Moral Dilemmas Among Workers at a University Hospital During the COVID-19 Pandemic in Brazil

Background: This study aimed to identify sociodemographic and occupational factors associated with facing moral dilemmas among workers at the Federal University of Pelotas-RS Teaching Hospital who worked on-site during the pandemic. Methods: A cross-sectional study was conducted in 2020 with all workers, including health professionals, support staff, and administrative personnel. Questions about moral dilemmas were grouped into two outcomes: witnessing behaviors or attitudes, and feeling pressured to act in disagreement with what they believed was right. Associations were estimated using Poisson regression with robust variance, based on a hierarchical model. Results: A total of 1,158 workers participated, most of whom were women (76.1%). The prevalence of moral dilemmas was 44% for witnessing and 15% for feeling pressured. Younger age, higher education, being a resident, working both day and night shifts, lack of PPE, and having an active or high-strain job were positively associated with both types of dilemmas, whereas the availability of social support and adequate resting areas reduced their occurrence. Conclusions: Reducing moral dilemmas requires promoting democratic leadership, ensuring adequate staffing, strengthening professional autonomy, encouraging social support, and creating rest spaces. These arrangements are essential for promoting workers’ psychological well-being.