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Turk JK, Claymore E, Dawoodbhoy N, Steinauer JE. "I Went Into This Field to Empower Other People, and I Feel Like I Failed": Residents Experience Moral Distress Post- Dobbs. J Grad Med Educ 2024; 16:271-279. [PMID: 38882403 PMCID: PMC11173027 DOI: 10.4300/jgme-d-23-00582.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/09/2024] [Accepted: 03/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background The 2022 Supreme Court ruling in Dobbs v Jackson Women's Health Organization nullified the constitutional right to abortion, which led to effective bans in at least 14 US states and placed obstetrics and gynecology (OB/GYN) residents in dilemmas where they may have to withhold care, potentially causing moral distress-a health care workforce phenomenon less understood among resident physicians. Objective To identify and explore moral distress experienced by OB/GYN residents due to care restrictions post-Dobbs. Methods In 2023, we invited OB/GYN residents, identified by their program directors, training in states with restricted abortion access, to participate in one-on-one, semi-structured interviews via Zoom about their experiences caring for patients post-Dobbs. We used thematic analysis to analyze interview data. Results Twenty-one residents described their experiences of moral distress due to restrictions. We report on 3 themes in their accounts related to moral distress (and 4 subthemes): (1) challenges to their physician identity (inability to do the job, internalized distress, and reconsidering career choices); (2) participating in care that exacerbates inequities (and erodes patient trust); and (3) determination to advocate for and provide abortion care in the future. Conclusions OB/GYN residents grappled with moral distress and identified challenges from abortion restrictions.
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Affiliation(s)
- Jema K Turk
- is Director of Evaluation, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Emily Claymore
- is Assistant Director of Programs, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Nafeesa Dawoodbhoy
- is Program Manager, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA; and
| | - Jody E Steinauer
- is Director, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
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Roze des Ordons AL, Ellaway RH. Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38635478 DOI: 10.1080/10401334.2024.2342443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024]
Abstract
PHENOMENON Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof. APPROACH A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives. FINDINGS Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues. INSIGHTS Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Division of Palliative Medicine, Department of Oncology, Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [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: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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4
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Faihs L, Neumann-Opitz C, Kainberger F, Druml C. Ethics teaching in medical school: the perception of medical students. Wien Klin Wochenschr 2024; 136:129-136. [PMID: 36547763 PMCID: PMC9774069 DOI: 10.1007/s00508-022-02127-7] [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: 08/31/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In times of a pandemic, morals and ethics take center stage. Due to the challenges of the pandemic and ongoing discussions about the end of life, student teaching demands might have changed. This study aimed to evaluate teaching ethics, law, and decision-making skills in medical education via a survey to customize the curriculum to the students' needs. Furthermore, gender differences were examined to determine gender equality in medical education. METHODS The medical students at the Medical University of Vienna were requested to complete an anonymous online survey, providing feedback on the teaching of ethics, law, and decision-making skills. RESULTS Our study showed the students' strong demand for more teaching of ethics, law, and decision-making skills. Moreover, we found that students were afraid to encounter ethical and moral dilemmas. Gender differences could be found, with female students assessing their knowledge and the teaching as being more insufficient, resulting in greater fear of encountering ethical and moral dilemmas. CONCLUSION The fear of encountering ethical and moral dilemmas might be linked to medical students' self-perceived insufficient legal knowledge. The education should guarantee gender equality in medical training and be customized to the students to provide the future doctors with the ethical and legal expertise to preserve the patient's rights and protect their mental health.
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Affiliation(s)
- Lorenz Faihs
- Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
| | | | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christiane Druml
- Unesco Chair on Bioethics at the Medical University of Vienna, Vienna, Austria
- Department of Ethics, Collections, and History of Medicine (Josephinum), Vienna, Austria
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Ward K. Too good for this world: moral bioenhancement and the ethics of making moral misfits. MEDICAL HUMANITIES 2024; 50:144-152. [PMID: 37932030 DOI: 10.1136/medhum-2023-012709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
Persson and Savulescu argue that moral bioenhancement is not only morally permissible; in some cases, it is morally obligatory. In this article, I introduce a new reason to worry about moral enhancement. I adapt the disability concept of misfit to show how moral enhancement could cause extreme moral disempowerment to those enhanced, which would result in moral injury. I argue that any safety framework that guides the development of moral bioenhancement must be sensitive to the problem of moral misfitting. I present the best case for moral bioenhancement before turning to my own worry concerning the development of moral bioenhancement and its practical implications. Finally, I consider a series of objections and responses.
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Affiliation(s)
- Katherine Ward
- Philosophy, Bucknell University, Lewisburg, Pennsylvania, USA
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6
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Trudel SM, Winter EL, Guerrera MP. Nature as Medicine and Classroom: Evaluating an Innovative, Outdoor Course for Medical and Dental Students. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241246788. [PMID: 38629109 PMCID: PMC11020736 DOI: 10.1177/27536130241246788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/14/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Background There is a growing, global awareness and recognition of the important, interdependent relationships between our natural world and human health. Several contemporary health organizations have placed calls to action and emphasize an urgent need for collaboration and interdisciplinary research, education, and clinical work to address the increasing degradation of our planetary and human health. With more research dedicated to nature's health impacts, health professions schools would benefit by including such training in their programs while also cultivating a comprehensive mind-body health perspective to support both the health of student practitioners and their future patients. Objective The present program evaluation investigates a five-day outdoor mini-course covering nature-based health techniques at a medical and dental school in the American Northeast. This unique outdoor course combines nature, creativity, and reflection within the context of modern medicine. Methods A concurrent mixed-method design using descriptive statistics, quantitative and qualitative data from students' anonymous final course evaluations and final reflection projects are evaluated. Results Data suggests that students benefitted from their experience during this five-day course. Students provided feedback reinforcing the enjoyment and transformative outcomes gleaned from the course experiences. Students entered the course describing feeling stressed, overwhelmed, and overextended, not uncommon for learners in medical and dental school, and completed the course describing the acquisition of applicable skills, increased attention and mindfulness, creativity, and connection to the natural world. Conclusions Students described a positive experience of the course. Several areas of personal and professional development were also described, such as improvements within cognitive domains, enhanced connection with nature, others, and themselves, increased mindfulness, and overall improved well-being. Findings have implications for medical and dental programs on how such innovative training may lean into the work of nature-based care to provide for the whole person.
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Affiliation(s)
- Sierra M. Trudel
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Mary P. Guerrera
- University of Connecticut School of Medicine, Farmington, CT, USA
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Hill L, Eaton G. Exploring paramedic professional identity. Br Paramed J 2023; 8:42-51. [PMID: 38046791 PMCID: PMC10690486 DOI: 10.29045/14784726.2023.12.8.3.42] [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] [Indexed: 12/05/2023] Open
Abstract
The notion of a paramedic (as a title protected in law) has recently entered its third decade, but the history of the paramedic is considerably older than that. Who are we as a profession? What does it mean to be a paramedic? What makes us who we are? These intriguing and yet seldom asked philosophical questions are at the heart of this article, which is intended to provoke discussion and serve as a foundation for further inquiry into questions of identity and philosophy in paramedicine. Literature pertaining to paramedic professional identity was explored and contextualised within current paramedic practice. Although the overall picture is complex, four key areas for discussion emerged: the history of the paramedic profession; role diversity; the influence of ambulance work; and the education and training of paramedics. The influence of ambulance work permeates all areas, suggesting that it is central to the development of paramedic professional identity. This discussion article is an exploration of the unique contexts and experiences that are associated with the process of being and becoming for paramedics.
