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Van Natta M. Second-Class Care: How Immigration Law Transforms Clinical Practice in the Safety Net. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241254390. [PMID: 39066548 DOI: 10.1177/00221465241254390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
This article examines how U.S. immigration law extends into the health care safety net, enacting medical legal violence that diminishes noncitizens' health chances and transforms clinical practices. Drawing on interviews with health care workers in three U.S. states from 2015 to 2020, I ask how federal citizenship-based exclusions within an already stratified health care system shape the clinical trajectories of noncitizens in safety-net institutions. Focusing specifically on cancer care, I find that increasingly anti-immigrant federal policies often reshape clinical practices toward noncitizens with a complex, life-threatening condition as they approach a "specialty care cliff" by (1) creating time penalties that keep many noncitizens in a protracted state of injury and (2) deterring noncitizens from seeking care through threats of immigration enforcement. Through these processes, medical legal violence also creates the potential for moral injury among health care workers, who must adapt clinical practices in response to socio-legal boundaries of belonging.
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Affiliation(s)
- Meredith Van Natta
- Department of Sociology, University of California Merced, Merced, CA, USA
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2
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See KC. Using artificial intelligence as an ethics advisor. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:454-455. [PMID: 39132962 DOI: 10.47102/annals-acadmedsg.202471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Ethical dilemmas are common in the practice of medicine and can lead to an array of seemingly reasonable decisions unless policies or regulations mandate certain actions. Choosing the appropriate solution requires not only biomedical evidence, but also requires the balancing of possibly divergent preferences, values, contextual factors and ethical theories. These include utilitarianism, which aims to optimise happiness for the largest number of people; versus deontology, which promotes actions based on rules and duties even if these actions do not result in the greatest common good. The inability to find common ground can both delay appropriate care and trigger moral distress among health professionals.1 However, training in ethical reasoning or obtaining ethics consultations may not be universally available. How then can frontline healthcare teams navigate ethical dilemmas?
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
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3
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Whitehead PB, Haisch CE, Hankey MS, Mutcheson RB, Dewitt SA, Stewart CA, Stewart JD, Bath JL, Boone SM, Jileaeva I, Faulks ER, Musick DW. Studying moral distress and moral injury among inpatient and outpatient healthcare professionals during the COVID-19 pandemic. Int J Psychiatry Med 2024; 59:469-486. [PMID: 37807925 DOI: 10.1177/00912174231205660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Objective: COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). The purpose of this study was to examine MD and MI among inpatient and outpatient HCPs during March of 2022.The study sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on background characteristics.Methods: A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at two academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings.Results: A moderate association was found between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded eight sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability.Conclusions: While interrelated conceptually, MD and MI should be viewed as distinct constructs. Many HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by those in all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being, work satisfaction, and the quality of patient care.
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Affiliation(s)
| | | | | | - Ryan B Mutcheson
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | | | | | | | | | - Ilona Jileaeva
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | | | - David W Musick
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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4
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Kassam A, Page S, Lauzon J, Hay R, Coret M, Mitchell I. Ethical issues in residency education related to the COVID-19 pandemic: a narrative inquiry study. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-108917. [PMID: 38925879 DOI: 10.1136/jme-2023-108917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories. METHOD We used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed. RESULTS 11 residents participated across several programmes. Three main themes emerged from the participants' stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants' journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together. DISCUSSION Cases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics. CONCLUSION Efforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.
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Affiliation(s)
- Aliya Kassam
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacey Page
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Lauzon
- Medical Genetics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Rebecca Hay
- Pediatric Critical Care Medicine, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Marian Coret
- Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian Mitchell
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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5
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Vermette D. How's Your Soul? JAMA 2024; 331:1363-1364. [PMID: 38546615 DOI: 10.1001/jama.2024.0884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
Abstract
In this narrative essay, a physician reflects on the way in which his residency program director’s unique background as a Master of Divinity helped him to focus on his growth as a human being rather than concentrating solely on clinical evaluations.
