Table 3 Comparisons between physicians and nurses in answers to questionnaireabc
From: Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned
Questions | Physicians (n) %a | Agree (n) %c | Disagree (n) %d | Nurses (n) %a | Agree (n) %c | Disagree (n) %d | MWU p-value | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Moral distress - Quality of care | ||||||||||||||||
 1. I felt I delivered the same quality of care compared to before. | (48) 100 | (18) 38 | (20) 42 | (99) 100 | (22) 22 | (62) 63 | 0.013* | |||||||||
 2. It touched me to see when a patient was not receiving good care. | (48) 100 | (21) 44 | (10) 21 | (99) 100 | (73) 74 | (7) 7 | 0.001** | |||||||||
 3. In most situations I had a strong sense of what did not constitute good care. | (48) 100 | (29) 60 | (3) 6 | (99) 100 | (67) 68 | (9) 9 | 0.674 | |||||||||
 4. I had strong beliefs about ‘good’ and ‘bad’ patient care. | (48) 100 | (28) 58 | (5) 10 | (99) 100 | (75) 76 | (5) 5 | 0.016* | |||||||||
 5. I feel my colleagues provided good care. | (48) 100 | (42) 88 | (0) 0 | (99) 100 | (59) 60 | (9) 9 | 0.000*** | |||||||||
 6. I felt I carried out medical tests and treatments which I myself found unnecessary. | (48) 100 | (8) 17 | (36) 75 | (99) 100 | (11) 11 | (67) 68 | 0.208 | |||||||||
 7. I witnessed a patient suffering as a result of a lack of continuity of caregivers. | (48) 100 | (10) 21 | (32) 67 | (99) 100 | (20) 20 | (56) 57 | 0.124 | |||||||||
 8. I felt had to choose between good care and something else I find important. | (48) 100 | (5) 10 | (29) 60 | (99) 100 | (38) 38 | (43) 43 | 0.001** | |||||||||
 9. I felt we provided suboptimal care because there was not enough personal protective equipment, time or manpower available. | (48) 100 | (13) 27 | (30) 63 | (99) 100 | (52) 53 | (39) 39 | 0.001** | |||||||||
 10. I felt I could do less for the patients than I used to. | (48) 100 | (26) 54 | (14) 29 | (99) 100 | (52) 53 | (38) 38 | 0.662 | |||||||||
Moral distress – Emotional stress | ||||||||||||||||
 11. Strong feelings arose when I saw a patient suffering. | (48) 100 | (17) 35 | (15) 31 | (99) 100 | (54) 55 | (21) 21 | 0.032* | |||||||||
 12. I felt strongly about the well-being of the patients. | (48) 100 | (36) 75 | (0) 0 | (99) 100 | (80) 81 | (2) 2 | 0.768 | |||||||||
 13. I felt that, in order to be able to finish my tasks, I had to put my values and views regarding good care aside. | (48) 100 | (6) 13 | (32) 67 | (99) 100 | (51) 52 | (39) 39 | 0.000*** | |||||||||
 14. I was worried my work was emotionally numbing me. | (48) 100 | (14) 29 | (26) 54 | (99) 100 | (41) 41 | (45) 45 | 0.062 | |||||||||
 15. I frequently thought to myself: what am I actually doing here? | (48) 100 | (13) 27 | (27) 56 | (99) 100 | (47) 47 | (35) 35 | 0.009** | |||||||||
 16. Compared to before, I enjoyed my work less. | (48) 100 | (11) 23 | (26) 54 | (99) 100 | (52) 53 | (34) 34 | 0.001** | |||||||||
 17. I worried about my work. | (48) 100 | (13) 27 | (22) 46 | (99) 100 | (60) 61 | (27) 27 | 0.001** | |||||||||
Team cooperation | ||||||||||||||||
 1. At the ICU, there was regular reflection on the quality of care we provided from the different perspectives of the employees. | (45) 94 | (14) 31 | (18) 40 | (94) 95 | (29) 31 | (45) 48 | 0.228 | |||||||||
