Moralsk stress i ambulancearbejdet: En kvalitativ interviewundersøgelse

Abstract

This thesis focuses on the causes, manifestations and coping strategies related to moral stress, with particular attention to the processes that lead to successful reconciliation in emergency service (EMS) work. The concept of moral distress originates in nursing practice where it is a well-recognised stressor. However, only a few studies have in-vestigated moral distress in other fields, such as EMS work. The aim of this thesis is to provide insights into moral distress in EMS work to help facilitate better interven-tions. The thesis consists of six chapters. The first chapter introduces the research agenda and outlines the research questions. The second chapter explores the concept of moral distress through a review and discussion of the existing research. This review reveals that an adequate understanding of moral distress must consider not only moral constraints but also moral conflicts, moral uncertainty, delayed moral distress, and ac-cumulated moral distress. Additionally, it becomes evident that an adequate under-standing of moral distress must also consider the complex sociopolitical environment that healthcare professionals must navigate. The third chapter outlines pragmatism as the scientific standpoint of the thesis and presents the methods chosen for data collection and data analysis. The data col-lected consists of three qualitative semi-structured interviews with EMS professionals consisting of two men and one woman. The data has been analysed using thematic analysis. Ethical considerations of the study are also discussed. In the fourth chapter, the data is analysed. Moral constraints such as institutional and hierarchical limitations (external constraints) and lack of competence or inatten-tion (internal constraints) emerge as significant causes of moral distress. Moral uncer-tainty – such as lack of closure and uncertainty about the patient’s condition – serves both as an independent cause and amplifier for other forms of moral distress. Moral conflicts – such as the conflict between prioritizing patient safety versus personal safety, or patient autonomy versus the perceived best course of action – also play a central role in EMS moral distress. Additionally, some first responders experience de-layed moral distress upon later realizing they made mistakes. These sources of moral distress manifest as frustration, feelings of powerlessness, self-blame, sympathy for patients, and painful moral emotions such as guilt and shame. First responders employ a range of individual coping strategies – such as break-ing the rules to act morally and rationalizing one’s actions to reduce the emotional discomfort. Older EMS professionals also engage in cultivating a collective masculin-ity culture in which the job’s inherent vulnerabilities are denied – ultimately limiting their younger peers’ coping opportunities. However, first responders also rely on col-lective coping communities, where dark humour and team dialogue provide effective ways to cope with moral distress. For such dialogue to lead to reconciliation, it must contain certain qualities such as validation, understanding and professionalism. The fifth chapter discusses the findings, which both reflect and extend previous research by discussing interrelated factors – such as budget cuts, understaffing, high demands and work-related uncertainties, which pressure first responders who, for moral reasons, put their personal safety aside to help patients. The fatigue resulting from such self-sacrifice can lead to inattention and mistakes, thereby contributing to further moral stress. The study argues that further research is needed on interrelated causes of moral distress – such as the different moral conflicts that EMS professionals experience. While the study adds valuable insight into how first responders cope with moral distress, the findings may have been presented in a somewhat decontextualised man-ner, underemphasizing the fact that EMS professionals work in pairs that influence one another’s coping strategies. Finally, the quality of the study is discussed, along with its potential implications for various stakeholders and recommendations for interven-tions against moral distress in EMS work. The study argues that focused efforts are needed to educate leaders and EMS professionals about the causes and coping of moral distress thereby helping to destigmatize these experiences. It is also recommended that hospitals produce flyers encouraging patients to seek out and provide closure to EMS professionals. Efforts to support collective coping – such as providing EMS profes-sionals with formal education in crisis psychology and enhancing informal debriefing and dialogue – are also recommended. For psychologists, it is recommended to apply a social perspective in therapy.

A master thesis from Aalborg University

Moralsk stress i ambulancearbejdet: En kvalitativ interviewundersøgelse

[Moral distress in emergency service work: A qualitative interview study]