51
|
Collins N, Crowder J, Ishcomer-Aazami J, Apedjihoun D. Perceptions and Experiences of Frontline Urban Indian Organization Healthcare Workers With Infection Prevention and Control During the COVID-19 Pandemic. FRONTIERS IN SOCIOLOGY 2021; 6:611961. [PMID: 33996989 PMCID: PMC8119887 DOI: 10.3389/fsoc.2021.611961] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has created significant challenges for outpatient healthcare providers and patients across the United States (U.S.). Forty-one Urban Indian Organizations (UIOs), who provide a wide spectrum of health services for American Indian and Alaska Native (AI/AN) populations and other underinsured and uninsured populations in urban areas across the country, are no exception. The National Council of Urban Indian Health (NCUIH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), set out to understand the needs, challenges, and opportunities for improvement in infection prevention and control (IPC) training and systems from the perspective of UIO frontline healthcare workers. As part of the CDC's Project Firstline, NCUIH was chosen as a partner in a national collaborative. The first task was to conduct listening sessions with frontline UIO staff to learn more about IPC practices in the context of the COVID-19 pandemic. Thirty staff from 16 UIOs, representing full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential treatment programs participated in virtual video focus groups in July of 2020. Thematic and content analysis protocols guided data analysis and coding. Analysis of findings generated four major themes: staff adaptation in the context of resilience; responsibility and duty to protect patients, families, and coworkers; mental and emotional issues for UIO staff; and IPC challenges in the context of COVID-19. Participants' challenges ranged from lack of access to personal protective equipment (PPE) to the absence of standardized training. Significant disparities in social determinants of health experienced by Native American and non-Native populations served by UIOs create additional challenges to the delivery of and access to care during the pandemic. The diverse array of tribal cultural values and contexts of the people and communities served by UIOs reportedly serve as both facilitators and barriers to care, awareness, and uptake of infectious disease public health practices.
Collapse
Affiliation(s)
- Noah Collins
- National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States
| | - Jolie Crowder
- International Association for Indigenous Aging, Silver Spring, MD, United States
| | - Jamie Ishcomer-Aazami
- National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States
| | - Dionne Apedjihoun
- National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States
| |
Collapse
|
52
|
Mert S, Sayilan AA, Karatoprak AP, Baydemir C. The effect of Covid-19 on ethical sensitivity. Nurs Ethics 2021; 28:1124-1136. [PMID: 33910398 DOI: 10.1177/09697330211003231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the midst of the Covid-19 pandemic, healthcare workers increasingly encounter serious ethical issues that negatively affect their professionalism. PURPOSE The study aims to examine the ethical sensitivity levels of physicians and nurses working in surgical units during the Covid-19 pandemic and the associating factors. METHOD The sample of this cross-sectional online questionnaire-based study consists of 161 healthcare workers working at the surgical units in Turkish hospitals. The data were collected using the "Nurse Descriptive Information Form" developed by the researchers and the "Ethical Sensitivity Questionnaire." ETHICAL CONSIDERATIONS Approval was granted by the ethics committee. Verbal and written consent was received from the healthcare workers. RESULTS Ethical sensitivity in the dimension of conflict was found to be higher in healthcare workers who had ethical issues during the Covid-19 pandemic, who were married, who were nurses, who worked more than 45 h, and who had a work experience of 7-10 years (p < 0.05). Healthcare workers with a family member diagnosed with Covid-19 had high ethical sensitivity in the dimension of conflict (p = 0.008), while those who reported being fully competent and ready (p = 0.038) about Covid-19 were found to have low ethical sensitivity. Besides, those who experienced inadequate supplies (p = 0.045), long working hours (p = 0.038), and problems in asepsis-sterilization (p = 0.046) during the Covid-19 pandemic were found to have low sensitivity in the holistic approach dimension. CONCLUSION The study revealed that ethical issues during the Covid-19 pandemic, sociodemographic characteristics, knowledge-skills about Covid-19, and the problems encountered in the work environment during the pandemic affect the ethical sensitivity of healthcare workers in the dimensions of conflict and holistic approach. Therefore, it is recommended that governments and all healthcare workers, and stakeholders in the health system in our country and other countries take action to promote ethical sensitivity in response to the rapidly increasing epidemic by considering the factors that adversely affect ethical sensitivity.
