Published: 27-03-2020 17:53 | Updated: 02-04-2020 16:59

Moral distress can affect healthcare personnel during COVID-19 crisis

With rising numbers of COVID-19 cases and a healthcare sector under increasing strain, healthcare personnel can find themselves facing difficult situations and moral challenges. Researchers at Karolinska Institutet and Uppsala University have recently published a paper in the journal Prehospital and Disaster Medicine precising what is known about moral distress, its risk and protection factors and likely implications. They also present suggestions about how the adverse effects can be mitigated.

When healthcare personnel find themselves in difficult situations and dilemmas that prevent them from acting in a way they believe to be right, they are susceptible to moral distress.

“Moral distress refers to a strain that can have serious negative consequences and that therefore cannot be ignored,” says Martina Gustavsson, registered nurse, research officer at the Department of Global Public Health, Karolinska Institutet and research assistant at Uppsala University.

Gustavsson is part of an interdisciplinary research project on moral distress among disaster responders, a collaboration between the Centre for Research on Healthcare in Disasters (Department of Global Public Health) and the Department of Learning, Informatics, Management and Ethics at Karolinska Institutet and the National Centre for Disaster Psychiatry at Uppsala University. Working alongside Filip Arnberg, Niklas Juth and Johan von Schreeb she has gathered together current knowledge on the concept of moral distress, its risk and protection factors and its likely implications.

How to reduce the negative effects

More research is needed in this field, but going by what is currently known, the researchers believe that the following points could reduce the negative effects of moral distress:

  • To be familiar with the concepts of moral distress, stress and stress management (and to have good self-awareness).
  • To have solid collegial support, a professional, open work environment and a willingness to improve and learn from experience.
  • To have good support from managers and organisation (as above).
  • To have workplace routines for (a) regular meetings – After Action Reviews – either as a distinct part of routine business or individually convened on a needs basis, and (b) comprehensive feedback, individually or in groups.
  • To have good access to external psychosocial support when needed, provided that the support person is adequately aware of the nature of the context and the profession’s roles and responsibilities.


“Moral Distress among Disaster Responders: What is it?”. Martina E. Gustavsson, Filip K. Arnberg, Niklas Juth, Johan von Schreeb. Prehospital and Disaster Medicine, online 28 January 2020, doi: 10.1017/S1049023X20000096.