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Tao H, Anderson G, Harris S, Sawyer A, Bailey A, Robinson P. Development and validation of the Moral Injury Symptom Scale - Clinician Version - Short Form (MISS-CV-SF). Contemp Nurse 2024:1-14. [PMID: 38885130 DOI: 10.1080/10376178.2024.2366915] [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: 09/11/2023] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy. OBJECTIVE To develop the Moral Injury Symptom Scale - Clinician-Short Form and validate it among United States based acute care nurses. . METHODS The Moral Injury Symptom Scale - Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve. RESULTS Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. . CONCLUSIONS The Moral Injury Symptom Scale - Clinician Version - Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations. .
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Richmond J, Anderson A, Cunningham-Erves J, Ozawa S, Wilkins CH. Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness. Annu Rev Public Health 2024; 45:465-484. [PMID: 38100649 PMCID: PMC11156570 DOI: 10.1146/annurev-publhealth-061022-044737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.
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Affiliation(s)
- Jennifer Richmond
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Consuelo H Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
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Park S, Thrul J, Cooney EE, Atkins K, Kalb LG, Closser S, McDonald KM, Schneider-Firestone S, Surkan PJ, Rushton CH, Langhinrichsen-Rohling J, Veenema TG. Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients. J Trauma Dissociation 2024; 25:202-217. [PMID: 38047579 DOI: 10.1080/15299732.2023.2289195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/13/2023] [Indexed: 12/05/2023]
Abstract
One factor potentially driving healthcare and hospital worker (HHW)'s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others' pandemic-related responses and behaviors. We investigated whether HHWs' betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.
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Affiliation(s)
- Soim Park
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaitlyn Atkins
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luther G Kalb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathryn M McDonald
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cynda H Rushton
- Johns Hopkins School of Nursing, Berman Institute of Bioethics, Baltimore, Maryland, USA
| | | | - Tener G Veenema
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rushton CH, Hanson GC, Boyce D, Holtz H, Nelson KE, Spilg EG, Robillard R. Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers. J Adv Nurs 2024; 80:1177-1187. [PMID: 37772644 DOI: 10.1111/jan.15873] [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: 05/28/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023]
Abstract
AIM To refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity. BACKGROUND Healthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues. Moral resilience is a resource that may mitigate negative consequences. To better understand mechanisms for doing so, a valid and reliable measurement tool is necessary. DESIGN Cross-sectional survey. METHODS Participants (N = 1297) had completed ≥1 items on the RMRS as part of the baseline survey of a larger longitudinal study. Item analysis, confirmatory factor analyses, reliability analyses (Cronbach's alpha), and correlations were used to establish reliability and validity of the revised RMRS. RESULTS Item and confirmatory factor analysis were used to refine the RMRS from 21 to 16 items. The four-factor structure (responses to moral adversity, personal integrity, relational integrity and moral efficacy) demonstrated adequate fit in follow-up confirmatory analyses in the initial and hold-out sub-samples. All subscales and the total scale had adequate reliabilities (α ≥ 0.70). A higher-order factor analysis supports the computation of either subscale scores or a total scale score. Correlations of scores with stress, anxiety, depression and moral distress provide evidence of the scale's validity. Reliability of the personal integrity subscale improved. CONCLUSION AND IMPLICATIONS The RMRS-16 demonstrates adequate reliability and validity, particularly the personal integrity subscale. Moral resilience is an important lever for reducing consequences when confronted with ethical challenges in practice. Improved reliability of the four subscales and having a shorter overall scale allow for targeted application and will facilitate further research and intervention development. PATIENT/PUBLIC CONTRIBUTION Data came from a larger study of Canadian healthcare workers from multiple healthcare organizations who completed a survey about their experiences during COVID-19.
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Affiliation(s)
- Cynda H Rushton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ginger C Hanson
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle Boyce
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heidi Holtz
- School of Nursing, Barnes College of Nursing, St. Louis, Missouri, USA
| | - Katie E Nelson
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edward G Spilg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Galanis P, Moisoglou I, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Kaitelidou D. Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era. NURSING REPORTS 2024; 14:254-266. [PMID: 38391065 PMCID: PMC10885038 DOI: 10.3390/nursrep14010020] [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: 12/17/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioannis Moisoglou
- Department of Nursing, University of Thessaly, 41500 Larissa, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children's Hospital, 11527 Athens, Greece
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Espinola CW, Nguyen B, Torres A, Sim W, Rueda A, Beavers L, Campbell DM, Jung H, Lou W, Kapralos B, Peter E, Dubrowski A, Krishnan S, Bhat V. Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial. JMIR Serious Games 2024; 12:e42813. [PMID: 38194247 PMCID: PMC10783335 DOI: 10.2196/42813] [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: 09/21/2022] [Revised: 08/03/2023] [Accepted: 09/30/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. OBJECTIVE This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. METHODS We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi-open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. RESULTS All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. CONCLUSIONS Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. TRIAL REGISTRATION ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32240.
