1
|
Girela-Lopez E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, Lopez-Valero M, Romero-Saldaña M. Measuring moral distress in health professionals using the MMD-HP-SPA scale. BMC Med Ethics 2024; 25:41. [PMID: 38570759 PMCID: PMC10993501 DOI: 10.1186/s12910-024-01041-z] [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: 04/13/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.
Collapse
Affiliation(s)
- Eloy Girela-Lopez
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Lopez-Valero
- Dispositivo de Cuidados Críticos y Urgencias, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy. Faculty of Medicine and Nursing, University of Cordoba, Córdoba, Spain
| |
Collapse
|
2
|
Sperling D. "They choke to death in front of your very eyes": nurses' lived experiences and perspectives on end-of-life care during COVID-19. BMC Palliat Care 2024; 23:35. [PMID: 38331781 PMCID: PMC10854065 DOI: 10.1186/s12904-024-01352-3] [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: 04/22/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an intensified fear and threat of dying, combined with dying and grieving in isolation, in turn significantly impacting nursing in end-of-life situations. The study aims (1) to understand the lived experiences of nurses who provided care to end-of-life patients during COVID-19; and (2) to explore whether providing care under such circumstances altered the perspectives of these nurses regarding end-of-life care. METHODS Applying the phenomenological-interpretive qualitative approach, 34 in-depth semi-structured interviews were conducted between March 2020-May 2021 with nurses from eight hospitals in Israel who were recruited through purposive and snowball sampling. Thematic analysis was applied to identify major themes from the interviews. RESULTS Five main themes emerged from the analysis, including: (1) a different death; (2) difficulties in caring for the body after death; (3) the need for family at end-of-life; (4) weaker enforcement of advance care directives; and (5) prolonging the dying process. DISCUSSION During the pandemic, nurses encountered numerous cases of death and dying, while facing ethical and professional issues regarding end-of-life care. They were required to administer more aggressive care than usual and even necessary, leading to their increased moral distress. The nurses' ethical concerns were also triggered by the requirement to wrap the corpse in black garbage-like bags to prevent contagion, which they felt was abusing the dead. The findings also demonstrate how family presence at end-of-life is important for the nursing staff as well as the patient. Finally, end-of-life situations during the pandemic in Israel were managed in an individual and personal manner, rather than as a collective mission, as seen in other countries. CONCLUSIONS The study offers insights into the nurses' attitudes towards death, dying, and end-of-life care. An emphasis should be placed on the key elements that emerged in this study, to assist nurses in overcoming these difficulties during and after medical crises, to enhance end-of-life care and professionalism and decrease burnout.
Collapse
|
3
|
Molinaro ML, Shen K, Agarwal G, Inglis G, Vanstone M. Family physicians' moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care. Br J Gen Pract 2024; 74:e41-e48. [PMID: 37957021 PMCID: PMC10664150 DOI: 10.3399/bjgp.2023.0193] [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: 04/18/2023] [Accepted: 08/10/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Family physicians (GPs) working with patients experiencing social inequities have witnessed patients' healthcare needs proliferate. Alongside increased workload demands fostered within current remuneration structures, this has generated concerning reports of family physician attrition and possible experiences of moral distress. AIM To explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities. DESIGN AND SETTING A critical narrative inquiry, informed by the analytic lens of moral distress, conducted in Ontario, Canada. METHOD Twenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews and had the opportunity to review the interview transcripts. RESULTS Family physicians' accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programmes. These structural elements left physicians unable to get patients much needed support and resources. CONCLUSION This study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system. Further research is needed to critically interrogate how health and social welfare systems around the world can be reformed to improve the health of patients and increase family physicians' professional quality of life, potentially improving retention.
