J Korean Med Sci.  2023 Jun;38(22):e169. 10.3346/jkms.2023.38.e169.

Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses

• Choi EK
• Kang J
• Park HY
• Kim YJ
• Hong J
• Yoo SH
• Kim MS
• Keam B
• Park HY

• KMID: 2542801
• DOI: http://doi.org/10.3346/jkms.2023.38.e169

Abstract

Background
Healthcare professionals often experience moral distress while providing endof-life care. This study explored how physicians and nurses experienced moral distress when they cared for critically and terminally ill patients in tertiary hospitals in South Korea.
Methods
This study used semi-structured in-depth interviews. A total of 22 people in two tertiary hospitals were interviewed, nine (40.9%) of which were physicians and 13 (59.1%) were nurses. The recorded interview files and memos were analyzed using grounded theory.
Results
Most physicians and nurses encountered similar feelings of anger, helplessness, and burden owing to a lack of appropriate resources for end-of-life care. However, the factors and contexts of their moral distress differed. Nurses mainly addressed poorly organized end-of-life care, intensive labor conditions without support for nurses, and providing care without participation in decision-making. Meanwhile, physicians addressed the prevailing misperceptions on end-of-life care, communication failure between physicians owing to hierarchy and fragmented disciplines, the burden of responsibility in making difficult decisions, and the burden of resource allocation.
Conclusion
Differences in moral distress between physicians and nurses leave them isolated and can affect communication regarding healthcare. Mutual understanding between job disciplines will enhance their communication and help resolve conflicts in end-of-life care.

Keyword

End-of-Life Care; Physician-Nurse Relations; Hospitals; Moral Distress; Qualitative Research

Figure

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  Fig. 1 Main aspects of moral distress in nurses and physicians.

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