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Affiliation(s)
- Caroline W Espinola
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Binh Nguyen
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Andrei Torres
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Walter Sim
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alice Rueda
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lindsay Beavers
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Douglas M Campbell
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Neonatal Intensive Care Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bill Kapralos
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Elizabeth Peter
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Adam Dubrowski
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Sridhar Krishnan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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7
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Zohn JH, Hovis S. The impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers: A narrative review. J Clin Nurs 2024; 33:224-241. [PMID: 36797214 DOI: 10.1111/jocn.16651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in the United States. Worldwide, over 700,000 people die by suicide each year. Healthcare workers are more vulnerable to suicide risk factors than the general population. The global COVID-19 pandemic presents additional workplace and health concerns that relate to suicide risk factors in healthcare workers. It is important to recognise suicide risk factors in healthcare workers and to implement strategies to reduce these risk factors. OBJECTIVES This study describes the impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers and identifies evidence-based strategies and resources to reduce suicide risk factors in healthcare workers. DESIGN The authors conducted a thematic analysis and narrative review of the literature. METHODS Using health science databases, the authors searched the literature, selected and analyzed studies, identified themes, synthesised findings and created a narrative review. The STROBE checklist was used in this study. RESULTS Two themes were identified (1) The impact of the COVID-19 pandemic on work-related suicide risk factors in healthcare workers; (2) The impact of the COVID-19 pandemic on mental health-related suicide risk factors in healthcare workers. The pandemic has affected suicide risk factors in healthcare workers. Many studies discussed evidence-based strategies and resources that can be used to reduce suicide risk factors. CONCLUSION The global COVID-19 pandemic has negatively impacted suicide risk factors in healthcare workers. It is time for individuals and healthcare delivery systems to implement suicide risk prevention strategies to protect healthcare workers now and in the future. RELEVANCE TO CLINICAL PRACTICE This review increases awareness of the pandemic's impact on healthcare workers' risk factors for suicide and identifies evidence-based suicide risk prevention strategies and resources for healthcare workers. PATIENT OR PUBLIC CONTRIBUTION Library services supported this research by generating search strategies and providing resources and tools.
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Affiliation(s)
- Jennifer H Zohn
- University of Colorado, Colorado Springs, Colorado Springs, Colorado, USA
| | - Sophia Hovis
- University of Colorado, Colorado Springs, Colorado Springs, Colorado, USA
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Abstract
Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included "moral injury" and "moral distress," identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs.
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Affiliation(s)
- Emily K Mewborn
- The University of Tennessee Health Science Center, Memphis, TN, USA
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Park S, Closser S, Cooney EE, Atkins K, Thrul J, McDonald KM, Langhinrichsen-Rohling J, Veenema TG. "A slap in the face": Institutional betrayal, burnout, and career choice regret among frontline health care workers serving COVID-19 patients. J Trauma Stress 2023; 36:980-992. [PMID: 37671574 DOI: 10.1002/jts.22967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 09/07/2023]
Abstract
The COVID-19 pandemic has exacted a physical and mental health toll on health care and hospital workers (HHWs). To provide COVID-19 care, HHWs expected health care institutions to support equipment and resources, ensure safety for patients and providers, and advocate for employees' needs. Failure to do these acts has been defined as institutional betrayal. Using a mixed-methods approach, this study aimed to explore the experience of institutional betrayal in HHWs serving COVID-19 patients and the associations between self-reported institutional betrayal and both burnout and career choice regret. Between July 2020 and January 2021, HHWs working in an urban U.S. health care system participated in an online survey (n = 1,189) and semistructured interview (n = 67). Among 1,075 quantitative participants, 57.8% endorsed institutional betrayal. Qualitative participants described frustration when the institution did not prioritize their safety while reporting they perceived receiving inadequate compensation from the system and felt that leadership did not sufficiently respond to their needs. Participants who endorsed prolonged breaches of trust reported more burnout and stronger intent to quit their job. Quantitatively, institutional betrayal endorsement was associated with 3-fold higher odds of burnout, aOR = 2.94, 95% CI [2.22, 3.89], and 4-fold higher odds of career choice regret, aOR = 4.31, 95% CI [3.15, 5.89], compared to no endorsement. Developing strategies to prevent, address, and repair institutional betrayal in HHWs may be critical to prevent and reduce burnout and increase motivation to work during and after public health emergencies.