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Affiliation(s)
- Lawrence Hill
- University of East Anglia ORCID iD https://orcid.org/0000-0002-9147-0934
| | - Georgette Eaton
- University of Oxford; London Ambulance Service NHS Trust ORCID iD: http://orcid.org/0000-0001-9421-2845
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8
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Currie GP, Laing RB. Moral distress in healthcare professionals: Time to reflect. J R Coll Physicians Edinb 2023; 53:237-238. [PMID: 37997844 DOI: 10.1177/14782715231215409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
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9
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Fino E, Daniels JK, Micheli G, Gazineo D, Godino L, Imbriaco G, Antognoli M, Sist L, Regnano D, Decaro R, Guberti M, Mazzetti M. Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting. Eur J Psychotraumatol 2023; 14:2263316. [PMID: 37815082 PMCID: PMC10566389 DOI: 10.1080/20008066.2023.2263316] [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: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 10/11/2023] Open
Abstract
Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.
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Affiliation(s)
- Edita Fino
- Department of Psychology “Renzo Cannestrari”, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Judith K. Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Giulia Micheli
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Domenica Gazineo
- Governo Clinico e Qualità, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lea Godino
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Guglielmo Imbriaco
- UO Centrale Operativa 118 Emilia Est, Ospedale ‘Maggiore’, Bologna, Italy
| | | | - Luisa Sist
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Domenico Regnano
- Team accessi vascolari, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Roberta Decaro
- UO Deg. Percorso fegato e vie biliari/Medicina interna trattamento gravi insufficienze d’organo/TI post-operatoria/TI trapianti, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Michela Mazzetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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Békés V, Szabó D, Lévay EE, Salgó E, Unoka Z. Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients. J Pers Disord 2023; 37:406-423. [PMID: 37721777 DOI: 10.1521/pedi.2023.37.4.406] [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: 09/19/2023]
Abstract
Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.
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Affiliation(s)
- Vera Békés
- From Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Dominik Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Erika Evelyn Lévay
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Ella Salgó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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11
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Thibodeau PS, Nash A, Greenfield JC, Bellamy JL. The Association of Moral Injury and Healthcare Clinicians' Wellbeing: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6300. [PMID: 37444147 PMCID: PMC10341511 DOI: 10.3390/ijerph20136300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Research focused on elucidating moral injury amongst healthcare workers (HCWs) is essential due to the deep connection with morality and individuals' overall wellbeing. Examining moral injury provides an avenue through which researchers can connect individual experiences with systemic level causes (i.e., structural power imbalances between clinicians and health systems) to better study workplace wellbeing. The omnipresence of the COVID-19 pandemic has amplified the need to study moral injury. This paper describes a systematic review conducted using PRISMA-P guidelines to answer the question, "what is the association between moral injury and professional wellbeing and mental health amongst healthcare workers." Twelve databases were searched to identify specified studies. This study's criteria included: (1) articles published through December 2022; (2) qualitative and quantitative empirical studies; (3) articles written in English; (4) articles including moral injury; and (5) articles including at minimum one other measure of professional or personal wellbeing. The initial search produced 248 articles, and 18 articles were ultimately included in the final review. To confirm that no articles were left out of this study, the first author of each included article was contacted to inquire about any additional works that met the inclusion criteria of this study. The elements of the 18 included articles described in this review are discussed. The results indicate that moral injury is associated with both professional wellbeing factors and mental health outcomes. Further theoretical development, including (professional- and identity-based) exploratory research on moral injury, and evidenced-based interventions for moral injury are needed.
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Affiliation(s)
- Pari Shah Thibodeau
- Graduate School of Social Work, University of Denver, 2148 S. High Street, Denver, CO 80210, USA
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Nair M, Moss N, Bashir A, Garate D, Thomas D, Fu S, Phu D, Pham C. Mental health trends among medical students. Proc AMIA Symp 2023; 36:408-410. [PMID: 37091765 PMCID: PMC10120543 DOI: 10.1080/08998280.2023.2187207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Student mental health concerns can manifest in several forms. Medical students juggling a multitude of trials (i.e., intense academic rigor, financial debt, sleep deprivation, lack of control, continual exposure to sickness and death, and training mistreatment) can help explain the higher prevalence of psychological disorders within this population. Furthermore, these mental health difficulties are not static; certain challenges move into the forefront as students face key transition points in schooling. Primary examples include the entry year of medical school, the shift from preclinical curriculum to clinical training, and the final moments prior to beginning residency. Given the existing mental health trends among medical students at baseline, it can be concluded that the COVID-19 pandemic has exacerbated the stress, anxiety, and depression associated with medical education. Solutions do indeed exist to address the moral injury medical students face, from expanded crisis management training and implementation of peer support networks to destigmatization of and improved access to professional mental health resources. It is up to the curators of the medical education system to make these solutions the new status quo.
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Affiliation(s)
| | | | | | - David Garate
- The University of Texas Medical Branch, School of Medicine, Galveston, Texas
| | - Devon Thomas
- The University of Texas Medical Branch, School of Medicine, Galveston, Texas
| | - Shangyi Fu
- Baylor College of Medicine, Houston, Texas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Daniel Phu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas
| | - Christine Pham
- School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
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13
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Tran M, Lin L, Cowell H, Makanjee C, Hayre CM, Lewis S. An exploratory study on recently qualified Australian radiographers' expectations and experiences in emergency and trauma imaging. J Med Imaging Radiat Sci 2023; 54:97-103. [PMID: 36529660 DOI: 10.1016/j.jmir.2022.11.015] [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: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Radiographers provide imaging services in multiple healthcare settings, including emergency and trauma. Transitioning to a qualified radiographer is already a time of vulnerability - with the increasing complexity and unpredictable nature of the emergency and trauma healthcare environment, recently qualified radiographers may experience this environment distinct from other service delivery areas. OBJECTIVE The study explored recently qualified radiographers' expectations and experiences in emergency and trauma imaging service delivery. METHODS An inductive qualitative phenomenological approach with a purposive sampling technique recruited recently qualified radiographers (n=19) involved in the delivery of emergency and trauma imaging services. Transcribed semi-structured individual interviews were thematically analysed. RESULTS Two themes and related categories were identified: 1. The multiplexity of diagnostic emergency and trauma imaging service delivery and 2. Approaching the complex nature of emergency and trauma imaging. CONCLUSION The expectations and experiences of emergency and trauma imaging varied, aligned to previous exposure to emergency and trauma imaging. Even though emergency and trauma imaging was challenging, the fast pace, patient dynamics and multidisciplinary deliverance; the experience was considered rewarding and an opportunity to improve skills. Participants coped through debriefing and calming strategies; however, radiology-specific debriefing was recommended to further foster the recently qualified radiographers' well-being.
