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Beadle ES, Walecka A, Sangam AV, Moorhouse J, Winter M, Munro Wild H, Trivedi D, Casarin A. Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies. PLoS One 2024; 19:e0303013. [PMID: 38935754 PMCID: PMC11210881 DOI: 10.1371/journal.pone.0303013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/17/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions. METHODS A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic. RESULTS Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients' care options, professionals' beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals' moral comfort. Patients' care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change. CONCLUSION This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals' disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals' beliefs, repercussions on professionals' wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.
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Affiliation(s)
- Emily S. Beadle
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | | | - Amy V. Sangam
- Intensive Care Unit, Royal Free Hospital, London, United Kingdom
| | | | - Matthew Winter
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Helen Munro Wild
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, School of Health and Social Work, The University of Hertfordshire, Hatfield, United Kingdom
| | - Annalisa Casarin
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Rhead R, Harber-Aschan L, Onwumere J, Polling C, Dorrington S, Ehsan A, Stevelink SAM, Khunti K, Mir G, Morriss R, Wessely S, Woodhead C, Hatch S. Ethnic inequalities among NHS staff in England: workplace experiences during the COVID-19 pandemic. Occup Environ Med 2024; 81:113-121. [PMID: 38378264 PMCID: PMC10958323 DOI: 10.1136/oemed-2023-108976] [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] [Received: 05/08/2023] [Accepted: 11/23/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study. METHODS An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). RESULTS Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health. CONCLUSIONS Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.
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Affiliation(s)
- Rebecca Rhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Demography Unit, Stockholm University, Stockholm, Sweden
| | - Juliana Onwumere
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Catherine Polling
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Annahita Ehsan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sharon A M Stevelink
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, UK
- Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR ARC East Midlands, University of Nottingham, Nottingham, UK
| | - Simon Wessely
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Charlotte Woodhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Stephani Hatch
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
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Schilling S, Armaou M, Morrison Z, Carding P, Bricknell M, Connelly V. "Trust people you've never worked with" - A social network visualization of teamwork, cohesion, social support, and mental health in NHS Covid personnel. Front Psychol 2024; 15:1293171. [PMID: 38445057 PMCID: PMC10913897 DOI: 10.3389/fpsyg.2024.1293171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Background The unprecedented rapid re-deployment of healthcare workers from different care pathways into newly created and fluid COVID-19 teams provides a unique opportunity to examine the interaction of many of the established non-technical factors for successful delivery of clinical care and teamwork in healthcare settings. This research paper therefore aims to address these gaps by qualitatively exploring the impact of COVID work throughout the pandemic on permanent and deployed personnel's experiences, their ability to effectively work together, and the effect of social dynamics (e.g., cohesion, social support) on teamwork and mental health. Methods Seventy-five interviews were conducted across the UK between March and December 2021 during wave 2 and 3 of COVID-19 with 75 healthcare workers who were either permanent staff on Intensive Care/High Dependency Units used as COVID wards, had been rapidly deployed to such a ward, or had managed such wards. Work Life Balance was measured using the WLB Scale. Interview transcripts were qualitatively coded and thematic codes were compared using network graph modeling. Results Using thematic network analysis, four overarching thematic clusters were found, (1) teamwork, (2) organizational support and management, (3) cohesion and social support, and (4) psychological strain. The study has three main findings. First, the importance of social factors for teamwork and mental health, whereby team identity may influence perceptions of preparedness, collaboration and communication, and impact on the collective appraisal of stressful events and work stressors. Secondly, it demonstrates the positive and negative impact of professional roles and skills on the development of teamwork and team identity. Lastly the study identifies the more pronounced negative impact of COVID work on deployed personnel's workload, mental health, and career intentions, exacerbated by reduced levels of social support during, and after, their deployment. Conclusion The thematic network analysis was able to highlight that many of the traditional factors associated with the successful delivery of patient care were impeded by pandemic constraints, markedly influencing personnel's ability to work together and cope with pandemic work stressors. In this environment teamwork, delivery of care and staff well-being appear to depend on relational and organizational context, social group membership, and psycho-social skills related to managing team identity. While results hold lessons for personnel selection, training, co-location, and organizational support during and after a pandemic, further research is needed into the differential impact of pandemic deployment on HCWs mental health and teamwork.