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Affiliation(s)
- Soim Park
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaitlyn Atkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Kathryn M McDonald
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Tener Goodwin Veenema
- Department of Environmental Health and Engineering, Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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D’Alessandro-Lowe AM, Karram M, Ritchie K, Brown A, Millman H, Sullo E, Xue Y, Pichtikova M, Schielke H, Malain A, O’Connor C, Lanius R, McCabe RE, McKinnon MC. Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6812. [PMID: 37835082 PMCID: PMC10572244 DOI: 10.3390/ijerph20196812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six (N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI (p's < 0.001), shame-related MI (p = 0.03 and p = 0.02, respectively) and trust-violation-related MI (p's < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history (p = 0.02) and self-compassion (p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees.
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Affiliation(s)
- Andrea M. D’Alessandro-Lowe
- Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 4L6, Canada;
- Homewood Research Institute, Guelph, ON N13 6K9, Canada
| | - Mauda Karram
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Kim Ritchie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- Trent/Fleming School of Nursing, Trent University, Peterborough, ON K9L 0G2, Canada
| | - Andrea Brown
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Heather Millman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Emily Sullo
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Yuanxin Xue
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mina Pichtikova
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON M5S 1V6, Canada
| | | | - Ann Malain
- Homewood Health Centre, Guelph, ON NIE 6K9, Canada
| | | | - Ruth Lanius
- Homewood Research Institute, Guelph, ON N13 6K9, Canada
- Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Margaret C. McKinnon
- Homewood Research Institute, Guelph, ON N13 6K9, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
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11
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Rabin S, Kika N, Lamb D, Murphy D, AM Stevelink S, Williamson V, Wessely S, Greenberg N. Moral Injuries in Healthcare Workers: What Causes Them and What to Do About Them? J Healthc Leadersh 2023; 15:153-160. [PMID: 37605753 PMCID: PMC10440078 DOI: 10.2147/jhl.s396659] [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: 04/28/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023] Open
Abstract
Moral injury (MI) refers to the persisting distress which may occur following exposure to potentially morally injurious events (PMIEs). The COVID-19 pandemic has drawn attention to MI in healthcare workers, who have been found to experience more frequent PMIEs in their day-to-day work than those in other occupational groups such as the military. These events may occur on an individual, team, organizational or system level and have been associated with increased clinician burnout and distress, and poor psychological wellbeing. This paper focuses on healthcare workers' experiences of MI, including potential causes and ways to reduce them. There are myriad challenges that influence the development of MI, such as chronic understaffing and the pressure to treat high numbers of patients with limited resources. There are also multiple impacts of MI: at the individual-level, MI can lead to increased staff absences and understaffing, and prolonged patient contact with limited decision-making power. COVID-19 exacerbated such impacts, with a lack of organizational support during a time of increased patient mortality, and uncertainty and heightened pressure on the clinical frontline associated with scarce resources and understaffing. Potential methods for reduction of MI in healthcare workers include pre-exposure mitigation, such as fostering work environments which treat PMIEs in the same way as other occupational hazards and post-exposure mitigation, such as facilitating healthcare workers to process their experiences of PMIEs in peer support groups or with spiritual advisors and, if MI is associated with mental ill-health, talking therapies using trauma-focused and compassion-oriented frameworks.
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Affiliation(s)
- Sarah Rabin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Natalia Kika
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Dominic Murphy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Department, Combat Stress, Leatherhead, UK
| | - Sharon AM Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Victoria Williamson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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12
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Rushton CH. Transforming Moral Suffering by Cultivating Moral Resilience and Ethical Practice. Am J Crit Care 2023; 32:238-248. [PMID: 37391375 DOI: 10.4037/ajcc2023207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Ethical challenges are inherent in nursing practice. They affect patients, families, teams, organizations, and nurses themselves. These challenges arise when there are competing core values or commitments and diverse views on how to balance or reconcile them. When ethical conflict, confusion, or uncertainty cannot be resolved, moral suffering ensues. The consequences of moral suffering in its many forms undermine safe, high-quality patient care, erode teamwork, and undermine well-being and integrity. My experience as a nurse in the pediatric intensive care unit and later as a clinical nurse specialist in confronting these moral and ethical challenges has been the foundation of my program of research. Together we will explore the evolution of our understanding of moral suffering-its expressions, meanings, and consequences and attempts to measure it. Moral distress, the most described form of moral suffering, took hold within nursing and slowly within other disciplines. After 3 decades of research documenting the existence of moral distress, there were few solutions. It was at this juncture that my work pivoted toward exploring the concept of moral resilience as a means for transforming but not eliminating moral suffering. The evolution of the concept, its components, a scale to measure it, and research findings will be explored. Throughout this journey, the interplay of moral resilience and a culture of ethical practice were highlighted and examined. Moral resilience is continuing to evolve in its application and relevance. Many vital lessons have been learned that can inform future research and guide interventions to harness the inherent capabilities of clinicians to restore or preserve their integrity and to engage in large-scale system transformation.