Collapse
Affiliation(s)
- Monica L Molinaro
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katrina Shen
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabrielle Inglis
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
4
|
Sherman M, Klinenberg E. Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge. Soc Sci Med 2024; 340:116471. [PMID: 38061219 DOI: 10.1016/j.socscimed.2023.116471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 01/23/2024]
Abstract
The U.S. is facing a national shortage of healthcare workers, as waves of clinicians quit their jobs or leave the profession entirely. Much of the public discourse around this exodus characterizes it as the result of widespread "burnout." This study draws on in-depth interviews with 22 healthcare workers in New York City to gain deeper understanding of what is leading them to abandon their roles despite the abundant need for their services. It finds that "burnout" in healthcare may be largely explained by moral distress and moral injury inflicted on healthcare workers struggling to care for patients during the COVID-19 pandemic. After presenting a review of the recent literature on moral injury and moral distress, this study lays out five kinds of experiences that emerged during the interviews as the most salient contributors to moral distress, on the one hand, and moral injury, on the other, among healthcare workers. Taken together, these experiences are referred to as "moral suffering." The key finding from this research is that moral suffering, even when undiagnosed and unnamed, affects HCWs' ability to provide care and influences their decisions to leave the healthcare profession. Ultimately, this article suggests a need to rethink the ways in which moral distress and moral injury are applied in social scientific research and concludes by indicating how future research can promote the transformation of networks of injury in healthcare into networks of care.
Collapse
Affiliation(s)
- Melina Sherman
- Knology, 40 Exchange Pl. Suite 1403, New York, NY, 10005, USA.
| | - Eric Klinenberg
- New York University, Department of Sociology, 295 Lafayette Street, 4th Floor, New York, NY, 10012, USA.
| |
Collapse
|
5
|
Li F, Zhong J, He Z. Moral distress, moral resilience, and job embeddedness among pediatric nurses. Nurs Ethics 2023:9697330231218347. [PMID: 38128146 DOI: 10.1177/09697330231218347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Nurses often face ethical issues in their daily work that can have an impact on their level of job embeddedness. And positive job embeddedness is essential to reduce burnout among nurses and improve professional retention in the medical industry. However, few studies have focused on the relationship between moral distress, moral resilience, and job embeddedness. OBJECTIVES To investigate the relationship between moral distress, moral resilience, and job embeddedness, and explore the mediating role of moral resilience between moral distress and job embeddedness among nurses. DESIGN A quantitative, cross-sectional study. METHODS Nurses from a number of tertiary general hospitals in central China were surveyed and assessed using the Moral Distress Scale, the Nurse Moral Resilience Scale, and the nurse job embeddedness Scale from February to March 2023. The study was conducted in line with the 1964 Declaration of Helsinki. ETHICAL CONSIDERATION All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-313). FINDINGS Moral distress was positively correlated with moral resilience (β = 0.525, p < 0.01) and negatively correlated job embeddedness (β = -0.470, p < 0.01). Moral resilience partially mediated the relationship between moral distress with job embeddedness (β = -0.087, p < 0.01). DISCUSSION The findings reveal a relationship between moral distress, job embeddedness, and moral resilience among nurses. CONCLUSION Moral distress and moral resilience are important correlates of job embeddedness in nurses. Interventions to reduce moral distress and increase moral resilience may have potential benefits for improving nurses' job embeddedness. It is recommended that clinical nursing administrators create a favorable ethical atmosphere, educate nurses about ethics, and increase nurses' moral resilience.
Collapse
Affiliation(s)
| | | | - Ziyuan He
- Hunan Vocational College of Science and Technology
| |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
- Emily K Mewborn
- The University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
7
|
Gebert RR, Behrens MR, Loschiavo MJ. Behind the scenes: Moral distress among psychosocial oncology clinical research staff during the COVID-19 pandemic. Palliat Support Care 2022; 20:777-778. [PMID: 35899761 DOI: 10.1017/s1478951522000943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Rebecca R Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mia R Behrens
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morgan J Loschiavo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
8
|
Moral Injury in the Context of Substance Use Disorders: a Narrative Review. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:321-330. [PMID: 36158584 PMCID: PMC9483387 DOI: 10.1007/s40501-022-00280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
|
9
|
Chemali S, Mari-Sáez A, El Bcheraoui C, Weishaar H. Health care workers' experiences during the COVID-19 pandemic: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:27. [PMID: 35331261 PMCID: PMC8943506 DOI: 10.1186/s12960-022-00724-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/09/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included. RESULTS 161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries. DISCUSSION This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances. CONCLUSIONS Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.