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Affiliation(s)
- Michelle Tran
- Discipline Medical Radiation Sciences, Faculty of Health Sciences, University of Canberra, Australia
| | - Lukas Lin
- Discipline Medical Radiation Sciences, Faculty of Health Sciences, University of Canberra, Australia
| | - Hannah Cowell
- Discipline Medical Radiation Sciences, Faculty of Health Sciences, University of Canberra, Australia
| | - Chandra Makanjee
- Discipline Medical Radiation Sciences, Faculty of Health Sciences, University of Canberra, Australia
| | - Christopher M Hayre
- Department of Health and Care Professions, University of Exeter, College of Medicine and Health, England
| | - Shantel Lewis
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
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Muñoz-Quiles JM, Ruiz-Fernández MD, Hernández-Padilla JM, Granero-Molina J, Fernández-Sola C, Ortega-Galán ÁM. Ethical conflicts among physicians and nurses during the COVID-19 pandemic: A qualitative study. J Eval Clin Pract 2023; 29:117-125. [PMID: 35856486 PMCID: PMC9349594 DOI: 10.1111/jep.13742] [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: 01/19/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES The healthcare system and professionals working in the sector have experienced a high caseload during the coronavirus disease 2019 (COVID-19) pandemic. This has increased the potential for morally harmful events that violate professionals' moral codes and values. The aim of this study was to understand and explore experiences of new moral challenges emerging among physicians and nurses caring for individuals during the COVID-19 pandemic. METHOD The consolidated criteria for reporting qualitative research (COREQ) checklist was used in this qualitative study based on Gadamer's phenomenology. Participants were selected using a convenience sampling method. Thirteen medicine and nursing graduates were interviewed in depth. The participants all worked on the frontline at the start of the COVID-19 pandemic. Data were gathered in two basic healthcare districts in Spain, encompassing both primary care and hospital care. RESULTS Four main themes emerged from the data analysis: (1) Betrayal of moral and ethical values as a key source of suffering; (2) Ethical and moral sense of failure accompanying loss of meaning; (3) Lack of confidence in performance; (4) Self-demand and self-punishment as personal condemnation among healthcare workers. CONCLUSIONS Health institutions must implement interventions for health professionals to help mitigate the consequences of experiencing complex ethical scenarios during the pandemic. In addition, they should promote training in moral and ethical deliberation and prepare them to make decisions of great ethical significance.
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Affiliation(s)
| | - María D Ruiz-Fernández
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almeria, Spain
| | - José M Hernández-Padilla
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almeria, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| | - José Granero-Molina
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almeria, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Almeria, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
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15
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Szabó D, Békés V, Lévay EE, Salgó E, Unoka ZS. Moral injury in psychiatric patients with personality and other clinical disorders: development, psychometric properties, and validity of the Moral Injury Events Scale-Civilian Version. Eur J Psychotraumatol 2023; 14:2247227. [PMID: 37650250 PMCID: PMC10472878 DOI: 10.1080/20008066.2023.2247227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023] Open
Abstract
Background: Moral injury emerges when someone perpetrates, fails to prevent, or witnesses acts that violate their own moral or ethical code. Nash et al. [(2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652] developed a short measure, the Moral Injury Events Scale (MIES) to facilitate the empirical study of moral injury in the military. Our study aimed to develop a civilian version of the measure (MIES-CV) and examine its psychometric properties in a sample of psychiatric inpatients .Methods: In this cross-sectional study, the sample comprised 240 adult patients (71.7% female) with a mean age of 31.57 (SD = 11.69). The most common diagnoses in the sample were anxiety disorders (58.3%), depressive disorders (53.8%), and borderline personality disorder (39.6%). Participants were diagnosed using structured clinical interviews and filled out psychological questionnaires.Results: Exploratory factor analysis suggested that Nash et al.'s model (Perceived Transgressions, Perceived Betrayals) represents the data well. This two-factor solution showed an excellent fit in the confirmatory factor analysis, as well. Meaningful associations were observed between moral injury and psychopathology dimensions, shame, reflective functioning, well-being, and resilience. The Perceived Betrayals factor was a significant predictor of bipolar disorders, PTSD, paranoid personality disorder, borderline personality disorder, and avoidant personality disorder.Conclusions: Our study demonstrated that this broad version of the MIES is a valid measure of moral injury that can be applied to psychiatric patients.
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Affiliation(s)
- Dominik Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Erika Evelyn Lévay
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Ella Salgó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Zsolt Szabolcs Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Gishen F, Chakrabarti R. Medical student perceptions of reflective practice in the undergraduate curriculum. MEDEDPUBLISH 2022; 12:53. [PMID: 36817617 PMCID: PMC9926505 DOI: 10.12688/mep.19211.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students' attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. Methods: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. Results: Five key themes emerged around student attitudes to RP, which were grouped into three domains: 'value of RP', 'barriers to engagement', and 'strategies for enabling RP'. 'Value of RP' centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. 'Barriers to engagement' centred on the purpose and tokenism of RP and in the third domain, 'strategies for enabling RP', the theme of student agency in RP emerged strongly. Conclusion: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum.
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Affiliation(s)
- Faye Gishen
- University College London Medical School, London, WC1E 6DE, UK,
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17
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Walton M, McLachlan S, Nelson M, Skeffington P, Phillipson L, Christian MD. A Psychological Resilience Briefing Intervention for Helicopter Emergency Medical Service Observers. Air Med J 2022; 41:549-555. [PMID: 36494171 DOI: 10.1016/j.amj.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This article describes a quality improvement project for HEMS observers at Essex & Herts Air Ambulance. METHODS A psychological resilience briefing intervention (PRBi) was developed and delivered during induction training with 60 HEMS observers. The PRBi aimed to raise awareness of traumatic events that observers may experience and provided basic education on 5 domains, including likely forms of trauma exposure, possible psychological reactions, advice on coping strategies and supporting colleagues, and resources that they could use if required. The intervention was intended to bolster resilience and reduce posttraumatic stress disorder symptoms, and to encourage adaptive coping styles in observers. RESULTS Observers learned from and valued the PRBi; statistically significant increases were observed in awareness of the 5 domains from pre- to post-delivery, and free-text responses cited a variety of benefits to the observers. There was no indication that the PRBi caused harm. CONCLUSION The PRBi has now been included in the routine induction of observers at Essex & Herts Air Ambulance and has the potential to be repurposed for use in other settings, including medical schools.
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Affiliation(s)
- Matthew Walton
- St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Essex, United Kingdom; Anglia Ruskin University, Essex, United Kingdom.
| | - Matthew Nelson
- School of Anaesthesia and Intensive Care, Health Education Yorkshire and Humber, Health Education England, Leeds, United Kingdom
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18
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Gishen F, Chakrabarti R. Medical student perceptions of reflective practice in the undergraduate curriculum. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19211.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. Methods: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. Results: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. Conclusion: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum.
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19
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Orsi A, Watson A, Wijegoonewardene N, Botan V, Lloyd D, Dunbar N, Asghar Z, Siriwardena AN. Perceptions and experiences of medical student first responders: a mixed methods study. BMC MEDICAL EDUCATION 2022; 22:721. [PMID: 36242030 PMCID: PMC9561313 DOI: 10.1186/s12909-022-03791-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective. METHODS We used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12. RESULTS We included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD - index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills. CONCLUSION MSFRs' attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.