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Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics, Berman Institute of Bioethics, and a professor of nursing and pediatrics, Johns Hopkins University School of Nursing, Baltimore, Maryland
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13
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Kubitza J, Große G, Schütte-Nütgen K, Frick E. Influence of spirituality on moral distress and resilience in critical care staff: A scoping review. Intensive Crit Care Nurs 2023; 76:103377. [PMID: 36669436 PMCID: PMC9850638 DOI: 10.1016/j.iccn.2022.103377] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Covid 19 pandemic has created a situation in which critical care staff experience moral distress. For reducing moral distress, resources such as spirituality can be used. The aim of this scoping review is to explore whether spirituality mitigates the moral distress of critical care staff and strengthens their resilience. The spiritual resources will be identified and the ability of the staff to use spiritual resources will be explored. METHODOLOGY A scoping review of studies reporting on the association between spirituality, moral distress, and resilience. Qualitative and quantitative studies from 2020 that examined critical care staff are included. This scoping review used the five-step framework proposed by Arksey and O'Malley and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in 12 databases. RESULTS 13 studies met inclusion criteria. Critical care staff declaring themselves as spiritual have a higher risk of moral distress and are often not able to use spiritual resources on their own. For effective use of spiritual resources to reduce moral distress, staff need to be skilled in the practice of spirituality with the aim to find inner peace, focus on the positive, and regain a sense of purpose in the work. CONCLUSION Spirituality does not automatically help the critical care staff to cope with moral distress and strengthen resilience. Institutions need to create conditions in which the critical care staff are supported to use their spiritual resources. IMPLICATION FOR CLINICAL PRACTICE Institutions need to involve staff more in the design, implementation, and delivery of spiritual interventions to minimise moral distress. Further research is necessary to examine the impact of critical care staff's demographic characteristics on their spirituality, moral distress, and resilience.
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Affiliation(s)
- Jenny Kubitza
- University Hospital rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Professorship of Spiritual Care and Psychosomatic Health, Technical University of Munich, Kaulbachstraße 22a, Munich 80539, Germany,Corresponding author
| | - Greta Große
- Ludwig-Maximilians-Universität München, Faculty of Medicine, Munich, Germany
| | - Katharina Schütte-Nütgen
- University Medical Center Freiburg, Clinic of Palliative Medicine, Robert-Koch-Straße 3, Freiburg 79106, Germany
| | - Eckhard Frick
- University Hospital rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Professorship of Spiritual Care and Psychosomatic Health, Technical University of Munich, Kaulbachstraße 22a, Munich 80539, Germany
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14
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Rodrigues S, Mercier JM, McCall A, Nannarone M, Hosseiny F. 'Against everything that got you into the job': experiences of potentially morally injurious events among Canadian public safety personnel. Eur J Psychotraumatol 2023; 14:2205332. [PMID: 37170904 PMCID: PMC10184585 DOI: 10.1080/20008066.2023.2205332] [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] [Received: 11/30/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
Background: Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations.Objective: This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada.Method: Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences.Results: PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes.Conclusion: The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context.
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Affiliation(s)
- Sara Rodrigues
- Research and Policy, Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Jean-Michel Mercier
- Research and Policy, Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Adelina McCall
- Research and Policy, Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Molly Nannarone
- Research and Policy, Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Fardous Hosseiny
- Research and Policy, Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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15
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Hinzmann D, Schütte-Nütgen K, Büssing A, Boenisch O, Busch HJ, Dodt C, Friederich P, Kochanek M, Michels G, Frick E. Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:333. [PMID: 36612657 PMCID: PMC9819312 DOI: 10.3390/ijerph20010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.
