Lessons and needs arising from experienced moral stress and moral dilemmas at the ICU during the COVID-19 pandemic

During the first part of the Corona crisis a lot was asked of care workers at the Intensive Cares in the Netherlands. Some were forced to perform tasks in which they felt less competent, while others were expected to take on a more supervisory role than that for which they were initially trained.
In addition, this was accompanied by a high workload, extra physical strain due to having to wear PPE and not being able to perform normal tasks such as family contact. All this has led to employees of the ICUs being confronted with moral issues and dilemmas. Some of these were new, other dilemmas are of all times but were magnified in this context. Research has already been done, or is being done, into work stress and psycho-social stress, but no specific attention has been paid to the moral dilemmas, the moral stress and how to deal with it.
The importance of investigating lessons and needs as a result of experiencing moral stress and moral dilemmas during this pandemic is great. Failure to pay sufficient attention to moral stress brings with it risks such as symptoms of guilt, shame, existential or moral conflict, loss of trust in the good, moral detachment and/or moral disorientation.
Until now, it is unknown what moral issues Dutch ICU staff faced during the Corona crisis and what degree of moral stress this caused. In addition, not all moral issues and moral dilemmas will automatically lead to stress. Experiencing moral stress and moral dilemmas can also be an incentive to learn both positive and negative lessons together.
It is important to take a critical look at the lessons learned and especially the needs, in order to recognize any bottlenecks in time and to be able to provide good care for our own employees and colleagues. Evaluation of, among other things, the support offered to care professionals can provide valuable insights.

Employees of the ICU experienced more moral issues and moral dilemmas during the first wave of COVID-19.
There are differences in experienced moral issues and dilemmas between professions (e.g. doctor vs. nurse).

First email regarding questionnaire send beginning of October 2020, a reminder was send at the end of October 2020. No reminders were send after because of the start of the second wave.