Collapse
|
53
|
Denning M, Goh ET, Tan B, Kanneganti A, Almonte M, Scott A, Martin G, Clarke J, Sounderajah V, Markar S, Przybylowicz J, Chan YH, Sia CH, Chua YX, Sim K, Lim L, Tan L, Tan M, Sharma V, Ooi S, Winter Beatty J, Flott K, Mason S, Chidambaram S, Yalamanchili S, Zbikowska G, Fedorowski J, Dykowska G, Wells M, Purkayastha S, Kinross J. Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study. PLoS One 2021; 16:e0238666. [PMID: 33861739 PMCID: PMC8051812 DOI: 10.1371/journal.pone.0238666] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/21/2021] [Indexed: 01/09/2023] Open
Abstract
The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and 'other clinical' (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.
Collapse
Affiliation(s)
- Max Denning
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ee Teng Goh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benjamin Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Melanie Almonte
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alasdair Scott
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guy Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jan Przybylowicz
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ying Xian Chua
- Pioneer Polyclinic, National University Polyclinic, National University Health System, Singapore, Singapore
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lucas Lim
- Department of Forensic Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Lifeng Tan
- Division of Healthy Ageing, Alexandra Hospital, Singapore, Singapore
| | - Melanie Tan
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Vijay Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shirley Ooi
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | | | - Kelsey Flott
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sam Mason
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Seema Yalamanchili
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Gabriela Zbikowska
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Grazyna Dykowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Poland
| | - Mary Wells
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
54
|
Le Dorze M, Kandelman S, Gateau V, Michel F, Veber B. COVID-19 and ethics: We learn as we go. But where are we going? Anaesth Crit Care Pain Med 2021; 40:100856. [PMID: 33785423 PMCID: PMC7999900 DOI: 10.1016/j.accpm.2021.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Matthieu Le Dorze
- University of Paris, U942 INSERM-MACOT, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Lariboisière University Hospital, 2, Rue Ambroise Paré, 75475 Paris Cedex 10, France.
| | - Stanislas Kandelman
- Department of Anaesthesiology, Royal Victoria Hospital, McGill University Health Center, Montréal, Canada
| | | | - Fabrice Michel
- Anesthésie-Réanimation Pédiatrique - APHM, Aix Marseille Univ, UMR ADES No 7268, EFS, CNRS, Marseille, France
| | - Benoit Veber
- Pôle Anesthésie Réanimation SAMU, Surgical Intensive Care Unit, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France
| | | |
Collapse
|
55
|
Delgado J, Siow S, de Groot J, McLane B, Hedlin M. Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106764. [PMID: 33762300 PMCID: PMC7992383 DOI: 10.1136/medethics-2020-106764] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 05/25/2023]
Abstract
This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.
Collapse
Affiliation(s)
- Janet Delgado
- NICU, University Hospital of the Canary Islands, La Laguna, La Laguna, Spain
- University Institute of Women's Studies, University of La Laguna, La Laguna, Spain
| | - Serena Siow
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Janet de Groot
- Department of Psychiatry, Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brienne McLane
- Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Margot Hedlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
56
|
Collignon O, Burman CF, Posch M, Schiel A. Collaborative Platform Trials to Fight COVID-19: Methodological and Regulatory Considerations for a Better Societal Outcome. Clin Pharmacol Ther 2021; 110:311-320. [PMID: 33506495 PMCID: PMC8014457 DOI: 10.1002/cpt.2183] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
For the development of coronavirus disease 2019 (COVID‐19) drugs during the ongoing pandemic, speed is of essence whereas quality of evidence is of paramount importance. Although thousands of COVID‐19 trials were rapidly started, many are unlikely to provide robust statistical evidence and meet regulatory standards (e.g., because of lack of randomization or insufficient power). This has led to an inefficient use of time and resources. With more coordination, the sheer number of patients in these trials might have generated convincing data for several investigational treatments. Collaborative platform trials, comparing several drugs to a shared control arm, are an attractive solution. Those trials can utilize a variety of adaptive design features in order to accelerate the finding of life‐saving treatments. In this paper, we discuss several possible designs, illustrate them via simulations, and also discuss challenges, such as the heterogeneity of the target population, time‐varying standard of care, and the potentially high number of false hypothesis rejections in phase II and phase III trials. We provide corresponding regulatory perspectives on approval and reimbursement, and note that the optimal design of a platform trial will differ with our societal objective and by stakeholder. Hasty approvals may delay the development of better alternatives, whereas searching relentlessly for the single most efficacious treatment may indirectly diminish the number of lives saved as time is lost. We point out the need for incentivizing developers to participate in collaborative evidence‐generation initiatives when a positive return on investment is not met.