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Affiliation(s)
- Stefan Schilling
- Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
| | - Maria Armaou
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Zoe Morrison
- Aberdeen Business School, Robert Gordon University, Aberdeen, United Kingdom
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom
| | - Martin Bricknell
- King’s College London, School of Security Studies, London, United Kingdom
| | - Vincent Connelly
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
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Chastney J, Gill HK, Nyatanga B, Patel R, Harrison G, Henshall C. "To tell you the truth I'm tired": a qualitative exploration of the experiences of ethnically diverse NHS staff. BMJ Open 2024; 14:e070510. [PMID: 38199638 PMCID: PMC10882200 DOI: 10.1136/bmjopen-2022-070510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES The aim of this paper was to explore the experiences and support needs of ethnically diverse healthcare staff and how they were affected by the COVID-19 pandemic. DESIGN A qualitative study using focus groups conducted remotely on Microsoft Teams. SETTING The study took place across 10 National Health Service Trusts in England; 5 were Acute Hospitals Trusts and 5 were Community and Mental Health Trusts. PARTICIPANTS 55 participants across 16 focus groups took part in the study. Participants were all healthcare staff members from ethnically diverse backgrounds. RESULTS Seven themes were generated which highlighted issues of negative experiences of discrimination at work, particularly during the COVID-19 pandemic, including participants often finding line managers unsupportive, appearing to lack care and compassion, and not understanding ethnic diversity issues. Participants identified many reasons for finding it difficult to speak up when faced with such experiences, such as feeling unsafe to do so, or feeling too exhausted to keep speaking up. Other staff had more positive experiences and described supportive interventions, and despite workplace difficulties, many participants discussed remaining motivated to work in the National Health Service. CONCLUSIONS Negative day-to-day experiences of ethnically diverse healthcare staff, and the difficulty of speaking up about these align with other, international literature on this topic. Progress in the area of staff equality is vital if healthcare organisations are to continue to provide high-quality patient care and retain skilled, compassionate staff who value their place of work. Recent literature suggests that many initiatives to reduce inequalities have not been successful, and there is a call for fundamental, cultural-level change. Future research is needed to understand how best to implement these organisational-level changes and to evaluate their effectiveness.
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Affiliation(s)
| | - Harmandeep Kaur Gill
- Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | | | | | - Catherine Henshall
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Allsopp K, Varese F, French P, White H, Chung P, Hassan AA, Wright SA, Young E, Barrett A, Bhutani G, McGuirk K, Huntley F, Sarsam M, Ten Cate H, Watson R, Willbourn J, Hind D. Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory. BMJ Open 2023; 13:e071826. [PMID: 37612138 PMCID: PMC10450134 DOI: 10.1136/bmjopen-2023-071826] [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: 01/12/2023] [Accepted: 06/11/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. DESIGN Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. SETTING Three Resilience Hubs in the North of England. PARTICIPANTS Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). RESULTS Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. CONCLUSIONS Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.
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Affiliation(s)
- Kate Allsopp
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Filippo Varese
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Hannah White
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Priscilla Chung
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Alysha A Hassan
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Sally-Anne Wright
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Ellie Young
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
- School of Health Sciences, University of Salford, Salford, UK
| | - Gita Bhutani
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Liverpool, UK
- Doctorate of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Ruth Watson
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Martin CA, Woolf K, Bryant L, Goss C, Gogoi M, Lagrata S, Papineni P, Qureshi I, Wobi F, Nellums L, Khunti K, Pareek M. Coverage, completion and outcomes of COVID-19 risk assessments in a multi-ethnic nationwide cohort of UK healthcare workers: a cross-sectional analysis from the UK-REACH Study. Occup Environ Med 2023; 80:399-406. [PMID: 37221040 PMCID: PMC10314065 DOI: 10.1136/oemed-2022-108700] [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] [Received: 10/13/2022] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION There are limited data on the outcomes of COVID-19 risk assessment in healthcare workers (HCWs) or the association of ethnicity, other sociodemographic and occupational factors with risk assessment outcomes. METHODS We used questionnaire data from UK-REACH (UK Research study into Ethnicity And COVID-19 outcomes in Healthcare workers), an ethnically diverse, nationwide cohort of UK HCWs. We derived four binary outcomes: (1) offered a risk assessment; (2) completed a risk assessment; (3) working practices changed as a result of the risk assessment; (4) wanted changes to working practices after risk assessment but working practices did not change.We examined the association of ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk variables on our outcomes using multivariable logistic regression. RESULTS 8649 HCWs were included in total. HCWs from ethnic minority groups were more likely to report being offered a risk assessment than white HCWs, and those from Asian and black ethnic groups were more likely to report having completed an assessment if offered. Ethnic minority HCWs had lower odds of reporting having their work change as a result of risk assessment. Those from Asian and black ethnic groups were more likely to report no changes to their working practices despite wanting them.Previous SARS-CoV-2 infection was associated with lower odds of being offered a risk assessment and having adjustments made to working practices. DISCUSSION We found differences in risk assessment outcomes by ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk factors. These findings are concerning and warrant further research using actual (rather than reported) risk assessment outcomes in an unselected cohort.