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Affiliation(s)
- David Vermette
- Division of General Medicine and Geriatrics, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
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Ajzenberg H, Connolly E, Morrison K, Oczkowski S. Exercising medical judgement: resuscitation and "Decision-Making for End-of-Life Care," a new policy from the College of Physician and Surgeons of Ontario. Can J Anaesth 2024; 71:447-452. [PMID: 38468076 DOI: 10.1007/s12630-024-02724-2] [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] [Received: 05/17/2023] [Revised: 08/21/2023] [Accepted: 11/29/2023] [Indexed: 03/13/2024] Open
Abstract
In March 2023, the College of Physicians and Surgeons of Ontario (CPSO) updated their policy entitled Decision-Making for End-of-Life Care. This policy will significantly change the landscape and clinical practice in Canada's most populous province with respect to decision-making for resuscitation. The update interrupts approximately eight years of CPSO policy that has mandated physicians to perform cardiopulmonary resuscitation (CPR) and other resuscitative measures unless they can explicitly obtain consent in the form of a do-not-resuscitate or no-CPR order. The policy is now aligned with the Wawrzyniak v. Livingstone, 2019 court decision which reaffirmed that physicians must only offer treatments that they think are within the standard of care and not offer treatments that are not likely to benefit their patient. In this commentary, we review the historical aspects of the CPSO policy from 2015 to 2023 and discuss how such a policy of a "consent to withhold" paradigm was ethically problematic and likely led to significant harm. We then review the updated CPSO policy, outline some remaining areas of uncertainty and challenges, and make recommendations for how to interpret this policy in clinical practice.
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Affiliation(s)
- Henry Ajzenberg
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia, Critical Care Medicine Residency Program, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada.
| | - Eoin Connolly
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Bioethics, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Kathryn Morrison
- Department of Philosophy, University of Waterloo, Waterloo, ON, Canada
- Department of Ethics and Spiritual and Religious Care, Health Sciences North, Sudbury, ON, Canada
| | - Simon Oczkowski
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, & Impact, McMaster University, Hamilton, ON, Canada
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7
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Ward K. Too good for this world: moral bioenhancement and the ethics of making moral misfits. MEDICAL HUMANITIES 2024; 50:144-152. [PMID: 37932030 DOI: 10.1136/medhum-2023-012709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
Persson and Savulescu argue that moral bioenhancement is not only morally permissible; in some cases, it is morally obligatory. In this article, I introduce a new reason to worry about moral enhancement. I adapt the disability concept of misfit to show how moral enhancement could cause extreme moral disempowerment to those enhanced, which would result in moral injury. I argue that any safety framework that guides the development of moral bioenhancement must be sensitive to the problem of moral misfitting. I present the best case for moral bioenhancement before turning to my own worry concerning the development of moral bioenhancement and its practical implications. Finally, I consider a series of objections and responses.
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Affiliation(s)
- Katherine Ward
- Philosophy, Bucknell University, Lewisburg, Pennsylvania, USA
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Matheson MA, Gatti JR, Reid LD, Gallozzi SN, Cooke SB. Unclaimed Bodies in Anatomical Education: Medical Student Attitudes at One U.S. Medical Institution. TEACHING AND LEARNING IN MEDICINE 2023:1-13. [PMID: 37964565 DOI: 10.1080/10401334.2023.2277843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
PHENOMENON Dissection of cadavers is a common practice in anatomical education. To meet demand for cadavers, some medical institutions facilitate dissection of individuals who did not provide consent during their life. This includes the bodies of individuals who passed away with either no living kin or no kin able to claim and bury their body. Recent literature demonstrates widespread discomfort with this practice among anatomy course directors at U.S. institutions, bringing into question continuation of this practice. However, attitudes among medical students must similarly be assessed as they represent key stakeholders in the dissection process. The purpose of this study was to assess prevailing attitudes among a sample of medical students at one U.S. medical institution regarding the dissection of unclaimed bodies and identify emerging themes in ethical viewpoints. APPROACH Two-hundred-twelve students (35% response rate) at one U.S. medical institution completed an anonymous online survey. Students came from different class cohorts at various stages of their training. Survey items were developed to capture students' academic and emotional experience with anatomical dissection and to identify emerging themes in attitudes. FINDINGS Students reported high regard for cadaveric dissection in general with 170 (80%) respondents endorsing it as critical to anatomical education. Regarding dissection of unclaimed bodies, 30% of students found the practice ethical while 47% of students found the practice unethical. Multivariate analysis found that ethical view was directly associated with comfort level (OR= 156.16; 95% CI: 34.04, 716.40). Most students expressed comfort dissecting self-donated bodies (n = 206, 97%), while fewer students expressed comfort dissecting unclaimed bodies (n = 66, 31.1%). This latter finding significantly correlated with gender (t = 3.361. p < 0.05), class cohort (F = 3.576, p < 0.01), but not with religious affiliation or age. Thematic analysis revealed the following themes in student responses: (1) invoking ethical paradigms to either justify or condemn the practice, (2) subjective experiences, and (3) withholding judgment of the practice. INSIGHTS Many students expressed negative attitudes toward the dissection of unclaimed bodies, with some citing issues of social vulnerability, justice, and autonomy. These findings indicate that many students' ethical code may conflict with institutional policies which permit this practice. Medical school represents a critical time in the professional development of trainees, and development practices which align with the moral code of local institutions and stakeholders is crucial.