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Affiliation(s)
- Dominik Hinzmann
- Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 München, Germany
| | | | - Arndt Büssing
- Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Boenisch
- Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Christoph Dodt
- Emergency Department, München Klinik, 81925 Munich, Germany
| | | | - Matthias Kochanek
- Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
| | - Guido Michels
- Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
| | - Eckhard Frick
- School of Medicine, Technical University of Munich, 80333 München, Germany
- Spiritual Care and Psychosomatic Health, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, 80539 Munich, Germany
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16
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Lombardo MC, Mackay P, Stavarski DH, Alderfer ME, Dutton S, Scala E, Gerstenhaber M. An academic and regional nurse research collaborative: Implications for nursing research. Nurs Forum 2022; 57:1162-1168. [PMID: 36285819 DOI: 10.1111/nuf.12815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION A diverse group of nurses and research Network Coordinators formed a collaboration to advance nursing research within Johns Hopkins Clinical Research Network, a partnership of academic and community hospitals in the mid-Atlantic region. The purpose of the Nurse Research Collaborative (NRC) is to provide mentoring, mutual growth, and assist the health care organizations to fulfill nursing research requirements. BACKGROUND We created a multiinstitutional nursing research organization with diversity of member participants and health care facilities. The NRC structure allowed nonacademic facilities to engage in a variety of nursing research projects. This allows for increases in study sample sizes of diverse populations to support and expand nursing research. The NRC is modeled after a physician clinical research network with an aligned mission, vision, goals, and strategic priorities across member organizations. MAIN IDEAS To strengthen multiinstitutional nursing research capability, the NRC developed an infrastructure of leadership, regular meetings, and formal educational presentations. The NRC completed three research studies, facilitating the Institutional Review Board application process, reviewing documents and contracts, providing individual institutional support, and coordinating site leader functions. CONCLUSION A research collaboration of nurses, across multiple hospitals provides efficiencies and expertise not otherwise available in every organization.
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Affiliation(s)
- MaryJo Carter Lombardo
- Department of Clinical Education, Howard County General Hospital, Johns Hopkins Medicine, Maryland, Columbia, USA
| | - Periwinkle Mackay
- Department of Crtical Care, Suburban Hospital, Johns Hopkins Medicine, Maryland, Bethesda, USA
| | - Debra Haas Stavarski
- Department of Research Compliance, Reading Hospital/Tower Health, Pennsylvania, Reading, USA
| | - Mary Ellen Alderfer
- Department of Office Research, Reading Hospital/Tower Health, Reading, Pennsylvania, USA
| | - Suzanne Dutton
- Department of Geriatrics, Sibley Memorial Hospital, Johns Hopkins Medicine, District of Columbia, Washington, USA
| | - Elizabeth Scala
- Institute for Clinical and Translational Research, The Johns Hopkins Hospital, Maryland, Baltimore, USA
| | - Melissa Gerstenhaber
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Maryland, Baltimore, USA
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17
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Zahiriharsini A, Gilbert-Ouimet M, Langlois L, Biron C, Pelletier J, Beaulieu M, Truchon M. Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study. J Psychiatr Res 2022; 155:269-278. [PMID: 36162193 PMCID: PMC9477440 DOI: 10.1016/j.jpsychires.2022.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
Healthcare workers (HCWs) on the frontline of the COVID-19 pandemic exhibit a high prevalence of depression and psychological distress. Moral injury (MI) can lead to such mental health problems. MI occurs when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. Since the start of the pandemic, psychosocial stressors at work (PSWs) might have been exacerbated, which might in turn have led to an increased risk of MI in HCWs. However, research into the associations between PSWs and MI is lacking. Considering these stressors are frequent and most of them are modifiable occupational risk factors, they may constitute promising prevention targets. This study aims to evaluate the associations between a set of PSWs and MI in HCWs during the third wave of the COVID-19 pandemic in Quebec, Canada. Furthermore, our study aims to explore potential differences between urban and non-urban regions. The sample of this study consisted of 572 HCWs and leaders from the Quebec province. Prevalence ratios (PR) of MI and their 95% confidence intervals (CI) were modelled using robust Poisson regressions. Several covariates were considered, including age, sex, gender, socio-economic indicators, and lifestyle factors. Results indicated HCWs exposed to PSWs were 2.22-5.58 times more likely to experience MI. Low ethical culture had the strongest association (PR: 5.58, 95% CI: 1.34-23.27), followed by low reward (PR: 4.43, 95% CI: 2.14-9.16) and high emotional demands (PR: 4.32, 95% CI: 1.89-9.88). Identifying predictors of MI could contribute to the reduction of mental health problems and the implementation of targeted interventions in urban and non-urban areas.