Collapse
Affiliation(s)
- Souaad Chemali
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Almudena Mari-Sáez
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| |
Collapse
|
10
|
Bradshaw A, Dunleavy L, Garner I, Preston N, Bajwah S, Cripps R, Fraser LK, Maddocks M, Hocaoglu M, Murtagh FE, Oluyase AO, Sleeman KE, Higginson IJ, Walshe C. Experiences of staff providing specialist palliative care during COVID-19: a multiple qualitative case study. J R Soc Med 2022; 115:220-230. [PMID: 35133216 PMCID: PMC9158238 DOI: 10.1177/01410768221077366] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the experiences of, and impact on, staff working in palliative care during the COVID-19 pandemic. Design Qualitative multiple case study using semi-structured interviews between November 2020 and April 2021 as part of the CovPall study. Data were analysed using thematic framework analysis. Setting Organisations providing specialist palliative services in any setting. Participants Staff working in specialist palliative care, purposefully sampled by the criteria of role, care setting and COVID-19 experience. Main outcome measures Experiences of working in palliative care during the COVID-19 pandemic. Results Five cases and 24 participants were recruited (n = 12 nurses, 4 clinical managers, 4 doctors, 2 senior managers, 1 healthcare assistant, 1 allied healthcare professional). Central themes demonstrate how infection control constraints prohibited and diluted participants’ ability to provide care that reflected their core values, resulting in experiences of moral distress. Despite organisational, team and individual support strategies, continually managing these constraints led to a ‘crescendo effect’ in which the impacts of moral distress accumulated over time, sometimes leading to burnout. Solidarity with colleagues and making a valued contribution provided ‘moral comfort’ for some. Conclusions This study provides a unique insight into why and how healthcare staff have experienced moral distress during the pandemic, and how organisations have responded. Despite their experience of dealing with death and dying, the mental health and well-being of palliative care staff was affected by the pandemic. Organisational, structural and policy changes are urgently required to mitigate and manage these impacts.
Collapse
Affiliation(s)
- Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| | - Ian Garner
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Rachel Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, HU6 7RX, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| |
Collapse
|
11
|
A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031666. [PMID: 35162689 PMCID: PMC8835282 DOI: 10.3390/ijerph19031666] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Abstract
Ethical dilemmas for healthcare workers (HCWs) during pandemics highlight the centrality of moral stressors and moral distress (MD) as well as potentially morally injurious events (PMIEs) and moral injury (MI). These constructs offer a novel approach to understanding workplace stressors in healthcare settings, especially in the demanding times of COVID-19, but they so far lack clear identification of causes and consequences. A scoping review of moral stressors, moral distress, PMIEs, and MI of healthcare workers during COVID-19 was conducted using the databases Web of Science Core Collection and PsycINFO based on articles published up to October 2021. Studies were selected based on the following inclusion criteria: (1) the measurement of either moral stress, MD, PMIEs, or MI among HCWs; (2) original research using qualitative or quantitative methods; and (3) the availability of the peer-reviewed original article in English or German. The initial search revealed n = 149,394 studies from Web of Science and n = 34 studies from EBSCOhost. Nineteen studies were included in the review. Conditions representing moral stressors and PMIEs as well as MD and MI as their potential outcomes in healthcare contexts during COVID-19 are presented and discussed. Highlighting MD and MI in HCWs during COVID-19 brings attention to the need for conceptualizing the impact of moral stressors of any degree. Therefore, the development of a common, theoretically founded model of MD and MI is desirable.