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Affiliation(s)
- Malcolm A Matheson
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Family and Community Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - John R Gatti
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lawrence D Reid
- Department of Family and Community Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Sharaya N Gallozzi
- The Chicago School of Professional Psychology - LA Campus, Los Angeles, California, USA
| | - Siobhán B Cooke
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Schenck EJ, Turetz ML, Niederman MS. Letter from the United States: An update on the New York experience with COVID-19. Respirology 2023; 28:892-894. [PMID: 37495224 DOI: 10.1111/resp.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Meredith L Turetz
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, USA
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10
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Lambert SJ, Horvath SK, Casas RS. Impact of the Dobbs Decision on Medical Education and Training in Abortion Care. Womens Health Issues 2023:S1049-3867(23)00079-8. [PMID: 37150657 DOI: 10.1016/j.whi.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Stephanie J Lambert
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Sarah K Horvath
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rachel S Casas
- Division of General Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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11
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Bloom SL. A Biocratic Paradigm: Exploring the Complexity of Trauma-Informed Leadership and Creating Presence™. Behav Sci (Basel) 2023; 13:bs13050355. [PMID: 37232592 DOI: 10.3390/bs13050355] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
A paradigm shift is under way in the human services because of breakthrough knowledge and research in understanding the underlying etiology of physical, emotional, and social problems at the micro-level of the individual, at the meso-level of the family and institutions, and at the macro-level of the entire society. The three levels of human existence-micro, mezzo, and macro-constitute interactive, interdependent, complex adaptive living systems. The complexity of these problems requires us to use our imaginations to envision health in individuals, organizations, and societies because it does not presently exist. After thousands of years of unrelenting exposure to trauma and adversity, we have all normalized what is a traumatogenic civilization. As a result, we live in a trauma-organized society in ways we are just beginning to understand in this century. This biopsychosocial knowledge base that is drawn upon here has come to be known as "trauma-informed" knowledge because it began with a deepening understanding of the impact of trauma on survivors of combat, disasters, and genocide, but now extends far beyond those specific boundaries. To lead any organization in a time of significant change means leading a revolution in understanding human nature and the fundamental causes of human pathology that are endangering all life on this planet and then helping organizational members develop skills to positively influence the changes necessary. In the 1930s, Dr. Walter B. Cannon, a Harvard physiologist who had named the "fight-flight" response and defined homeostasis, used the word "biocracy" to describe the relationship between the physical body and the social body, emphasizing the vital importance of democracy. This paper is a beginning attempt at integrating the concept of a biocratic organization with that of the trauma-informed knowledge necessary for leadership. Hope lies in properly diagnosing the problem, remembering ancient peace-making strategies, embracing universal life-preserving values, inspiring a new vision for the future, and radically and consciously changing our present self and other-destructive behavior. The paper concludes with a brief description of a new online educational program called Creating Presence™ that is being used in organizations as a method for creating and supporting the development of biocratic, trauma-informed organizations.
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Affiliation(s)
- Sandra L Bloom
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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12
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Tavakol N, Molazem Z, Rakhshan M, Asemani O, Bagheri S. Moral distress in psychiatric nurses in Covid-19 crisis. BMC Psychol 2023; 11:47. [PMID: 36805836 PMCID: PMC9936116 DOI: 10.1186/s40359-023-01048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/10/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient's lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic. METHOD This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. RESULTS By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies). CONCLUSION New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.
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Affiliation(s)
- Nahid Tavakol
- grid.412571.40000 0000 8819 4698Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Science, Shiraz, Islamic Republic of Iran
| | - Zahra Molazem
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Zand St., Namazee Sq., Shiraz, 7193613119, Islamic Republic of Iran.
| | - Mahnaz Rakhshan
- grid.412571.40000 0000 8819 4698Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Omid Asemani
- grid.412571.40000 0000 8819 4698Department of Medical Ethics and Philosophy of Health, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran ,grid.412571.40000 0000 8819 4698Center for Interdisciplinary Research in Islamic Education and Health Sciences, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Shahpar Bagheri
- grid.412571.40000 0000 8819 4698Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Brulin E, Henriksson K, Landstad BJ. An impaired learning environment: Resident physicians' experience of the transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden. Front Psychol 2023; 13:1090515. [PMID: 36687854 PMCID: PMC9853888 DOI: 10.3389/fpsyg.2022.1090515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Extensive studies regarding the COVID-19 pandemic have shown negative effects on physicians-in-training. Besides a high workload, their learning environment has been affected. A quality learning environment is vital for residents' physician's clinical development and also their health. Nevertheless, few studies have explored this. The aim of this study was to explore resident physicians' experiences of transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden. Method In this qualitative study, 12 Swedish resident physicians were interviewed using a semi-structured interview guide. They were interviewed between June and October of 2020 and asked to reflect on the pandemic and, more specifically, the first wave. The empirical material was analysed using qualitative content analysis. The analysis resulted in one theme and four categories. Results The theme identified was An impaired learning environment which signifies the disruptions the resident physicians experienced during the first wave of the pandemic. The four categories, Professional role insecurity, High expectations but little influence, Stagnant clinical development, and Professional growth through experience, describe in what way the learning environment was impacted.