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Affiliation(s)
- Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London Medical School, London, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charles Goss
- Department of Occupational Health, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Susie Lagrata
- Queen Square Insitute of Neurology and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Harrow, UK
| | - Irtiza Qureshi
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Fatimah Wobi
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
- School of Law, University of Leicester, Leicester, UK
| | - Laura Nellums
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Zay Hta MK, Ting RSK, Goh PH, Gan QH, Jones L. A systematic review on the cultural factors associated with stigma during pandemics. CURRENT PSYCHOLOGY 2023:1-32. [PMID: 37359581 PMCID: PMC10016190 DOI: 10.1007/s12144-023-04509-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
Both public stigma and perceived self-stigma are prevalent during pandemics threatening a divide among the global community. This systematic review examined the cultural factors associated with viral respiratory-related pandemic stigma. Following PRISMA guidelines, the keywords, "culture, stigma, and pandemic" were searched across relevant databases for empirical papers between January 2000 to March 2022. Quality assessment and coding were adopted in the screening process. Thirty-one articles were included in the final analysis. Themes revealed that collectivistic values, cultural identities, and non-western regions were associated with public (others) stigma; mismatch of cultural values, minority groups, and North America, Asia, Oceania, and African regions were associated with higher perceived and self-stigma. We further mapped the themes into a proposed systemic cultural stigma model to integrate the dynamic intersection of cultural values, identity, and ecology. The cultural factors and their influence on stigma were then explained by drawing on two evolutionary theories: Cultural rationality theory and scapegoating theory. Lastly, we proposed culturally sensitive and responsive practices for stigma management at the community level, especially in non-Western regions during the pandemic recovery phase.
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Affiliation(s)
- May Kyi Zay Hta
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Rachel Sing-Kiat Ting
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Pei Hwa Goh
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Qian Hui Gan
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Liz Jones
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
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Cooper Brathwaite A, Varsailles D, Haynes D. Building Solidarity with Black Nurses to Dismantle Systemic and Structural Racism in Nursing. Policy Polit Nurs Pract 2023; 24:5-16. [PMID: 36300199 DOI: 10.1177/15271544221130052] [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] [Indexed: 01/05/2023]
Abstract
Systemic and structural racism in nursing have profound impacts on Black People, Indigenous Peoples, and People of Color. They contributed to underrepresentation in faculty, senior nurse executives, and presidents' positions in academic and healthcare organizations, physical and mental health issues in racialized groups. This quality improvement study described ways in which the Black Nurses Task Force of the Registered Nurses Association of Ontario can build solidarity with nursing and government organizations to dismantle systemic and structural racism in nursing. This study used a structured online survey, comprised of quantitative and qualitative questions. The qualitative data were analyzed using interpretative thematic analysis and the quantitative data were analyzed with descriptive statistics. Findings showed that 88% of participants experienced racism and 63% said racism affected their mental health. Three themes emerged from the qualitative data: Social support for Black nurses, accountability of leaders and solidarity with Black nurses. These findings demonstrated the urgent need to dismantle systemic and structural racism in nursing.