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Affiliation(s)
- Andrew Orsi
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
- East Midlands School of Anaesthesia, Health Education England, Leeds, UK
| | - Adam Watson
- Medical Science Division, University of Oxford, Oxford, UK
| | | | - Vanessa Botan
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
| | - Dylan Lloyd
- Medical School, University of Buckingham, Buckingham, UK
| | - Nic Dunbar
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Zahid Asghar
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
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20
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Liu LX, Goldszmidt M, Calvert S, Burm S, Torti J, Cristancho S, Sukhera J. From distress to detachment: exploring how providing care for stigmatized patients influences the moral development of medical trainees. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1003-1019. [PMID: 35643994 PMCID: PMC9148414 DOI: 10.1007/s10459-022-10125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
In acute hospital settings, medical trainees are often confronted with moral challenges and negative emotions when caring for complex and structurally vulnerable patients. These challenges may influence the long term moral development of medical trainees and have significant implications for future clinical practice. Despite the importance of moral development to medical education, the topic is still relatively under-explored. To gain a deeper understanding of moral development in trainees, we conducted a qualitative exploration of how caring for a stigmatized population influences their moral development. Data were collected from 48 medical trainees, including observational field notes, supplemental interviews, and medical documentation from inpatient units of two urban teaching hospitals in a Canadian context. Utilizing a practice-based approach which draws on constructivist grounded theory, we conducted constant comparative coding and analysis. We found that caring for stigmatized populations appeared to trigger frustration in medical trainees, which often perpetuated feelings of futility as well as avoidance behaviours. Additionally, hospital policies, the physical learning environment, variability in supervisory practices, and perceptions of judgment and mistrust all negatively influenced moral development and contributed to apathy and moral detachment which has implications for the future. Recognizing the dynamic and uncertain nature of care for stigmatized patients, and addressing the influence of structural and material factors provide an opportunity to support moral experiences within clinical training, and to improve inequities.
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Affiliation(s)
- Lisa X Liu
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Mark Goldszmidt
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sara Calvert
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sarah Burm
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jacqueline Torti
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sayra Cristancho
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Javeed Sukhera
- Chair/Chief of Psychiatry, Hartford Hospital and the Institute of Living, 200 Retreat Avenue Terry Building, Hartford, CT, 06106, USA.
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21
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Power H, Skene I, Murray E. The positives, the challenges and the impact; an exploration of early career nurses experiences in the Emergency Department. Int Emerg Nurs 2022; 64:101196. [PMID: 36108493 DOI: 10.1016/j.ienj.2022.101196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/02/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The intense working environment of the Emergency Department (ED) is exciting and rewarding; but is renowned for high staff turnover and burnout. The wellbeing and retention of the existing workforce is imperative. The purpose of this study was to explore the experiences of early careers nurses in the ED; identify aspects of ED they enjoyed, the challenges and explore potential coping mechanisms used to mitigate negative situations. METHODS A qualitative design was used. Eleven semi-structured interviews were conducted with adult and paediatric emergency nurses who had worked in the ED for less than three years. Data were transcribed, open coded and analysed using thematic analysis. RESULTS Four key themes emerged; (1) Drawn to emergency nursing; (2) Teamwork; (3) Time to care; and (4) Reflections on the impact. CONCLUSION Opportunities for learning and development and being able to provide good levels of patient care were identified important to participants. Challenging aspects of the job included high workloads, exposure to traumatic incidents, violence and aggression. The psychological impact included feelings of burnout, exhaustion, flashbacks, personal growth and perspective. Teamwork, a strong support network and opportunities for formal and informal debrief were identified as helping to mitigate challenging aspects of the job.
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Affiliation(s)
| | | | - Esther Murray
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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22
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Gishen F, Chakrabarti R. Medical student perceptions of reflective practice in the undergraduate curriculum. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19211.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. Methods: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. Results: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. Conclusion: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum.
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23
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Sra M, Gupta A, Jaiswal A, Yadav K, Goswami A, Goswami K. Willingness of medical students to volunteer during the Covid-19 pandemic: Assessment at a tertiary care hospital in India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:247-251. [PMID: 36715037 DOI: 10.25259/nmji_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The involvement of medical students in strategies to control Covid-19 might be considered to cope with the shortage of healthcare workers. We assessed the knowledge about Covid-19, willingness to volunteer, potential areas of involvement and reasons for hesitation among medical students towards volunteering. Methods We did this cross-sectional study among undergraduate students at a tertiary care teaching hospital in New Delhi. We used a web-based questionnaire to elicit demographic information, knowledge of Covid-19, willingness to volunteer and reasons deterring them from working during the Covid-19 pandemic, and self-declared knowledge in six domains. Results A total of 292 students participated in the study with a mean (SD) age of 19.9 (3.1) years. The mean (SD) knowledge score of Covid-19 was 6.9 (1.1) (maximum score 10). Knowledge score was significantly different among preclinical (6.5), paraclinical (7.18) and clinical groups (7.03). Almost three-fourth (75.3%) participants were willing to volunteer in the Covid-19 pandemic, though 67.8% had not received any training in emergency medicine or public health crisis management. Willingness to work was maximum in areas of social work and indirect patient care (62.3% each). Lack of personal protective equipment was cited as a highly deterring factor for volunteering (62.7%) followed by fear of transmitting the infection to family members (45.9%), fear of causing harm to the patient (34.2%) and the absence of available treatment (22.2%). Conclusions A majority of the students were willing to volunteer even though they had not received adequate training. Students may serve as an auxiliary force during the pandemic, especially in non-clinical settings.
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Affiliation(s)
- Manraj Sra
- Undergraduate students All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Amulya Gupta
- Undergraduate students All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Anil Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kiran Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Ngo SB, Clark PJ, Parr SE, Thomas AR, Dayal A, Sanker R, Hess BW, Stull DC. Moral Injury during the COVID-19 pandemic: A delphi model survey of family medicine residents. Int J Psychiatry Med 2022; 57:293-308. [PMID: 34961337 PMCID: PMC9209884 DOI: 10.1177/00912174211054385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective is to investigate the primary factors that created experiences leading to moral injury in family medicine residents during the COVID-19 pandemic and also to identify any barriers keeping these residents from seeking or receiving help when they experienced moral injury. METHOD A DELPHI model study utilizing three rounds of surveys was conducted at four family medicine residency programs in the United States. Resident responses to Survey 1 generated factors perceived to be causing them moral injury or constituting barriers to their seeking help. Thematic analysis identified common themes which were presented to residents in Survey 2 for rating and justification. Results and feedback from Survey 2 were shared with residents in Survey 3, where residents were prompted to reevaluate their ratings for factors and barriers for the purpose of generating consensus among themselves. A ranked list of factors and barriers was thereby created for the participating sites. RESULTS Residents shared several stories about the factors that most pressured them to violate their moral values. The most severe and frequent factors contributing to moral injury involved disruptions to doctor-patient relationships, patient-family relationships, and relationships with other healthcare professionals. Time was the major barrier to residents seeking help. CONCLUSION During times of crisis, moral injury among residents may be minimized by protecting and promoting important clinical and professional relationships with patients, colleagues, and other medical professionals. While residents report that lack of time was the most significant barrier to seeking help, it is unclear how this complicated and ubiquitous problem would be resolved or mitigated.