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Affiliation(s)
- Azita Zahiriharsini
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada; CHU de Québec-Laval University Research Center, Quebec, Canada; Réseau intersectoriel de recherche en santé de l'Université du Québec (RISUQ), Quebec, Canada.
| | - Mahée Gilbert-Ouimet
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada,CHU de Québec-Laval University Research Center, Quebec, Canada,Réseau intersectoriel de recherche en santé de l’Université du Québec (RISUQ), Quebec, Canada
| | - Lyse Langlois
- Faculty of Social Sciences, Department of Industrial Relations, Laval University, Quebec, Canada
| | - Caroline Biron
- Department of Management, Laval University, Quebec, Canada
| | - Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada
| | | | - Manon Truchon
- School of Psychology, Laval University, Quebec, Canada,Centre de recherche interdisciplinaire en réadaptation et intégration sociale (CIRRIS), Quebec, Canada
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18
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Swavely D, Romig B, Weissinger G, Holtz H, Alderfer M, Lynn L, Adil T, Rushton CH. The Impact of Traumatic Stress, Resilience, and Threats to Core Values on Nurses During a Pandemic. J Nurs Adm 2022; 52:525-535. [PMID: 36166631 PMCID: PMC9512236 DOI: 10.1097/nna.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to understand the traumatic stress and resilience of nurses who cared for patients with COVID-19. BACKGROUND Studies have shown a high proportion of healthcare workers are at risk for developing posttraumatic stress disorder after a pandemic. Resilience factors are believed to play an important role in the well-being of healthcare professionals. METHODS This was a triangulated mixed methods study; a phenomenological qualitative approach with survey data was used to triangulate the findings, and sensemaking was used as the theoretical framework. RESULTS Four themes emerged from the study: 1) phases of traumatic stress response to perceived threats; 2) honoring their sacrifice; 3) professional self-identity; and 4) sustaining resilience in a stressful work environment. Quantitative results on traumatic stress, general resilience, and moral resilience supported the themes. CONCLUSIONS The findings will help leaders understand the potential for postpandemic mental health problems and the role of resilience in maintaining well-being.
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Affiliation(s)
- Deborah Swavely
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Barbara Romig
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Guy Weissinger
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Heidi Holtz
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Mary Alderfer
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Lisa Lynn
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Thomas Adil
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
| | - Cynda Hylton Rushton
- Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading Hospital; and Assistant Professor (Dr Weissinger), Villanova University, Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins University, Baltimore, Maryland
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19
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Malamateniou C. The legacy of COVID-19 for radiography practice, education, and research: How to use lessons learned to navigate the "new normal"? Radiography (Lond) 2022; 28 Suppl 1:S9-S12. [PMID: 36202471 PMCID: PMC9527505 DOI: 10.1016/j.radi.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Laher Z, Robertson N, Harrad-Hyde F, Jones CR. Prevalence, Predictors, and Experience of Moral Suffering in Nursing and Care Home Staff during the COVID-19 Pandemic: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159593. [PMID: 35954948 PMCID: PMC9368354 DOI: 10.3390/ijerph19159593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022]
Abstract
(1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual’s moral beliefs and elicits adverse emotional responses. (2) Method: A systematic review was conducted to explore the prevalence, predictors, and psychological experience of MI and MD in the aforementioned population during the COVID-19 pandemic. The databases CINAHL, APA PsychINFO, APA PsychArticles, Web of Science, Medline, and Scopus were systematically searched for original research studies of all designs, published in English, with no geographical restrictions, and dating from when COVID-19 was declared a public health emergency on the 30 January 2020 to the 3 January 2022. Out of 531 studies screened for eligibility, 8 studies were selected for review. A thematic analysis was undertaken to examine the major underpinning themes. (3) Results: MI, MD, and related constructs (notably secondary traumatic stress) were evidenced to be present in staff, although most studies did not explore the prevalence or predictors. The elicited major themes were resource deficits, role challenges, communication and leadership, and emotional and psychosocial consequences. (4) Conclusions: Our findings suggest that moral injury and moral distress were likely to be present prior to COVID-19 but have been exacerbated by the pandemic. Whilst studies were generally of high quality, the dearth of quantitative studies assessing prevalence and predictors suggests a research need, enabling the exploration of causal relationships between variables. However, the implied presence of MI and MD warrants intervention developments and workplace support for nursing and care home staff.
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Affiliation(s)
- Zainab Laher
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK
- Correspondence: (Z.L.); (C.R.J.)
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK
| | - Fawn Harrad-Hyde
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Ceri R. Jones
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK
- Correspondence: (Z.L.); (C.R.J.)