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Affiliation(s)
- Emma Brulin
- The Department of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Bodil J. Landstad
- The Department of Health Sciences, Mid Sweden University, Östersund, Sweden,The Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden,*Correspondence: Bodil J. Landstad, ✉
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Zhu J, Zhu GP, Weng YM, Zhang Y, Li BX. Clinical Practice and Effectiveness Analysis of the Management of Corona Virus Disease 2019 Infected at Shanghai Fangcang Shelter Hospital: A Descriptive Study. Risk Manag Healthc Policy 2023; 16:337-346. [PMID: 36883054 PMCID: PMC9985874 DOI: 10.2147/rmhp.s403414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Background The Fangcang shelter hospital has gradually become the primary management mode in China's fight against this Corona Virus Disease 2019 (COVID-19) in 2020. In early 2022, the Fangcang shelter hospital management model was successfully applied to the new outbreak of COVID-19 in Shanghai also. Although Fangcang shelter hospitals are no longer the prevailing mode of prevention of COVID-19, the management experience of Shanghai makeshift hospitals is worthy of reference for public health. Methods The authors conducted a descriptive statistical analysis of Hall 6-2 of the Shanghai National Convention and Exhibition Center Fangcang shelter hospital. The whole hall of the Fangcang shelter hospital was managed by the one hospital, and the inclusion of third-party management personnel alleviated the shortage of medical personnel human resources. Through practice, a new procedure for treating batch infected people was introduced. Results By optimizing ward management, 72 on-duty doctors, 360 on-duty nurses, 3 sense-control administrators, and 15 administrators cured 18,574 infected people in 40 days, and created a record of a doctor managing 700 infected people without compromising the quality of treatment. There have been no deaths and no complaints from the infected people located in Hall 6-2 of the Shanghai National Convention and Exhibition Center Fangcang shelter hospital. Conclusion Compared with previous data, the new management mode of Fangcang shelter hospitals provides a reference for the management of the new infectious diseases for public health.
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Affiliation(s)
- Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, People's Republic of China
| | - Guang-Ping Zhu
- Department of Endocrinology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, People's Republic of China
| | - Yan-Ming Weng
- Department of Stomatology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, People's Republic of China
| | - Yong Zhang
- Department of Integrative Medicine, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, People's Republic of China
| | - Bi-Xi Li
- Department of Anesthesiology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, Hubei Province, People's Republic of China
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15
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Krishnan JK, Shin JK, Ali M, Turetz ML, Hayward BJ, Lief L, Safford MM, Aronson KI. Evolving Needs of Critical Care Trainees during the COVID-19 Pandemic: A Qualitative Study. ATS Sch 2022; 3:561-575. [PMID: 36726700 PMCID: PMC9886097 DOI: 10.34197/ats-scholar.2022-0026oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Critical care trainees were integral in the coronavirus disease (COVID-19) pandemic response. Several perspective pieces have provided insight into the pandemic's impact on critical care training. Surveys of program directors and critical care trainees have focused on curricular impact. There is a lack of data from the trainee perspective on curricular enhancements, career development, and emotional and well-being needs to succeed in a critical care career in the ongoing COVID-19 pandemic. Objective Our objective was to elicit perspectives from critical care trainees on their personal and professional needs as they continue to serve in the COVID-19 pandemic. Methods This was a hypothesis-generating qualitative study. Individuals in a U.S. critical care training program during the COVID-19 pandemic participated in either focus groups or semistructured interviews. Interviews were conducted between July 2020 and March 2021 until data saturation was achieved. Audio recordings were professionally transcribed and analyzed using qualitative content analysis. A codebook was generated by two independent coders, with a third investigator reconciling codes when there were discrepancies. Themes and subthemes were identified from these codes. Results Thirteen participants were interviewed. The major themes identified were as follows: 1) Curricular adaptation is necessary to address evolving changes in trainee needs; 2) COVID-19 impacted career development and highlighted that trainees need individualized help to meet their goals; 3) receiving social support at work from peers and leaders is vital for the sustained well-being of trainees; 4) fostering and maintaining a sense of meaning and humanity in one's work is important; and 5) trainees desire assistance and support to process their emotions and experiences. Conclusion The needs expressed by critical care trainees are only partially captured in conceptual models of physician well-being. The need for multilevel workplace social networks and identifying meaning in one's work have been magnified in this pandemic. The themes discussing curricular gaps, career development needs, and skills to process work-related trauma are less well captured in preexisting conceptual models and point to areas where further research and intervention development are needed.
