Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study

Abstract

Background: Burnout threatens intensive care unit (ICU) professionals' capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work-life balance and culture. This study aimed to disentangle the associations of ICU professionals' moral distress and other risk factors with the components of burnout-emotional exhaustion, depersonalisation and personal accomplishment-suggesting informed burnout prevention strategies.

Methods: Cross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work-home balance (Survey Work-Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out.

Results: 251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27).

Conclusions: Understanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work-home imbalance. Interventions that support individual coping with moral distress and a work-home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.

Keywords: critical care; healthcare quality improvement; leadership; mental health; surveys.

Figure 1

Associations between moral distress and emotional exhaustion through negative work–home interactions. Using Hayes PROCESS Macro, all pathways could be tested. The mediation analysis was controlled for by other risk factors of BOS, including the demographics and all the subdomains of personality reported in tables 1 and 2. BOS, burnout syndrome.

Figure 2

Association between moral distress and emotional exhaustion moderated by felt support from direct supervisors.1The Y-axis reports emotional exhaustion on the original 7-point Likert scale ranging from never (0) to daily (6).