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21
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Rushton CH, Boston-Leary K. Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare. Nurs Manag (Harrow) 2022; 53:7-11. [PMID: 35913813 DOI: 10.1097/01.numa.0000853148.17873.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is the Anne & George L. Bunting professor of clinical ethics, nursing and pediatrics at Johns Hopkins University's Berman Institute of Bioethics and School of Nursing in Baltimore, Md. Katie Boston-Leary is the director of nursing programs and Healthy Nurse, Healthy Nation at the American Nurses Association in Silver Spring, Md
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22
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Fitzpatrick JJ, Pignatiello G, Kim M, Jun J, O'Mathúna DP, Duah HO, Taibl J, Tucker S. Moral Injury, Nurse Well-being, and Resilience Among Nurses Practicing During the COVID-19 Pandemic. J Nurs Adm 2022; 52:392-398. [PMID: 35815868 DOI: 10.1097/nna.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine relationships between moral injury (MI), well-being, and resilience among staff nurses and nurse leaders practicing during the COVID-19 (coronavirus disease 2019) pandemic. BACKGROUND Attention to MI among health professionals, including nurses, increased in 2021, particularly related to the pandemic. Few studies examined MI, well-being, and resilience; even fewer provided implications for leadership/management. METHODS The sample included 676 RNs practicing in Ohio. The electronic survey included assessments of MI, well-being, and resilience distributed via the Ohio Nurses Association and the schools of nursing alumni Listservs. RESULTS There was a significant association between MI and negative well-being and negative association between MI and resilience. Differences were observed between staff nurses and leaders. CONCLUSIONS This is the first study relating MI, resilience, and well-bring among nurses and nurse leaders during the pandemic. There is a need for additional research to further our understanding about nurses' health and well-being during the pandemic and beyond.
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Affiliation(s)
- Joyce J Fitzpatrick
- Author Affiliations: Director, Marian K. Shaughnessy Nurse Leadership Academy, Elizabeth Brooks Ford Professor of Nursing, and Distinguished University Professor (Dr Fitzpatrick), Frances Payne Bolton School of Nursing, Case Western Reserve University; and Instructor (Dr Pignatiello), Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland: Assistant Professor (Dr Kim), College of Nursing, University of Cincinnati, Cincinnati; Assistant Professor (Dr Jun) and Associate Professor (Dr O'Mathúna), College of Nursing, The Ohio State University, Columbus; PhD Student (Mr Duah), College of Nursing, University of Cincinnati, Cincinnati; DNP Student (Ms Taibl), Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland; and Grayce Sills Endowed Professor in Psychiatric Mental Health Nursing, Director of DNP Nurse Executive Core, and Director of Implementation Science Core (Dr Tucker), Fuld EBP Institute, College of Nursing, The Ohio State University, Columbus
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23
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Rushton CH, Nelson KE, Antonsdottir I, Hanson GC, Boyce D. Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic: Secondary analysis. Nurs Manag (Harrow) 2022; 53:12-22. [PMID: 35776417 PMCID: PMC9245532 DOI: 10.1097/01.numa.0000834524.01865.cc] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It's crucial to understand the perspective of nurses during the pandemic to determine actionable steps for moving forward. This analysis looks at nurses' perceptions of their organizations' effectiveness during the first surge of the COVID-19 pandemic and its impact on moral injury and moral resilience.
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Affiliation(s)
- Cynda Hylton Rushton
- At Johns Hopkins University in Baltimore, Md., Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics, Nursing and Medicine at the Berman Institute of Bioethics & School of Nursing; Katie Nelson is a PhD candidate; Inga Antonsdottir is the program coordinator for the COVID Dementia Caregivers Supplement Project, and a graduate research assistant/coordinator for the Memory and Aging Services Innovation (MASI) Center in the Department of Psychiatry & Behavioral Sciences; Ginger C. Hanson is an assistant professor, and Danielle Boyce is an assistant professor, neurology
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24
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Jouini A, Mokline A, Sabta H, Smadhi I, Ben Cheikh M, Dziri C. Impact of the COVID-19 pandemic on the development of burnout syndrome in healthcare providers: prevalence and predictive factors. LA TUNISIE MEDICALE 2022; 100:470-476. [PMID: 36206066 PMCID: PMC9589243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In Tunisia, the pandemic is still ongoing, resulting in the burnout of healthcare providers. AIMS This study aimed to assess the impact of the management of COVID-19 patients on the physical and mental health of healthcare providers, and to identify the independent and predictive variables for the three components of severe burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment at work. METHODS It was a cross-sectional survey. Data were collected between February 8, and April 11, 2021. Healthcare providers, who were positive for COVID, completed the questionnaire. The primary endpoint was to assess the degree of burnout in healthcare providers by adopting the original version of the severe Maslach Burnout Inventory: emotional exhaustion (≥30), depersonalization (≥12), and lack of personal accomplishment at work (≤ 33). A descriptive analysis followed by a bi- and multivariate analysis was performed to identify independent and predictive factors for each component of burnout. RESULTS 700 healthcare providers were audited. Emotional exhaustion was ≥ 30 in 86%, depersonalization was ≥ 12 in 61%, and lack of personal accomplishment at work was ≤ 33 in 69%. Of the 700 healthcare providers, 93% were working at the same time in the COVID units, 85% had not received compensatory rest. Healthcare provider who had been infected by COVID-19 was the only independent predictive variable of severe emotional exhaustion and severe depersonalization. Healthcare provider who had been infected by COVID-19 and did not have a compensatory rest were two independent predictive variables of severe lack of personal accomplishment at work. CONCLUSION Healthcare provider who had been infected by COVID-19 was the only predictive variable of severe emotional exhaustion and severe depersonalization. Healthcare provider who had been infected by COVID-19 and did not have a compensatory rest were two independent and predictive variables of severe lack of personal accomplishment at work.
