Background and Objectives

Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies.

Methods

This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis.

Results

Of 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to “bend the rules,” lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes.

Conclusions

These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked.

中文翻译：

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学术家庭医学诊所的道德困境经历

背景和目标

初级保健提供者 (PCP) 报告工作满意度下降和高度倦怠，但人们对他们的道德困扰经历知之甚少。本研究的目的是深入了解 PCP 在道德困扰方面的经历，包括致病因素和建议的缓解策略。

方法

这项定性试点研究使用半结构化访谈来确定学术家庭医学部门 PCP 道德困扰的原因。使用传统的内容分析对访谈进行分析。

结果

在 35 名符合条件的参与者中，有 12 人完成了研究（参与率为 34%）。大多数是白人女性，从业时间不到 10 年。由于道德困境，四名 PCP 曾考虑离职。参与者确定了道德困扰的五个原因：与患者需求相冲突的政策和程序、初级保健的不可预测性、需要“改变规则”、缺乏问责制和缺乏支持人员。六种内部冲突使得解决道德上令人痛苦的情况变得困难：无力感、责任感、服从命令的社会化、工作的情感代价、相互竞争的义务和对错误的恐惧。

结论

这些发现与当前文献中的主题相匹配，并确定了一个坚定的基础设施。这一点，再加上初级保健的混乱性质，导致经常出现道德困境。参与者提供了减少和减轻道德困扰的解决方案（也与当前文献相似），并建议道德困扰和倦怠密切相关。