Collapse
Affiliation(s)
| | - Carl-Fredrik Burman
- Statistical Innovation, Data Science, and Artificial Intelligence, AstraZeneca R&D, Gothenburg, Sweden
| | - Martin Posch
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
57
|
Tariman JD, Klugman CM, Webber-Ritchey KJ, Amer K. Care Delivery and Treatment Decision Making: Bioethical and Nursing Considerations During and After the COVID-19 Pandemic. Clin J Oncol Nurs 2021; 25:61-68. [PMID: 33480884 DOI: 10.1188/21.cjon.61-68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The disruption in the supply chain of resources and interruptions in cancer treatments caused by the pandemic presented tremendous challenges to the healthcare system. OBJECTIVES This article describes the National Academy of Medicine-defined states of medical and nursing care delivery for which local plans should be drawn and the shifting and evolving systems framework that can guide decisions to optimize the crisis standards of care. METHODS A case study is presented to describe the process of shifting the state of medical and nursing care delivery and bioethical nursing considerations during the pandemic and beyond. FINDINGS An evolving and shifting systems framework for crises rooted in deontology, principlism, and the ethics of care model provide meaningful guidance for establishing priorities for patient care.
Collapse
|
58
|
Cheung ATM, Parent B. Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers. JOURNAL OF MEDICAL ETHICS 2021; 47:73-77. [PMID: 33106381 DOI: 10.1136/medethics-2020-106801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called 'tie-breaker' situations. In particular, one's status as a frontline healthcare worker (HCW) has been a proposed criterion for prioritisation in the event of a tie. This article outlines two major grounds for reconsidering HCW prioritisation. The first recognises trust as an indispensable element of clinical care and mistrust as a hindrance to any public health strategy against the virus, thus raising concerns about the outward appearance of favouritism. The second considers the ways in which proponents of HCW prioritisation deviate from the very 'ethics frameworks' that often preface triage policies and serve to guide resource allocation-a rhetorical strategy that may undermine the very ethical foundations on which triage policies stand. By appealing to trust and consistency, we re-examine existing arguments in favour of HCW prioritisation and provide a more tenable justification for adjudicating on tie-breaker events during crisis standards of care.
Collapse
Affiliation(s)
- Alexander T M Cheung
- Division of Medical Ethics, New York University School of Medicine, New York, New York, USA
| | - Brendan Parent
- Division of Medical Ethics, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
59
|
Jones XM, Zimba O, Gupta L. Informed Consent for Scholarly Articles during the COVID-19 Pandemic. J Korean Med Sci 2021; 36:e31. [PMID: 33463097 PMCID: PMC7813582 DOI: 10.3346/jkms.2021.36.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/06/2021] [Indexed: 11/20/2022] Open
Abstract
The coronavirus disease 2019 pandemic has caused a breakdown in the healthcare system worldwide. The need to rapidly update guidelines in order to control the transmission in the population and for evidenced-based healthcare care has led to the need for timely, voluminous and valid research. Amid the quest for a vaccine and better therapies, researchers clamouring for information has led to a wide variety of ethical issues due to the unique situation. This paper aims to examine the positive and negative aspects of recent changes in the process of obtaining informed consent. The article outlines the various aspects, from history, previously described exemptions to consenting as well as those implemented during the pandemic and the current impact of virtual methods. Further, the authors make recommendations based on the outcome of suggested adjustments described in the literature. This article looks into increasing the awareness of physicians and researchers about ethical issues that need to be addressed to provide optimal care for patients while assuring their integrity and confidentiality.
