Evidence-Informed Strategies to Mitigate the Negative Effects of Social Worker’s Moral Distress

Background and Purpose: The COVID-19 pandemic has negatively influenced frontline social workers’ professional efficacy. Barriers in high quality service provision, rapid and frequent changes in organizational policies and practices, and individual health and safety considerations in high risk fields have become shared knowledge. Encounters of moral distress (MD) occur when institutional or individual constraints prevent ethical and socially just decision-making; social workers perform tasks that conflict with their professional code of ethics and values. Negative effects of MD include poor patient care, damaged peer relationships, and job dissatisfaction and attrition. Yet, there is limited research on MD in social work. Extant research in nursing and medicine has led to intervention strategies that do not reflect an interdisciplinary approach to support frontline workers’ mental health and well-being. The purpose of this presentation is to report and comment on findings from a multi-phase qualitative study on healthcare social worker’s experiences of MD prior to and during the COVID-19 pandemic.

Methods: Our qualitative study aimed to examine MD among healthcare social workers across Texas. The initial phase of the study began prior to the Covid-19 pandemic at a large tertiary care hospital in a major metropolitan city. In Fall/Winter 2020, recruitment expanded to include participants across Texas owing to the unprecedented events caused by the pandemic. The onset of the Delta variant resulted in a final recruitment phase in Spring 2021. Participants were recruited via social media and chain referrals. Fifty-nine semi-structured interviews were conducted, recorded, and transcribed verbatim. The sample predominantly female (93%), White (49% White, 25% Black, 17% Hispanic). Directed content analysis was applied to code interview data, and the research team met frequently to reach consensus on emerging patterns and themes.

Results: Findings suggest that the COVID-19 pandemic exacerbated social workers’ MD by having to: (1) balance patient privacy with community and public health risks, (2) confront systemic injustices of the U.S. health system, and (3) work within systems that devalue social work competencies. The data suggest that interventions to alleviate MD ought to be implemented at micro, mezzo, and macro levels of practice. Micro-level strategies may include establishing trustworthy support systems, identifying boundaries at work, and acknowledging limits to one’s professional competencies. Mezzo-level strategies include building cohesive team-based communication and strong mentorship and supervisory relationships. Institutional-level policies include implementing strategies to support professional development and afford leadership opportunities that challenge the hierarchy of the health system. As social workers’ MD may derive from systems of oppression beyond their organization, applying social justice advocacy initiatives may alleviate feelings of self-doubt, powerlessness, and apathy.

Conclusions: Our research demonstrates that social workers are experiencing heightened levels of MD during the pandemic; yet evidence-informed interventions are still created for the benefit of alleviating short-term negative stress responses of nurses and physicians. Our research demonstrates the need for empirical research that aims to understand the unique triggers of social workers’ MD to create long-term intervention platforms that address social workers’ longstanding physical, emotional, and psychological health.