of ICU professionals’ mental health.



[link url=""]Critical Care Medicine study (Restricted access)[/link]

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