Collapse
Affiliation(s)
| | - Olena Zimba
- Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Latika Gupta
- Department Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| |
Collapse
|
60
|
Brelje AB, Pinals DA. Provision of health care for prisoners during the COVID-19 pandemic: an ethical analysis of challenges and summary of select best practices. Int J Prison Health 2020. [DOI: 10.1108/ijph-07-2020-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to analyze the COVID-19 pandemic response in prisons, focusing on the USA, which imprisons a higher percentage of its population than any other country in the world.
Design/methodology/approach
This paper evaluates the current pandemic response in prisons based on legal and ethical imperatives for providing health care to prisoners.
Findings
Themes of best practices identified include increasing rapid detection of new cases, reducing transmission and advocating for both short- and long-term ethical health care policies. Halting progress now could risk dire consequences and is unacceptable on legal, ethical and public health grounds.
Research limitations/implications
This paper does not involve primary research with prisoners; rather it focuses on reviewing the pandemic response in prisons. Although it may be possible to translate findings in this study to similar environments (e.g. jails and detainment centers), there are unique characteristics pertaining to each that deserve separate, focused analyses.
Originality/value
Outbreaks that occur within prisons are likely to spread to the community and vice versa. Analyses based on ethics, law and public health point to the same conclusion: preventing significant outbreaks within prisons will benefit not only prisoners but also the general public. Furthermore, even though the scientific understanding of the pandemic may change with future research, the ethical and legal principles highlighted in this paper will continue to be foundational when considering just care for prisoners.
Collapse
|
61
|
Giannini A. Who gets the last bed? Ethics criteria for scarce resource allocation in the era of COVID-19. Minerva Anestesiol 2020; 87:267-271. [PMID: 33319957 DOI: 10.23736/s0375-9393.20.15345-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy -
| |
Collapse
|
62
|
Bibler T. Between Crisis and Convention: How Should We Address Contingency? Hastings Cent Rep 2020; 50:17-19. [PMID: 33095490 DOI: 10.1002/hast.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The Covid-19 pandemic has brought about renewed conversation about equality and equity in the distribution of medical resources. Much of the recent conversation has focused on creating and implementing policies in times of crisis when resources are exhausted. Depending on how the pandemic develops, some communities may implement crisis measures, but many health care facilities are currently experiencing shortages of staff and materials even if the facilities have not implemented crisis standards. There is a need for shared conversation about equality and equity in these times of contingency between conventional and crisis medicine. To respond well to these challenges, I recommend that institutions rely on policy, professional education, and ethics consultation. As is the case with crisis policies, creating contingency policies requires that health care professionals decide on how, specifically, to achieve equity. A policy is only as effective as its implementation; therefore, institutions should invest in context-specific education on contingency policies. Finally, ethics consultation should be available for questions that contingency policies cannot address.
Collapse
|
63
|
Guerrini CJ, Storch EA, McGuire AL. Essential, not peripheral: Addressing health care workers' mental health concerns during the COVID-19 pandemic. J Occup Health 2020; 62:e12169. [PMID: 33009709 PMCID: PMC7532262 DOI: 10.1002/1348-9585.12169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022] Open
Abstract
In this Opinion, we synthesize recent evidence regarding the mental health impacts of the pandemic with an emphasis on health care workers. Departing from the literature that has already been published on this topic, we focus on health care workers with mental health concerns that preexisted the pandemic and discuss evidence suggesting that this population has suffered disproportionately from pandemic conditions.