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Affiliation(s)
- Sean B Ngo
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Payson J Clark
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Sarah E Parr
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Abel R Thomas
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Akshat Dayal
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Richard Sanker
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | | | - Dillon C Stull
- Stanford University School of Medicine, Stanford, CA, USA
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25
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Andersson H, Svensson A, Frank C, Rantala A, Holmberg M, Bremer A. Ethics education to support ethical competence learning in healthcare: an integrative systematic review. BMC Med Ethics 2022; 23:29. [PMID: 35305627 PMCID: PMC8933936 DOI: 10.1186/s12910-022-00766-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions. METHODS In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms 'health personnel', 'students', 'ethics', 'moral', 'simulation', and 'teaching'. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis. RESULTS The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient's best interests, along with making decisions about what needs to be done in a specific situation. CONCLUSIONS The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals' and students' readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
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Affiliation(s)
- Henrik Andersson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, 50190, Borås, Sweden.
| | - Anders Svensson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Kronoberg, Växjö, Sweden
| | - Catharina Frank
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Andreas Rantala
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
- Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Kalmar County, Kalmar, Sweden
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Ericsson CR, Nordquist H, Lindström V, Rudman A. Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study. BMC Public Health 2021; 21:1789. [PMID: 34610798 PMCID: PMC8490964 DOI: 10.1186/s12889-021-11851-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics’ professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period. Methods A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants’ recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman’s correlation coefficients. Results Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores. Conclusions Finnish paramedics’ more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics’ increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11851-0.
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Affiliation(s)
- Christoffer R Ericsson
- Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Department of Healthcare, Arcada University of Applied Sciences, Jan Magnus Janssons plats 1, 00560, Helsinki, Finland.
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ann Rudman
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Brown MEL, Proudfoot A, Mayat NY, Finn GM. A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1229-1253. [PMID: 33847851 PMCID: PMC8452574 DOI: 10.1007/s10459-021-10046-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/22/2021] [Indexed: 06/02/2023]
Abstract
Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK.
| | - Amy Proudfoot
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Nabilah Y Mayat
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Sukhera J, Kulkarni C, Taylor T. Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:222-229. [PMID: 33914288 PMCID: PMC8082743 DOI: 10.1007/s40037-021-00663-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has taken a significant toll on the health of structurally vulnerable patient populations as well as healthcare workers. The concepts of structural stigma and moral distress are important and interrelated, yet rarely explored or researched in medical education. Structural stigma refers to how discrimination towards certain groups is enacted through policy and practice. Moral distress describes the tension and conflict that health workers experience when they are unable to fulfil their duties due to circumstances outside of their control. In this study, the authors explored how resident physicians perceive moral distress in relation to structural stigma. An improved understanding of such experiences may provide insights into how to prepare future physicians to improve health equity. METHODS Utilizing constructivist grounded theory methodology, 22 participants from across Canada including 17 resident physicians from diverse specialties and 5 faculty members were recruited for semi-structured interviews from April-June 2020. Data were analyzed using constant comparative analysis. RESULTS Results describe a distinctive form of moral distress called structural distress, which centers upon the experience of powerlessness leading resident physicians to go above and beyond the call of duty, potentially worsening their psychological well-being. Faculty play a buffering role in mitigating the impact of structural distress by role modeling vulnerability and involving residents in policy decisions. CONCLUSION These findings provide unique insights into teaching and learning about the care of structurally vulnerable populations and faculty's role related to resident advocacy and decision-making. The concept of structural distress may provide the foundation for future research into the intersection between resident well-being and training related to health equity.
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Affiliation(s)
- Javeed Sukhera
- Departments of Psychiatry/Paediatrics and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Chetana Kulkarni
- Hospital for Sick Children (SickKids), Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynecology and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Wang Z, Al Zaben F, Koenig HG, Ding Y. Spirituality, moral injury and mental health among Chinese health professionals. BJPsych Open 2021; 7:e135. [PMID: 36043686 PMCID: PMC8329767 DOI: 10.1192/bjo.2021.972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Moral injury has been found to be prevalent among healthcare professionals during the COVID-19 public health crisis. AIMS The present study examines the relationship between spirituality, moral injury, and mental health among physicians and nurses in mainland China during the COVID-19 pandemic. METHOD An online cross-sectional study was conducted involving 3006 physicians and nurses in mainland China, where the COVID-19 pandemic has caused high rates of hospital admission and death. The Moral Injury Symptoms Scale-Health Professional was administered, along with measures of mental health and spirituality. Hierarchical linear regression modelling was used to examine the mediating and moderating role of moral injury in the relationship between spirituality and mental health. RESULTS Spirituality was positively correlated with moral injury (β = 2.41, P < 0.01), depressive symptoms (β = 0.74, P < 0.01) and anxiety symptoms (β = 0.65, P < 0.01) after controlling sociodemographic variables. Moral injury significantly mediated the relationship between spirituality and both depression and anxiety, explaining 60% (0.46/0.76) of the total association between spirituality and depression and 58% (0.38/0.65) of the association with anxiety. No moderating effect of moral injury was found on the spirituality-mental health relationship. CONCLUSIONS Although they were the findings of a cross-sectional study, these results suggest that concern over transgressing moral values during the pandemic may have been a driving factor for negative mental health symptoms among Chinese health professionals for whom spirituality was somewhat important. Future longitudinal studies are needed to determine the causal nature of these relationships.
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Affiliation(s)
- Zhizhong Wang
- Department of Epidemiology and Statistic, School of Public Health at Guangdong Medical University, Dongguan, Guangdong, China
| | - Faten Al Zaben
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Harold G. Koenig
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, and Departments of Psychiatry and Medicine, Duke University Medical Center, Durham, NC, USA
| | - Yuanlin Ding
- Department of Epidemiology and Statistic, School of Public Health at Guangdong Medical University, Dongguan560001, Guangdong, China
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Abstract
In spite of the growing awareness on medical students' mental health in recent years, epidemiologic literature about the topic is scarce, particularly for what concerns suicide. Here, we collected cases of suicides among medical students enrolled at a local University in Italy and compared it to the general population of the same age group. Our sample was collected using records of suicides in the city of Pavia, Italy between the years of 2014 and 2019. This record was cross-referenced with enrolment numbers to the Medical Faculty of the city in order to select cases that involved medical students A time-window of 6 years was chosen for the evaluation. The odds ratio of suicide in medical students in comparison to the general population was of 14.58 (p value at the exact Poisson test <0.001). We then differentiated between native Italians and students from abroad. In this case, an odds ratio of 6.81 was observed (p value at the exact Poisson test 0.011). Our estimated suicide rates exceeded what was previously reported for the general population. We call for a closer attention on mental health in medical students, and an increased effort in collecting objective data on the topic.