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Affiliation(s)
| | - Joseph K. Shin
- Division of General Internal Medicine,
Weill Cornell Medicine, New York, New York
| | - Maha Ali
- Division of General Internal Medicine,
Weill Cornell Medicine, New York, New York
| | | | | | - Lindsay Lief
- Divison of Pulmonary and Critical Care
Medicine and
| | - Monika M. Safford
- Division of General Internal Medicine,
Weill Cornell Medicine, New York, New York
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Adeyemo OO, Tu S, Falako S, Keene D. Stressors on frontline healthcare workers during the COVID-19 pandemic: a focus on moral injury and implications for the future. Int Arch Occup Environ Health 2022; 95:1755-1762. [PMID: 35482111 PMCID: PMC9048619 DOI: 10.1007/s00420-022-01867-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has placed a psychological strain on health care workers (HCWs). To provide effective support, it is important to explore the stressors that HCWs face that place them at risk of negative psychological outcomes. However, there is a limited number of systematic qualitative studies on the stressors that HCWs faced in the United States of America (USA) during the first wave of the pandemic. Therefore, we explored the stressors that frontline HCWs in the USA experienced during the initial phase of the pandemic. METHODS We performed a qualitative study based on open-ended, semi-structured, one-on-one interviews conducted virtually among HCWs from June 1st to July 18th, 2020. We interviewed frontline HCWs (N = 45) including physicians, nurses, respiratory therapists, and patient care assistants who worked in various specialties and roles in 3 health systems across Connecticut, USA. We offered participants a $25 gift card as a token of appreciation. We used inductive techniques derived from grounded theory to develop themes. RESULTS We identified 3 main themes related to stressors experienced by HCWs during the initial phase of the pandemic namely: (1) Stress of witnessing an unprecedented number of deaths and the impact on patient families; (2) Stress of changing work environment and unmet professional expectations and; (3) Concern for safety in personal life. Furthermore, we highlight experiences that HCWs faced that place them at risk of developing a moral injury. CONCLUSIONS Our findings highlight stressors faced by HCWs that could aid in the provision of well-guided support to HCWs in the present and post-pandemic era.
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Affiliation(s)
- Oluwatosin O Adeyemo
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
| | | | - Simileoluwa Falako
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Danya Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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King EL, Hawkins LE. Identifying and mitigating moral injury risks in military behavioral health providers. MILITARY PSYCHOLOGY 2022; 35:169-179. [PMID: 37133488 DOI: 10.1080/08995605.2022.2093599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The term "moral injury" was initially used to describe the multifaceted pain that service members feel after perpetrating, witnessing, or failing to prevent acts that conflict with their moral codes. More recently the term has been used to describe healthcare providers' pain stemming from their experiences serving on the frontlines of the healthcare system when: a medical error causes serious harm to patients, systems continuously impede their abilities to provide proper care, or providers assess that they have acted in ways that conflict with their professional ethics or oaths to "do no harm." This article explores moral injury risk at the intersection of military service and healthcare by examining challenges that military behavioral healthcare providers face. Leveraging moral injury definitions previously applied to service members (personal or witnessed transgressions) and in two healthcare contexts ("second victim" to adverse client outcomes and system-driven moral distress), as well as literature on ethical challenges in military behavioral health, this paper uncovers situations that may amplify military behavioral health providers' risks for moral injury. It concludes by offering policy and practice recommendations germane to military medicine aimed at alleviating pressures military behavioral healthcare providers face and mitigating moral injuries' potential ripple effects on provider wellness, retention and care quality.
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Affiliation(s)
- Erika L. King
- Army-University of Kentucky Master of Social Work Program, University of Kentucky, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Lataya E. Hawkins
- Army-University of Kentucky Master of Social Work Program, University of Kentucky, Joint Base San Antonio-Fort Sam Houston, TX, USA
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Josiah Macy Jr. Foundation Conference on COVID-19 and the Impact on Medical and Nursing Education: Conference Recommendations Report. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S3-S11. [PMID: 34736279 DOI: 10.1097/acm.0000000000004506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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