Collapse
|
64
|
Spector-Bagdady K, Laventhal N, Applewhite M, Firn JI, Hogikyan ND, Jagsi R, Marks A, McLeod-Sordjan R, Parker LS, Smith LB, Vercler CJ, Shuman AG. Flattening the Rationing Curve: The Need for Explicit Guidelines for Implicit Rationing during the COVID-19 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:77-80. [PMID: 32716786 DOI: 10.1080/15265161.2020.1779409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
65
|
Rueda J, Hannikainen IR, Hortal-Carmona J, Rodriguez-Arias D. Examining Public Trust in Categorical versus Comprehensive Triage Criteria. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:106-109. [PMID: 32716774 DOI: 10.1080/15265161.2020.1779867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
66
|
Marks JH. COVID-19, Pandemic Triage, and the Polymorphism of Justice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:103-106. [PMID: 32716781 DOI: 10.1080/15265161.2020.1779410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jonathan H Marks
- Bioethics Program, Pennsylvania State University, University Park, PA, United States
| |
Collapse
|
67
|
Garrett JR, McNolty LA. More than Warm Fuzzy Feelings: The Imperative of Institutional Morale in Hospital Pandemic Responses. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:92-94. [PMID: 32716791 DOI: 10.1080/15265161.2020.1779407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
68
|
Nelson RH, Ram B, Majumder MA. Disability and Contingency Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:190-192. [PMID: 32716778 DOI: 10.1080/15265161.2020.1779863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
69
|
Ferguson K, Caplan A. It's Not Easy Bein' Fair. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:160-162. [PMID: 32716783 DOI: 10.1080/15265161.2020.1777352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
70
|
Rhodes R. Justice and Guidance for the COVID-19 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:163-166. [PMID: 32716807 DOI: 10.1080/15265161.2020.1777354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
71
|
Janwadkar AS, Bibler TM. Ethical Challenges in Advance Care Planning During the COVID-19 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:202-204. [PMID: 32716803 DOI: 10.1080/15265161.2020.1779855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
72
|
Sveen W, Antommaria AHM. Why Healthcare Workers Should Not Be Prioritized in Ventilator Triage. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:133-135. [PMID: 32716811 DOI: 10.1080/15265161.2020.1779852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- William Sveen
- Cincinnati Children's Hospital Medical Center
- University of Cincinnati College of Medicine
| | | |
Collapse
|
73
|
Harter TD, Iltis A, Clay MC, Aulisio M. COVID-19 and Financial Vulnerability: What Health Care Organizations and Society Owe Each Other. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:139-141. [PMID: 32432515 DOI: 10.1080/15265161.2020.1764143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
74
|
Harter TD. Ethical Considerations for "Reopening" Health Care Organizations Amid COVID-19. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:95-97. [PMID: 32716808 DOI: 10.1080/15265161.2020.1779851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
75
|
Fink S. Ethical Dilemmas in Covid-19 Medical Care: Is a Problematic Triage Protocol Better or Worse than No Protocol at All? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:1-5. [PMID: 32716771 DOI: 10.1080/15265161.2020.1788663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
76
|
Berger JT, Miller DR. Corona and Community: The Entrenchment of Structural Bias in Planning for Pandemic Preparedness. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:112-114. [PMID: 32716812 DOI: 10.1080/15265161.2020.1779853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
77
|
Potter J, Ginsberg J, Lesandrini J, Andrelchik A. To Procure or Not to Procure: Hospitals Face Significant Ethical Dilemmas Regarding Organ Donation During the COVID-19 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:193-195. [PMID: 32716801 DOI: 10.1080/15265161.2020.1779861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
78
|
Shlobin NA, Rosenow JM, Ford PJ. Using Functionality Rather than Elective Nature to Characterize Neurosurgeries During Pandemic Triage. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:196-198. [PMID: 32716782 DOI: 10.1080/15265161.2020.1777353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
79
|
Kalwani L, Kostick K, Storch EA, Lázaro-Muñoz G. Reconceptualizing Triage to Incorporate Principles of Risk and Uncertainty: An Example from Deep Brain Stimulation Patients with Treatment-Resistant Disorders. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:207-209. [PMID: 32716764 PMCID: PMC7453975 DOI: 10.1080/15265161.2020.1779397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
80
|
Wicclair M. Allocating Ventilators During the COVID-19 Pandemic and Conscientious Objection. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:204-207. [PMID: 32716798 DOI: 10.1080/15265161.2020.1777347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
81
|
Aulisio MP, May T. Why Healthcare Workers Ought to Be Prioritized in ASMR During the SARS-CoV-2 Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:125-128. [PMID: 32716809 DOI: 10.1080/15265161.2020.1779411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
82
|
Schonfeld T, Alfandre D, Berkowitz K, Chanko B, Foglia MB, Geppert C. Implementing VA's Authoritative Ethical Guidance in a Pandemic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:145-147. [PMID: 32716800 DOI: 10.1080/15265161.2020.1779860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
83
|
Parsons JA, Martin DE. A Call for Dialysis-Specific Resource Allocation Guidelines During COVID-19. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:199-201. [PMID: 32716788 DOI: 10.1080/15265161.2020.1777346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|