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Moral distress among maternity and neonatal healthcare workers during the COVID-19 pandemic in Sweden : Results from the COPE staff longitudinal cohort study

Ernst, Patricia ; Linden, Karolina LU orcid ; Roczniewska, Marta ; Hadzibajramovic, Emina ; Wessberg, Anna ; Andersson, Ola LU orcid ; Carlsson, Ylva ; Graner, Sofie ; Jonsson, Maria LU and Veje, Malin , et al. (2025) In Acta Obstetricia et Gynecologica Scandinavica 104(7). p.1399-1409
Abstract

Introduction: Moral distress arises when healthcare workers face difficult decisions without adequate information and/or when patient care is compromised due to limited resources, communication issues, or altered work routines in exceptional circumstances. While moral distress in maternity and neonatal healthcare workers (MNHCWs) has been noted, its prevalence, intensity, and impact on well-being and turnover in Sweden remain unexplored. The aim of this study was to investigate the level of disturbance and frequency of experiencing moral distress among Swedish MNHCWs during the COVID-19 pandemic and the effects on MNHCWs' well-being and intention to leave their job. Material and Methods: A longitudinal cohort study was conducted during... (More)

Introduction: Moral distress arises when healthcare workers face difficult decisions without adequate information and/or when patient care is compromised due to limited resources, communication issues, or altered work routines in exceptional circumstances. While moral distress in maternity and neonatal healthcare workers (MNHCWs) has been noted, its prevalence, intensity, and impact on well-being and turnover in Sweden remain unexplored. The aim of this study was to investigate the level of disturbance and frequency of experiencing moral distress among Swedish MNHCWs during the COVID-19 pandemic and the effects on MNHCWs' well-being and intention to leave their job. Material and Methods: A longitudinal cohort study was conducted during January–May 2021 (n = 645) and January–March 2022 (n = 503), utilizing the Moral Distress Scale-Revised (MDS-R). The study was set in hospital-based maternity and neonatal units across all 21 Swedish healthcare regions and included midwives, physicians, registered nurses, and assistant nurses. Quantitative and descriptive analyses were performed, with comparisons of moral distress levels between time points and professions. The main outcome measures were moral distress (level of disturbance and frequency) and intention to leave their job. Results: Among the respondents, 6%–47% reported being frequently exposed to morally challenging situations, and 51%–91% reported a high level of disturbance in connection to such situations. Uncertain staffing, continuity-of-care challenges, and limited opportunities for patient/family counseling posed frequent moral challenges across time and professions. Of the respondents, 14% in 2021 and 18% in 2022 considered leaving their jobs due to moral distress. There were no overall significant differences in outcomes between the two time points. Conclusions: Swedish MNHCWs commonly experienced moral distress during the COVID-19 pandemic. Interventions targeting underlying reasons may be needed to ensure the well-being of MNHCWs in situations when the healthcare system is under strained working conditions.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COVID-19 pandemic, healthcare workers, maternity healthcare, moral distress, neonatal healthcare, Sweden
in
Acta Obstetricia et Gynecologica Scandinavica
volume
104
issue
7
pages
1399 - 1409
publisher
Wiley-Blackwell
external identifiers
  • pmid:40247755
  • scopus:105005169346
ISSN
0001-6349
DOI
10.1111/aogs.15125
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
id
d8a7a06f-9bc9-4254-b046-d942990746fd
date added to LUP
2025-07-15 12:19:20
date last changed
2025-07-15 15:44:34
@article{d8a7a06f-9bc9-4254-b046-d942990746fd,
  abstract     = {{<p>Introduction: Moral distress arises when healthcare workers face difficult decisions without adequate information and/or when patient care is compromised due to limited resources, communication issues, or altered work routines in exceptional circumstances. While moral distress in maternity and neonatal healthcare workers (MNHCWs) has been noted, its prevalence, intensity, and impact on well-being and turnover in Sweden remain unexplored. The aim of this study was to investigate the level of disturbance and frequency of experiencing moral distress among Swedish MNHCWs during the COVID-19 pandemic and the effects on MNHCWs' well-being and intention to leave their job. Material and Methods: A longitudinal cohort study was conducted during January–May 2021 (n = 645) and January–March 2022 (n = 503), utilizing the Moral Distress Scale-Revised (MDS-R). The study was set in hospital-based maternity and neonatal units across all 21 Swedish healthcare regions and included midwives, physicians, registered nurses, and assistant nurses. Quantitative and descriptive analyses were performed, with comparisons of moral distress levels between time points and professions. The main outcome measures were moral distress (level of disturbance and frequency) and intention to leave their job. Results: Among the respondents, 6%–47% reported being frequently exposed to morally challenging situations, and 51%–91% reported a high level of disturbance in connection to such situations. Uncertain staffing, continuity-of-care challenges, and limited opportunities for patient/family counseling posed frequent moral challenges across time and professions. Of the respondents, 14% in 2021 and 18% in 2022 considered leaving their jobs due to moral distress. There were no overall significant differences in outcomes between the two time points. Conclusions: Swedish MNHCWs commonly experienced moral distress during the COVID-19 pandemic. Interventions targeting underlying reasons may be needed to ensure the well-being of MNHCWs in situations when the healthcare system is under strained working conditions.</p>}},
  author       = {{Ernst, Patricia and Linden, Karolina and Roczniewska, Marta and Hadzibajramovic, Emina and Wessberg, Anna and Andersson, Ola and Carlsson, Ylva and Graner, Sofie and Jonsson, Maria and Veje, Malin and Sengpiel, Verena and Akerstrom, Magnus}},
  issn         = {{0001-6349}},
  keywords     = {{COVID-19 pandemic; healthcare workers; maternity healthcare; moral distress; neonatal healthcare; Sweden}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1399--1409}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Obstetricia et Gynecologica Scandinavica}},
  title        = {{Moral distress among maternity and neonatal healthcare workers during the COVID-19 pandemic in Sweden : Results from the COPE staff longitudinal cohort study}},
  url          = {{http://dx.doi.org/10.1111/aogs.15125}},
  doi          = {{10.1111/aogs.15125}},
  volume       = {{104}},
  year         = {{2025}},
}