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Masood Shah A, Waseem A, Yaqoob U. Call for medical students to join the workforce: A potential solution to deal with novel Coronavirus infectious disease 19 pandemic? Int J Clin Pract 2021; 75:e13809. [PMID: 33289236 PMCID: PMC7744906 DOI: 10.1111/ijcp.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Asfia Waseem
- Dow University of Health SciencesKarachiPakistan
| | - Uzair Yaqoob
- Dow University of Health SciencesKarachiPakistan
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Ritchie DT, Elhalwagy O. Debriefing for medical students in a virtual age. CLINICAL TEACHER 2021; 18:316. [PMID: 33619870 DOI: 10.1111/tct.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Duncan T Ritchie
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Institute of Prehospital Care, London's Air Ambulance, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Omar Elhalwagy
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Institute of Prehospital Care, London's Air Ambulance, London, UK
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Lefèvre H, Stheneur C, Cardin C, Fourcade L, Fourmaux C, Tordjman E, Touati M, Voisard F, Minassian S, Chaste P, Moro MR, Lachal J. The Bulle: Support and Prevention of Psychological Decompensation of Health Care Workers During the Trauma of the COVID-19 Epidemic. J Pain Symptom Manage 2021; 61:416-422. [PMID: 32961219 PMCID: PMC7836408 DOI: 10.1016/j.jpainsymman.2020.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023]
Abstract
The coronavirus disease 2019 pandemic presents unprecedented challenges for the health care system. The pressure on health care staff continues to intensify, accentuated by the confinement (lockdown) of the population and the unprecedented duration of this emergency. Separately and especially together, overwork, degraded conditions of care because of the never-ending emergency, and the risk of exposure to the virus can lead to acute psychological distress or signs of burnout. This original program was developed at Cochin Hospital in Paris, France to prevent these potentially dramatic psychological consequences, support the medical staff, and identify those most affected to offer them specific care. A program and a space for relaxation and support for hospital caregivers by hospital caregivers, the Port Royal Bulle (the Bubble) offers these workers help in decompression and relaxation. It combines a warm and caring welcome that promotes attention, listening, conversations, and exchanges as needed, empathetic support, and the ability to participate in soothing, relaxing, or low-impact physical activities. It takes care of caregivers. The Bubble is a program that is simple to set up and that appears to meet professionals' expectations. Making it permanent and enlarging its scale, as a complement to existing programs, might help to support health care personnel in their work.
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Affiliation(s)
- Hervé Lefèvre
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France; Université de Paris, PCPP, Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Chantal Stheneur
- Fondation Santé des Etudiants de France, Centre Varennes Jarcy, Varennes Jarcy, France; UVSQ, Versailles, France
| | | | - Lola Fourcade
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, Paris, France
| | - Christine Fourmaux
- Fondation Santé des Etudiants de France, Centre Varennes Jarcy, Varennes Jarcy, France
| | - Elise Tordjman
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, Paris, France
| | - Marie Touati
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, Paris, France
| | - Flore Voisard
- Fondation Santé des Etudiants de France, Centre Varennes Jarcy, Varennes Jarcy, France; APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, Paris, France
| | - Sevan Minassian
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Pauline Chaste
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, Paris, France; Université de Paris, Paris, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France; Université de Paris, PCPP, Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Jonathan Lachal
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France; Université de Paris, PCPP, Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.
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Murray H, Ehlers A. Cognitive therapy for moral injury in post-traumatic stress disorder. COGNITIVE BEHAVIOUR THERAPIST 2021; 14:e8. [PMID: 34191944 PMCID: PMC7853755 DOI: 10.1017/s1754470x21000040] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022]
Abstract
Moral injury is the profound psychological distress that can arise following participating in, or witnessing, events that transgress an individual's morals and include harming, betraying, or failure to help others, or being subjected to such events, e.g. being betrayed by leaders. It has been primarily researched in the military, but it also found in other professionals such as healthcare workers coping with the COVID-19 pandemic and civilians following a wide range of traumas. In this article, we describe how to use cognitive therapy for post-traumatic stress disorder (CT-PTSD) to treat patients presenting with moral injury-related PTSD. We outline the key techniques involved in CT-PTSD and describe their application to treating patients with moral injury-related PTSD. A case study of a healthcare worker is presented to illustrate the treatment interventions. KEY LEARNING AIMS (1)To recognise moral injury where it arises alongside PTSD.(2)To understand how Ehlers and Clark's cognitive model of PTSD can be applied to moral injury.(3)To be able to apply cognitive therapy for PTSD to patients with moral injury-related PTSD.
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Affiliation(s)
- Hannah Murray
- Department of Experimental Psychology, University of Oxford, Oxford, UK and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK and Oxford Health NHS Foundation Trust, Oxford, UK
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Čartolovni A, Stolt M, Scott PA, Suhonen R. Moral injury in healthcare professionals: A scoping review and discussion. Nurs Ethics 2021; 28:590-602. [PMID: 33427020 PMCID: PMC8366182 DOI: 10.1177/0969733020966776] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.
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Affiliation(s)
- Anto Čartolovni
- 324714Catholic University of Croatia, Croatia; University of Hull, UK
| | | | - P Anne Scott
- 8799National University of Ireland Galway, Ireland
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Martin J, Kam J, Aziz S. Coffee & Cases: Peer learning in prehospital care. CLINICAL TEACHER 2021; 18:370-371. [PMID: 33415830 DOI: 10.1111/tct.13326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Joyce Kam
- GKT School of Medicine, King's College London, London, UK
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Hines SE, Chin KH, Glick DR, Wickwire EM. Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E488. [PMID: 33435300 PMCID: PMC7826570 DOI: 10.3390/ijerph18020488] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/19/2022]
Abstract
The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.
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Affiliation(s)
- Stella E. Hines
- Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA; (K.H.C.); (D.R.G.); (E.M.W.)
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Suppan L, Chan M, Gartner B, Regard S, Campana M, Chatellard G, Cottet P, Larribau R, Sarasin FP, Niquille M. Evaluation of a Prehospital Rotation by Senior Residents: A Web-Based Survey. Healthcare (Basel) 2020; 9:healthcare9010024. [PMID: 33383633 PMCID: PMC7824315 DOI: 10.3390/healthcare9010024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
The added value of prehospital emergency medicine is usually assessed by measuring patient-centered outcomes. Prehospital rotations might however also help senior residents acquire specific skills and knowledge. To assess the perceived added value of the prehospital rotation in comparison with other rotations, we analyzed web-based questionnaires sent between September 2011 and August 2020 to senior residents who had just completed a prehospital rotation. The primary outcome was the perceived benefit of the prehospital rotation in comparison with other rotations regarding technical and non-technical skills. Secondary outcomes included resident satisfaction regarding the prehospital rotation and regarding supervision. A pre-specified subgroup analysis was performed to search for differences according to the participants’ service of origin (anesthesiology, emergency medicine, or internal medicine). The completion rate was of 71.5% (113/158), and 91 surveys were analyzed. Most senior residents found the prehospital rotation either more beneficial or much more beneficial than other rotations regarding the acquisition of technical and non-technical skills. Anesthesiology residents reported less benefits than other residents regarding pharmacological knowledge acquisition and confidence as to their ability to manage emergency situations. Simulation studies should now be carried out to confirm these findings.
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Affiliation(s)
- Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
- Correspondence:
| | - Michèle Chan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
| | - Birgit Gartner
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
| | - Simon Regard
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
| | - Mathieu Campana
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
- Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Ghislaine Chatellard
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
- Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Philippe Cottet
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
| | - François Pierre Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine University of Geneva, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (M.C.); (B.G.); (S.R.); (M.C.); (G.C.); (P.C.); (R.L.); (F.P.S.); (M.N.)
