Structural issues causing moral distress for women in the health care industry

SFU study highlighted the issues that increase distress, predate the pandemic

This is a photo of a woman working in a health care room. The woman appears to be doing a surgical procedure based on her clothes, but no patient is shown in the photo.
PHOTO: Artur Tumasjan / Unsplash

By: Pranjali J Mann, News Writer

A recent study conducted by SFU health sciences assistant professor, Julia Smith, found women in health care experienced increased moral distress during the pandemic. 

During COVID-19, staffing shortages and a lack of access to necessary equipment — like personal protective equipment (PPE) kits and masks — was found to increase moral distress in 2020 and 2021. The study also indicated that “at home, women experienced moral constraints related to inability to support children’s education and well-being.” 

Moral distress, a central theme of the research, pointed to a situation “when you know the ethically correct action to take, but you are constrained from taking it.” According to the study, women in the healthcare industry were constrained in their ability to provide quality care to COVID-19 patients due to existing flaws in the health care system like worker shortage and “increasing privatization and marketization of health care.” These factors left them feeling distressed with the inability to cope with crises.  

The researchers mapped out four forms of participant challenges “related to moral events which were categorized as constraints, conflicts, dilemmas, or uncertainties.” The study data was gathered through individual and focus group interviews among 88 health care providers in British Columbia. The research was published last month in Nursing Ethics

The study implements framework analysis methodology. This qualitative research method is used in public and health policy research where research findings from interviews are categorized into a “corresponding participant and theme.” Through the interviews, Smith and the research associates found that women health care providers feel “double distress.” This dilemma comes from the many responsibilities women in health care face — they often also provide care for their families at home, in addition to the their care-oriented professions. 

To find out more about this research, The Peak interviewed Smith. She underlined the importance of studying the case of women health care workers in the pandemic. 

Smith said, “We focused on women because the majority of healthcare workers identify as women and also we recognize that women in Canada tend to do more unpaid care work.” Women healthcare workers simultaneously provided a workforce and cared for families, thus doing “two to three times more unpaid care work than men.”  

She also identified a lack of research in this field — understanding moral distress, constraints, and unpaid labour provided by women health care providers. Unpaid labor includes “work required to maintain the household — from chores such as grocery shopping, cooking and cleaning, to taking care of the children, sick, and elderly within the family.” This kind of work is usually not compensated by wages and often expected to be performed by women. 

She illustrated the participants felt moral distress because they were required to work overtime in COVID-19 related shortages. This resulted in less family time for child care, mental burnout, and physical exhaustion. “It’s the multiple burdens that have this dramatic effect,” said Smith. 

According to SFU News, “supervisors or managers were too distanced from the realities of care work” and were not flexible for working conditions as childcare closures occurred at the height of the pandemic. Uncertainty was also key during this time as correct ways to care for the patients was unclear. 

Smith called for systemic changes to increase investment in health care as a whole, along with other industries like childcare. She suggested some individual coping strategies as well. She said, “Not all the healthcare workers we spoke to had access to counselling, had the resources to pay for counselling, for example. So I think what we need to see in terms of broader changes would be policies to ensure adequate staffing including increased pay raises, better conditions of work in order to attract people to these sectors.” 

To learn more about Smith’s study, visit the Nursing Ethics journal.