Moral distress among inpatient child and adolescent psychiatry staff: a mixed-methods study of experiences and associated factors.

Abstract

Background: Moral distress among healthcare staff is associated with emotional strain and workforce attrition but remains insufficiently explored in child and adolescent psychiatry (CAP). We investigated the experiences and factors contributing to moral distress among staff in inpatient CAP.

Methods: We conducted a 2023 nationwide mixed-methods survey with 106 staff members from CAP inpatient units in Sweden. Quantitative data on moral distress were collected using the Stress of Conscience Questionnaire, while open-ended questions provided qualitative data on perceptions of moral distress and the impact of working with coercive measures. Findings were integrated using triangulation.

Results: Staff reported high levels of moral distress, with physicians experiencing the highest. Triangulation revealed converging findings with younger and less experienced staff experiencing more moral distress. Aligning with the qualitative theme "Providing care one does not believe in", moral distress was also strongly associated with quantitative data of a demanding work environment, low social support, and intention to resign from job. The theme "Ethical dilemmas about coercive measures" indicated how coercive measure use could contribute to moral distress, while a more positive attitude to coercive measures was associated with lower moral distress.

Conclusions: Moral distress among CAP inpatient staff in Sweden was pronounced, particularly among younger, less experienced professionals, and physicians. Addressing moral distress appears critical in supporting staff well-being, promoting workforce retention, and maintaining high-quality patient care.