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Affiliation(s)
| | - Dania Varsailles
- Registered Nurses Association of Ontario (RNAO), Toronto, ON, Canada
| | - Deborah Haynes
- Registered Nurses Association of Ontario (RNAO), Toronto, ON, Canada
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Silverio SA, De Backer K, Dasgupta T, Torres O, Easter A, Khazaezadeh N, Rajasingam D, Wolfe I, Sandall J, Magee LA. On race and ethnicity during a global pandemic: An 'imperfect mosaic' of maternal and child health services in ethnically-diverse South London, United Kingdom. EClinicalMedicine 2022; 48:101433. [PMID: 35783482 PMCID: PMC9249549 DOI: 10.1016/j.eclinm.2022.101433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between race and ethnicity, and healthcare provision amongst maternity and children's healthcare professionals, during the SARS-CoV-2 pandemic. Methods A qualitative study consisting of semi-structured interviews (N = 53) was undertaken with maternity (n = 29; August-November 2020) and children's (n = 24; June-July 2021) healthcare professionals from an NHS Trust in ethnically-diverse South London, UK. Data pertinent to ethnicity and race were subject to Grounded Theory Analysis, whereby data was subjected to iterative coding and interpretive analysis. Using this methodology, data are compared between transcripts to generate lower and higher order codes, before super-categories are formed, which are finally worked into themes. The inter-relationship between these themes is interpreted as a final theory. Findings Grounded Theory Analysis led to the theory: An 'Imperfect Mosaic', comprising four themes: (1) 'A System Set in Plaster'; (2) 'The Marginalised Majority'; (3) 'Self-Discharging Responsibility for Change-Making'; and (4) 'Slow Progress, Not No Progress'. The NHS was observed to be brittle, lacking plasticity to deliver change at pace. Overt racism based on skin colour has been replaced by micro-aggressions between in-groups and out-groups, defined not just by ethnicity, but by other social determinants. Contemporaneously, responsibility for health, wellbeing, and psychological safety in the workplace is discharged to, and accepted by, the individual. Interpretation Our findings suggest three practicable solutions: (1) Representation of marginalised groups at all NHS levels; (2) Engagement in cultural humility which extends to other social factors; and (3) Collective action at system and individual levels, including prioritising equity over simplistic notions of equality. Funding This service evaluation was supported by the King's College London King's Together Rapid COVID-19 Call, successfully awarded to Laura A. Magee, Sergio A. Silverio, Abigail Easter, & colleagues (reference:- 204823/Z/16/Z), as part of a rapid response call for research proposals. The King's Together Fund is a Wellcome Trust funded initiative.
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Affiliation(s)
- Sergio A. Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Tisha Dasgupta
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Ofelia Torres
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England and Improvement, Wellington House, 133-155 Waterloo Road, Southwark, London SE1 8UG, United Kingdom
| | - Daghni Rajasingam
- Maternity Services, St. Thomas’ Hospital, Guy's and St. Thomas’ NHS Foundation Trust, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Ingrid Wolfe
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Laura A. Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
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Qureshi I, Gogoi M, Wobi F, Chaloner J, Al-Oraibi A, Hassan O, Pan D, Nellums LB, Pareek M. Healthcare Workers From Diverse Ethnicities and Their Perceptions of Risk and Experiences of Risk Management During the COVID-19 Pandemic: Qualitative Insights From the United Kingdom-REACH Study. Front Med (Lausanne) 2022; 9:930904. [PMID: 35847806 PMCID: PMC9285103 DOI: 10.3389/fmed.2022.930904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Healthcare workers (HCWs) are at higher risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies have examined factors relating to infection amongst HCWs, including those from ethnic minority groups, but there is limited data regarding the lived experiences of HCWs in relation to self-protection and how they deal with SARS-CoV-2 infection prevention. In this study, we presented data from an ethnically diverse sample of HCWs in the United Kingdom (UK) to understand their perceptions of risks and experiences with risk management whilst working throughout the COVID-19 pandemic. Methods We undertook a qualitative study as part of the United Kingdom Research study into Ethnicity and COVID-19 outcomes among Healthcare workers (United Kingdom-REACH) conducting semi-structured interviews and focus groups which were recorded with participants' permission. Recordings were transcribed and thematically analyzed. Findings A total of 84 participants were included in the analysis. Five broad themes emerged. First, ethnic minority HCWs spoke about specific risks and vulnerabilities they faced in relation to their ethnicity. Second, participants' experience of risk assessments at work varied; some expressed satisfaction while many critiqued it as a "tick-box" exercise. Third, most participants shared about risks related to shortages, ambiguity in guidance, and inequitable distribution of Personal Protective Equipment (PPE), particularly during the start of the pandemic. Fourth, participants reported risks resulting from understaffing and inappropriate redeployment. Finally, HCWs shared the risk mitigation strategies which they had personally employed to protect themselves, their families, and the public. Conclusion Healthcare workers identified several areas where they felt at risk and/or had negative experiences of risk management during the pandemic. Our findings indicate that organizational shortcomings may have exposed some HCWs to greater risks of infection compared with others, thereby increasing their emotional and mental burden. Ethnic minority HCWs in particular experienced risks stemming from what they perceived to be institutional and structural racism, thus leading to a loss of trust in employers. These findings have significance in understanding staff safety, wellbeing, and workforce retention in multiethnic staff groups and also highlight the need for more robust, inclusive, and equitable approaches to protect HCWs going forward.
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Affiliation(s)
- Irtiza Qureshi
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Jonathan Chaloner
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Osama Hassan
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Pan
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Laura B Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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