Collapse
|
12
|
Xue Y, Lopes J, Ritchie K, D'Alessandro AM, Banfield L, McCabe RE, Heber A, Lanius RA, McKinnon MC. Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review. Front Psychiatry 2022; 13:863232. [PMID: 35770054 PMCID: PMC9234401 DOI: 10.3389/fpsyt.2022.863232] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these cohorts have not been systematically explored, nor have the unique circumstances that may exist across countries been explored. Here, we sought to identify and compare, across the globe, potentially morally injurious or distressful events (PMIDEs) in HCWs and PSP during the COVID-19 pandemic. A scoping review was conducted to identify and synthesize global knowledge on PMIDEs in HCWs and select PSP. Six databases were searched, including MEDLINE, EMBASE, Web of Science, PsychInfo, CINAHL, and Global Health. A total of 1,412 articles were retrieved, of which 57 articles were included in this review. These articles collectively described the experiences of samples from 19 different countries, which were comprised almost exclusively of HCWs. Given the lack of PSP data, the following results should not be generalized to PSP populations without further research. Using qualitative content analysis, six themes describing circumstances associated with PMIDEs were identified: (1) Risk of contracting or transmitting COVID-19; (2) Inability to work on the frontlines; (3) Provision of suboptimal care; (4) Care prioritization and resource allocation; (5) Perceived lack of support and unfair treatment by their organization; and (6) Stigma, discrimination, and abuse. HCWs described a range of emotions related to these PMIDEs, including anxiety, fear, guilt, shame, burnout, anger, and helplessness. Most PMIDE themes appeared to be shared globally, particularly the 'Risk of contracting or transmitting COVID-19' and the 'Perceived lack of support and unfair treatment by their organization.' Articles included within the theme of 'Stigma, discrimination, and abuse' represented the smallest global distribution of all PMIDE themes. Overall, the present review provides insight into PMIDEs encountered by HCWs across the globe during COVID-19. Further research is required to differentiate the experience of PSP from HCWs, and to explore the impact of social and cultural factors on the experience of MD and MI.
Collapse
Affiliation(s)
- Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Jillian Lopes
- Psychology, Neuroscience and Behaviour Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Kimberly Ritchie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | | | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Alexandra Heber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Veterans Affairs Canada, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON, Canada.,Department of Psychiatry, Western University of Canada, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
13
|
Hegarty S, Lamb D, Stevelink SAM, Bhundia R, Raine R, Doherty MJ, Scott HR, Marie Rafferty A, Williamson V, Dorrington S, Hotopf M, Razavi R, Greenberg N, Wessely S. 'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic. Eur J Psychotraumatol 2022; 13:2128028. [PMID: 36276556 PMCID: PMC9586685 DOI: 10.1080/20008066.2022.2128028] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone's moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) [Nash et al., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652] at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HIGHLIGHTS Clinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patients.HCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbance.Most HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress.
Collapse
Affiliation(s)
- Siobhan Hegarty
- 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
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | | | - Hannah R Scott
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, 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
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Reza Razavi
- King's Wellcome Trust EPSRC Centre For Medical Engineering, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
14
|
Mishna F, Milne B, Sanders J, Greenblatt A. Social Work Practice During COVID-19: Client Needs and Boundary Challenges. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 9:113-120. [PMID: 34754722 PMCID: PMC8569291 DOI: 10.1007/s40609-021-00219-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
While information and communication technologies (ICTs) permeated social work practice long before the onset of COVID-19, the abrupt need to close non-essential workplaces resulted in an unparalleled incorporation of digital technology into practice across the globe. The onset of COVID-19 occurred during phase two of research in which we were investigating social workers' informal use of ICT with clients. Prior to COVID-19, we were conducting interviews with practitioners and clients from four agencies serving diverse client populations in a large city in Canada. With the onset of COVID-19, we adapted to the COVID-19 context and amended the questions to investigate ICT use during the pandemic. In addition, with ethics approval, we conducted second interviews with practitioners interviewed prior to COVID-19 with a revised guide to address the pandemic context; and we continued to recruit and interview practitioners and clients using an amended interview guide incorporating pandemic-related questions. The sample comprised 27 practitioners and 22 clients. Eleven practitioners participated in interviews prior to and during COVID-19. Analysis of transcribed interviews revealed that the COVID-19 context had led to a paradigm shift in practitioners' ICT use, with two key themes identified: (1) boundary challenges and (2) clients' diverging ICT needs. We discuss these themes and present implications for policy and practice in a post-COVID-19 world.