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Walker CA, McGregor L, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med 2020; 7:259-266. [PMID: 33440103 PMCID: PMC7808839 DOI: 10.15441/ceem.19.086] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Team-based resuscitation in emergency departments (EDs) is an excellent opportunity for hot debriefs (HDBs). In creating a bespoke HDB model for emergency medicine resuscitations, we sought to optimize learning from clinical experience, identify team strengths, challenges, encourage honest reflection and focus on ways of improving future performance. METHODS Multidisciplinary ED focus groups reviewed existing models, identified benefits/barriers and created new frame works, testing and adapting further using fottage of a simulated complex resuscitation case. The new HDB tool was coined: "STOP5" (STOP for 5 minutes). Cases targeted were prehospital retrievals, major trauma, cardiac arrests, deaths in resuscitation, and staff-triggered. The framework details included a specifically scripted introduction followed by core elements that were S: summarize the case; T: things that went well; O: opportunities to improve; P: points to action and responsibilities. Staffs were surveyed at 1 month prior then 6 and 18 months post-introduction. Data collection forms were used to identify and track hard outcomes/system improvements resulting directly from HDBs. RESULTS Potential benefits identified by respondents included: improved staff morale; team cohesion; improved care for future patients; promoting a culture for learning, patient safety and quality improvement. Ten process and equipment changes resulted directly from STOP5 over 12 months. CONCLUSION We anticipate the STOP5 framework to be globally generalizable and effective for many ED teams.
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Affiliation(s)
- Craig Andrew Walker
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Critical Care Department, St John’s Hospital, Livingston, United Kingdom
| | - Laura McGregor
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Forth Valley, United Kingdom
| | - Cameron Taylor
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sara Robinson
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Nanjundaswamy MH, Pathak H, Chaturvedi SK. Perceived stress and anxiety during COVID-19 among psychiatry trainees. Asian J Psychiatr 2020; 54:102282. [PMID: 32679530 PMCID: PMC7334909 DOI: 10.1016/j.ajp.2020.102282] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Madhuri H Nanjundaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
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Zhizhong W, Koenig HG, Yan T, Jing W, Mu S, Hongyu L, Guangtian L. Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry 2020; 20:556. [PMID: 33238949 PMCID: PMC7686837 DOI: 10.1186/s12888-020-02954-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Moral injury among physicians and other health professionals has attracted attention in the mainstream literature, this study aim to assess the psychometric properties of the 10-item Moral Injury Symptoms Scale-Health Professional (MISS-HP) among healthcare professionals in China. METHODS A total of 583 nurses and 2423 physicians were recruited from across mainland China. An online survey was conducted from March 27 to April 26, 2020 (during the middle of the COVID-19 pandemic) using the Chinese version of the MISS-HP. Reliability was assessed by internal consistency reliability and test-retest reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine scale structure. RESULTS Cronbach's α of the scale for both samples was acceptable (0.71 for nurses and 0.70 for physicians), as was test-retest reliability (ICCs for the individual items ranged from 0.41 to 0.74, with 0.77 for the overall scale in physicians). EFA suggested three factors, and the CFA indicated good fit to the data. Convergent validity was demonstrated with the 4-item Expressions of Moral Injury Scale (r = 0.45 for physicians, r = 0.43 for nurses). Discriminant validity was demonstrated by correlations with burnout and well-being (r = 0.34-0.47), and concurrent validity was suggested by correlations with depression and anxiety symptoms (r = 0.37-0.45). Known groups validity was indicated by a higher score in those exposed to workplace violence (B = 4.16, 95%CI: 3.21-5.10, p < 0.001). CONCLUSIONS The MISS-HP demonstrated acceptable reliability and validity in a large sample of physicians and nurses in mainland China, supporting its use as a screening measure for moral injury symptoms among increasingly stressed health professionals in this country during the COVID-19 pandemic.
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Affiliation(s)
- Wang Zhizhong
- Department of Research, Futian Center for Chronic Disease Control, #9 Xinsha Road, Shenzhen, 518000, People's Republic of China. .,Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, Yinchuan, 750004, People's Republic of China.
| | - Harold G. Koenig
- grid.412125.10000 0001 0619 1117Department of Medicine, King Abdulaziz University, Jeddah, 21589 Saudi Arabia ,grid.189509.c0000000100241216Department of Psychiatry, Duke University Medical Center, Durham, NC 27710 USA
| | - Tong Yan
- Department of Infectious Disease Control, Center for Disease Control and Prevention at Shizuishan City, Shizuishan, 750000 People’s Republic of China
| | - Wen Jing
- grid.412194.b0000 0004 1761 9803Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, Yinchuan, 750004 People’s Republic of China
| | - Sui Mu
- grid.412194.b0000 0004 1761 9803Department of Health Management, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004 People’s Republic of China
| | - Liu Hongyu
- grid.412194.b0000 0004 1761 9803Department of Health Management, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004 People’s Republic of China
| | - Liu Guangtian
- Department of Infectious Disease at the Fourth People Hospital of Ningxia, Yinchuan, 750004 People’s Republic of China
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Abdulghani HM, Sattar K, Ahmad T, Akram A. Association of COVID-19 Pandemic with undergraduate Medical Students' Perceived Stress and Coping. Psychol Res Behav Manag 2020; 13:871-881. [PMID: 33154682 PMCID: PMC7608141 DOI: 10.2147/prbm.s276938] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
Purpose The COVID-19 pandemic poses a major challenge for medical students’ learning and has become a potential stressor, with a profound influence on their psychological well-being. We aimed to determine the effect of the current pandemic on undergraduate medical students’ learning. We also explored the association of their stress level with coping strategies, educational, and psychological variables. Materials and Methods This is a cross-sectional design study, and participants were the 1st to 5th year medical students. A self-administered questionnaire (18 items) and a well-known Kessler 10 Psychological Distress questionnaire (10 items) were used to collect the data related to perceived stress with an association of educational, psychological, and coping variables. Results The prevalence of overall stress was significantly higher (χ2= 16.3; P=0.000) in female medical students, ie, (40%) as compared to the male students (16.6%), and was highest (48.8%) during the 3rd medical year. It was also noted that the most effective strategy, embraced by students to cope with the severe stress, was “indulging in religious activities” (OR= 1.08; P=0.81). Furthermore, 22.3% of students had perceived severe stress as they did not prefer online learning. Similarly, those students who have not believed or refused the online learning or disagree in “there is pleasure in the study due to COVID” they have significantly higher stress (χ2=39.7; P=0.000) 21.5% mild, 17.8% of moderate, and 21.2% severe. Conclusion We found that the COVID-19 pandemic has induced stress and changes in medical students’ educational attitudes and strategies. The results exhibited that the predominance of stress is higher in females than males, and also more stress was perceived by the students during their transitional year, ie, 3rd medical year (from pre-clinical to clinical) and also the respondents who regularly did religious meditation were at lower levels of stress. COVID-19’s influence on medical education and students’ well-being will be felt at an extended level, which necessitates an appropriate plan for preparedness.