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Affiliation(s)
- Asma Jouini
- 1. Nurse anesthetist, school of nursing central, Honoris united universities, Department of anesthesiology- La Rose Clinic-Tunis
| | - Amel Mokline
- 2. Professor of Intensive care, Tunis El Manar University, Medical school of Tunis
| | - Hager Sabta
- 3. Nurse anesthetist, Department A of Surgery – Charles Nicolle’s hospital –Tunis
| | - Ichrak Smadhi
- 4. Nurse anesthetist, Department of anesthesiology – Military hospital of Tunis
| | - Maamoun Ben Cheikh
- 5. Professor of anesthesia, Simulation educator, Honoris Medical Simulation center- Tunis
| | - Chadli Dziri
- 6. Professor Emeritus of General Surgery, Tunis El Manar University, Medical school of Tunis, Director of Honoris Medical Simulation Center
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25
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Veenema TG, Meyer D, Rushton CH, Bruns R, Watson M, Schneider-Firestone S, Wiseman R. The COVID-19 Nursing Workforce Crisis: Implications for National Health Security. Health Secur 2022; 20:264-269. [PMID: 35723879 DOI: 10.1089/hs.2022.0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tener Goodwin Veenema
- Tener Goodwin Veenema, RN, PhD, MS, MPH, FAAN, is a Contributing Scholar, Johns Hopkins Center for Health Security, Baltimore, MD.,Tener Goodwin Veenema is also a Senior Scientist, Department of International Health, Baltimore, MD
| | - Diane Meyer
- Diane Meyer, RN, MPH, and Matthew Watson are Senior Analysts, Johns Hopkins Center for Health Security, Baltimore, MD.,Diane Meyer is a Research Associate, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cynda Hylton Rushton
- Cynda Hylton Rushton, PhD, RN, FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics and Nursing, Johns Hopkins University Berman Institute of Bioethics and the Johns Hopkins School of Nursing, Baltimore, MD
| | - Richard Bruns
- Richard Bruns, PhD, is a Senior Scholar, Johns Hopkins Center for Health Security, Baltimore, MD.,Richard Bruns is an Assistant Scientist, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew Watson
- Matthew Watson is a Senior Research Associate, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Schneider-Firestone
- Sarah Schneider-Firestone, MSW, is a Research Project Manager, Johns Hopkins School of Nursing, Baltimore, MD
| | - Rebecca Wiseman
- Rebecca Wiseman, PhD, RN, is an Associate Professor and Director, Maryland Nursing Workforce Center, University of Maryland School of Nursing, Baltimore, MD
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Maguen S, Griffin BJ. Research Gaps and Recommendations to Guide Research on Assessment, Prevention, and Treatment of Moral Injury Among Healthcare Workers. Front Psychiatry 2022; 13:874729. [PMID: 35492723 PMCID: PMC9051037 DOI: 10.3389/fpsyt.2022.874729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Healthcare workers face numerous occupational stressors, including some that may challenge personal and shared morals and values. This is particularly true during disasters and crises such as the COVID-19 pandemic, which require critical decisions to be made with little time and information often under personal distress and situational constraints. Consequently, healthcare workers are at risk for moral injuries characterized by stress-related and functional impacts. Although research on the evaluation and treatment of moral injury among military veterans burgeoned in the recent decade, addressing moral injury in healthcare workers and other civilians remains an important gap. In this perspective piece, we identify research gaps and make recommendations to advance future work on assessment, prevention, and treatment of moral injury in healthcare workers. We draw on empirical studies of moral injury in veterans, limited studies of moral injury in health professionals, and our clinical experiences with healthcare workers affected by moral injury.
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Affiliation(s)
- Shira Maguen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,San Francisco VA Healthcare System, San Francisco, CA, United States
| | - Brandon J Griffin
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Central Arkansas VA Healthcare System, Little Rock, AR, United States
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