Collapse
Affiliation(s)
- Faye Mishna
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON M5S 1V4 Canada
| | - Betsy Milne
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON M5S 1V4 Canada
| | - Jane Sanders
- Present Address: School of Social Work, King’s University College at Western University, London, ON Canada
| | - Andrea Greenblatt
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON M5S 1V4 Canada
| |
Collapse
|
15
|
Gangamma R, Walia B, Luke M, Lucena C. Continuation of teletherapy post COVID-19: Survey data from licensed mental health professionals (Preprint). JMIR Form Res 2021; 6:e32419. [PMID: 35584317 PMCID: PMC9162131 DOI: 10.2196/32419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/02/2023] Open
Abstract
Background The use of teletherapy has exponentially increased in the context of the ongoing COVID-19 pandemic. Studies on teletherapy documented substantial benefits of accessibility and convenience even before the start of the pandemic. Although recent studies show that this modality of therapy delivery is here to stay, few have studied who will most benefit from this trend. Objective In this paper, we report predictors of continued teletherapy usage in a sample of licensed mental health professionals in the United States during a time period when pandemic-related restrictions began diminishing. As such, it is one of the first studies to examine factors related to continued benefits of teletherapy postpandemic. Methods Participation from licensed mental health professionals was sought on listservs of national organizations of multiple mental health organizations. Data were collected via an anonymous link to a survey on Qualtrics between January 2021 and April 2021. Participants responded to questions on therapist demographics, practice setting, experiences of shifting to teletherapy, perspectives on continued use of teletherapy, and their client characteristics. Findings related to client characteristics that predicted continued teletherapy usage are presented here. Results A total of 186 individuals consented to participate in the survey, with a final sample of 114 with complete data. A majority of participants identified as female (92/114, 80.7%), White (94/114, 82.5%), and having a master's degree (75/114, 65.5%) from a nationally accredited program (106/114, 93%). Data were analyzed using heteroskedastic regression modeling with client-related factors as predictors. Two models were run with and without distance travelled by clients as a control variable. Model estimates from both models showed that continued use of teletherapy postpandemic was predicted by the following factors: higher percentage of clients from rural areas, younger and older adult clients, clients with Medicare, and clients with marginalized gender and religious/spiritual identities. Significantly, having a higher percentage of clients from lower socioeconomic status, a higher percentage of those with Medicaid coverage, and a higher percentage of couples and families as clients predicted decreased use of teletherapy postpandemic. Conclusions Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries, and those who seek couple and family therapy may be less likely to be served by it. These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing, and childcare issues, as well as the need for continued training for licensed professionals.
Collapse
Affiliation(s)
- Rashmi Gangamma
- Department of Marriage and Family Therapy, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Bhavneet Walia
- Department of Public Health, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| | - Melissa Luke
- Department of Counseling & Human Services, School of Education, Syracuse University, Syracuse, NY, United States
| | - Claudine Lucena
- Department of Marriage and Family Therapy, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, United States
| |
Collapse
|
16
|
Kogan LR, Bussolari C. Exploring the Potential Impact of a Virtual Body Scan Meditation Exercise Conducted With Pet Dogs on Recipients and Facilitators. Front Psychol 2021; 12:698075. [PMID: 34335415 PMCID: PMC8322236 DOI: 10.3389/fpsyg.2021.698075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
Numerous recent studies have shown that COVID-19 and the accompanying mandated lifestyle changes have resulted in significant negative effects on people's mental health. To meet the increased need for mental health support, while also maintaining physical safety, a variety of telehealth services have been created or expanded. A body scan mindfulness program is an intervention that can easily be modified to be offered virtually. This study was designed to determine if a virtual body scan mindfulness exercise, with participants' holding their dog or a pillow/blanket, could reduce their stress and anxiety as well as that of the facilitators. Significant differences in pre/post-State Anxiety Assessment scores for participants and facilitators were found. These results are discussed within the framework of the human animal bond and the potential of this form of intervention as a useful virtual tool for participants and facilitators alike.
Collapse
Affiliation(s)
- Lori R. Kogan
- Department of Clincal Sciences, Colorado State University, Fort Collins, CO, United States
| | - Cori Bussolari
- Department of Clinical Psychology, University of San Francisco, San Francisco, CA, United States
| |
Collapse
|