Individual and system causes of moral distress experienced by public health practitioners in Canada

Publisher abstract

Moral distress has been studied across many health arenas; however, public health has often been overlooked. Canada is facing a healthcare crisis with a significant number of staff leaving the healthcare field. This study explores the experiences of moral distress in public healthcare practitioners across Canada. Better understanding these experiences can provide insights into how to support staff and prevent attrition in public health across the globe. This is a qualitative study using in-depth semi-structured interviews. Fifteen in-depth interviews were conducted between May and July 2023, through remote and in person methods. Recruitment material was distributed across Canada and participants self-identified. Participants were from nursing, social work, medicine, and dietetics, all working in public health across Canada. Data-driven, inductive thematic analysis was used. Iterative analysis as interviews occurred supported the development of a codebook. Themes were compared within and across data sets and by participant age and years of experience. Experiences that contributed to moral distress included systemic powerlessness, political and ideological overreach, unethical work environments and undervalued expertise. Years of experience and diversity in gender and ethnicity impacted how practitioners navigated moral distress. Experiences where practitioners felt actions went against their values increased during the pandemic, contributing to moral injury. This study situates the unique position of public health within the health system and explores experiences of moral distress both during and outside the COVID-19 pandemic. While the pandemic brought the concept of moral distress to the forefront of many people’s minds, these experiences existed prior. Addressing the underlying causes will contribute to establishing approaches to support public health practitioners suffering from moral distress and injury.