 2. At the ICU there was an open and constructive culture in which criticism could easily be expressed. | (45) 94 | (27) 60 | (6) 13 | (94) 95 | (29) 31 | (35) 37 | 0.000*** | |||||||||
 3. At the ICU there was regular structural discussion between the various disciplines within the team about patient care. | (45) 94 | (23) 51 | (12) 27 | (94) 95 | (36) 38 | (29) 31 | 0.177 | |||||||||
 4. At the ICU there were regular opportunities for open and informal discussions between care providers. | (45) 94 | (29) 64 | (4) 9 | (94) 95 | (55) 59 | (24) 26 | 0.045* | |||||||||
 5. At the ICU, I had confidence in the professional competencies of my team members. | (48) 100 | (42) 88 | (2) 4 | (99) 100 | (66) 67 | (12) 12 | 0.006** | |||||||||
Ethical climate | ||||||||||||||||
 1. At the ICU I was always considered and addressed as a full member of the team by everyone in the team. | (48) 100 | (41) 85 | (3) 6 | (99) 100 | (57) 56 | (30) 30 | 0.001** | |||||||||
 2. At the ICU, team members from another discipline respected my work. | (48) 100 | (43) 90 | (1) 2 | (99) 100 | (68) 69 | (16) 16 | 0.000*** | |||||||||
 3. I considered being vulnerable as a sign of weakness. | (45) 94 | (5) 11 | (38) 84 | (94) 95 | (13) 14 | (70) 74 | 0.446 | |||||||||
Ways of dealing with challenges around end of life decisions | ||||||||||||||||
 1. At the ICU there was a structured formal debrief after a difficult situation in patient care. | (46) 96 | (17) 37 | (13) 28 | (98) 99 | (30) 31 | (35) 36 | 0.133 | |||||||||
 2. At the ICU, moral and ethical problems were discussed. | (47) 98 | (30) 64 | (4) 9 | (99) 100 | (43) 43 | (31) 31 | 0.009** | |||||||||
 3. At the ICU, nurses were involved in end-of-life decisions. | (46) 96 | (19) 41 | (11) 24 | (98) 99 | (31) 32 | (20) 20 | 0.265 | |||||||||
 4. At the ICU, there was good cooperation between nurses and physicians regarding end-of-life care. | (46) 96 | (31) 67 | (5) 11 | (98) 99 | (45) 46 | (12) 12 | 0.057 | |||||||||
 5. Different opinions and values regarding end-of-life care were tolerated at the ICU. | (47) 98 | (40) 85 | (1) 2 | (99) 100 | (54) 55 | (7) 7 | 0.001** | |||||||||
 6. My colleagues understood my ideas/feelings regarding difficult end-of-life decisions. | (47) 98 | (33) 70 | (1) 2 | (99) 100 | (46) 46 | (4) 4 | 0.003** | |||||||||
 7. Providing care to patients who I thought shouldn’t receive care. | (48) 100 | (10) 21 | (32) 67 | (99) 100 | (10) 10 | (70) 71 | 0.504 | |||||||||
 8. At the ICU, death was considered therapeutic failure, so decisions to scale back or not start therapy were rarely made. | (46) 96 | (3) 7 | (36) 78 | (97) 98 | (11) 11 | (43) 44 | 0.000*** | |||||||||
 9. Starting life-saving actions that I thought only delayed death. | (48) 100 | (22) 46 | (13) 27 | (99) 100 | (47) 47 | (30) 30 | 0.793 | |||||||||
 10. At the ICU, end-of-life decisions were often postponed. | (46) 96 | (15) 33 | (23) 50 | (96) 97 | (36) 38 | (20) 21 | 0.008** | |||||||||
 11. At the ICU, patients with a small chance of recovery regularly occupied an ICU bed from which other patients could benefit more. | (46) 96 | (11) 24 | (14) 30 | (96) 97 | (31) 32 | (17) 18 | 0.169 | |||||||||