Moral distress among healthcare professionals working in intensive care units in Spain

Objective: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). Design: Cross-sectional, prospective study. Setting: ICUs in Spain. Participants: HCPs currently working in Spanish ICUs. Interventions: A 55-item questionnaire was electronically distributed. Main variables: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). Results: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p = 0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p < 0.001). The MMDHP-SPA was inversely correlated with the HECS (r = -0.277, p < 0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. Conclusions: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job. (C) 2021 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.