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Affiliation(s)
- Hamza Mohammad Abdulghani
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Kamran Sattar
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ashfaq Akram
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Fang H, Wei L, Mao J, Jia H, Li P, Li Y, Fu Y, Zhao S, Liu H, Jiang K, Jiao M, Qiao H, Wu Q. Extent and risk factors of psychological violence towards physicians and Standardised Residency Training physicians: a Northern China experience. Health Qual Life Outcomes 2020; 18:330. [PMID: 33028344 PMCID: PMC7542751 DOI: 10.1186/s12955-020-01574-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/21/2020] [Indexed: 02/03/2023] Open
Abstract
Purpose Physicians and Standardised Residency Training physicians (SRTPs) have relatively high exposure to psychological violence. Its adverse effects are far greater than those of physical violence. However, no previous research has paid attention to the problem of psychological violence among them. This study aims to evaluate the extent, characteristics, and risk factors of psychological violence among SRTPs in comparison to physicians, and also to highlight the psychological violence experienced by SRTPs and suggest preventive measures. Methods A cross-sectional survey was conducted in northern China. 884 physicians and 537 SRTPs completed a questionnaire which compiled by the ILO, ICN, WHO and PSI in 2003 to measure violence in the workplace. Descriptive statistics and logistic regression analysis were used to analyse results. Results The effective response rates of physicians and SRTPs were 63.1%(884/1400) and 86.3%(537/622) respectively. 73.0%(645/884) of physicians and 24.8%(133/537) of SRTPs suffered psychological violence in the past year. Compared to physicians (29/645, 4.5%), SRTPs (42/133, 31.6%) experience more internal violence. Further, after experiencing psychological violence, physicians are willing to talk to family and friends, but SRTPs generally take no action. Shift work was a risk factor for both physicians (OR 1.440, 95% CI 1.014–2.203) and SRTPs (OR 1.851, 95% CI 1.217–2.815) suffering from psychological violence. In contrast, no anxiety symptoms protected physicians (OR 0.406, 95% CI 0.209–0.789) and SRTPs (OR 0.404, 95% CI 0.170–0.959) against psychological violence. Conclusions SRTPs and physicians in northern China have a high risk of experiencing psychological violence, and physicians experience more. Meanwhile, there are obvious differences in responses to psychological violence and risk factors between them. Therefore, medical institutions should pay more attention to psychological violence, especially among SRTPs, such as supporting the reporting of psychological violence, strengthening team relationships, and providing psychological comfort and counselling. Trial registration number (Project Identification Code: HMUIRB20160014), Registered May 10, 2016.
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Affiliation(s)
- Huiying Fang
- President's Office of Qingdao Women and Children's Hospital, Qingdao, 266011, China
| | - Lifeng Wei
- Department of Health, Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Jingfu Mao
- Department of Human Resource Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Haonan Jia
- Department of Medical Affairs, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 150081, China
| | - Peng Li
- Education Section of Qingdao Women and Children's Hospital, Qingdao, 266011, China
| | - Yuze Li
- Harbin No.6 High School, Harbin, 150300, China
| | - Yapeng Fu
- Graduate Department of Cancer Hospital Affiliated to Harbin Medical University, Harbin, 150000, China
| | - Siqi Zhao
- Department of Psychology and Humanities Nursing, Hebei Medical University, Donggang Road 48, Yuhua District, Shijiazhuang, 050017, China
| | - He Liu
- Office of Academic Affairs, Hebei Medical University, 361 Zhongshan East Road, Chang'an District, Shijiazhuang, 050017, China
| | - Kexin Jiang
- Department of Health, Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Mingli Jiao
- Department of Health, Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Hong Qiao
- Endocrine and Metabolic Diseases, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, 150081, China.
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Hines SE, Chin KH, Levine AR, Wickwire EM. Initiation of a survey of healthcare worker distress and moral injury at the onset of the COVID-19 surge. Am J Ind Med 2020; 63:830-833. [PMID: 32677108 PMCID: PMC7404965 DOI: 10.1002/ajim.23157] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Stella E. Hines
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimore Maryland
- Department of Medicine, Division of Occupational and Environmental MedicineUniversity of Maryland School of MedicineBaltimore Maryland
| | - Katherine H. Chin
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimore Maryland
| | - Andrea R. Levine
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimore Maryland
| | - Emerson M. Wickwire
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimore Maryland
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimore Maryland
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O'Byrne L, Gavin B, McNicholas F. Medical students and COVID-19: the need for pandemic preparedness. JOURNAL OF MEDICAL ETHICS 2020; 46:623-626. [PMID: 32493713 PMCID: PMC7316103 DOI: 10.1136/medethics-2020-106353] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 05/18/2023]
Abstract
The COVID-19 pandemic has prompted unprecedented global disruption. For medical schools, this has manifested as examination and curricular restructuring as well as significant changes to clinical attachments. With the available evidence suggesting that medical students' mental health status is already poorer than that of the general population, with academic stress being a chief predictor, such changes are likely to have a significant effect on these students. In addition, there is an assumption that these students are an available resource in terms of volunteerism during a crisis. This conjecture should be questioned; however, as those engaging in such work without sufficient preparation are susceptible to moral trauma and adverse health outcomes. This, in conjunction with the likelihood of future pandemics, highlights the need for 'pandemic preparedness' to be embedded in the medical curriculum.
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Affiliation(s)
- Lorcan O'Byrne
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Blánaid Gavin
- Department of Child and Adolescent Psychiatry, SMMS, University College Dublin, Dublin, Ireland
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, SMMS, University College Dublin, Dublin, Ireland
- Children Health Ireland, Crumlin, Dublin 12, Ireland
- Lucena Clinic Rathgar, Dublin 6, Ireland
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Brewis A, Wutich A, Mahdavi P. Stigma, pandemics, and human biology: Looking back, looking forward. Am J Hum Biol 2020; 32:e23480. [PMID: 32790149 PMCID: PMC7435551 DOI: 10.1002/ajhb.23480] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Alexandra Brewis
- School of Human Evolution and Social ChangeArizona State UniversityTempeArizonaUSA
| | - Amber Wutich
- School of Human Evolution and Social ChangeArizona State UniversityTempeArizonaUSA
| | - Pardis Mahdavi
- School of Social TransformationArizona State UniversityTempeArizonaUSA
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Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020; 368:m1211. [PMID: 32217624 DOI: 10.1136/bmj.m1211] [Citation(s) in RCA: 961] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Neil Greenberg
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | | | | | - Simon Wessely
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
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Abstract
SUMMARYCaring for people in distress or illness is emotionally draining and physically demanding. This article focuses on the experiences and needs of health service staff as professional carers. It overviews the current circumstances in the UK and links readers to the findings of: the Stevenson/Farmer Review of 2017; the report of the General Medical Council on the state of medical education and practice of 2018; and the British Medical Association survey of doctors and medical students published in 2019. We review the sources of stress that affects healthcare practitioners and introduce the concepts of emotional labour, psychological safety and psychosocial resilience. We draw attention to the vital importance of social support and leadership to protecting healthcare staff. We conclude this review of the topic by outlining a stepped model for actions that aim to: develop staff of healthcare services and help them to thrive at work; support staff who are struggling at work; and intervene to care for staff who are distressed or unwell whether they are continuing to work or not.
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Graham B, Elbeltagi H, Nelmes P, Jenkin A, Smith JE. What difference can a year make? Findings from a survey exploring student, alumni and supervisor experiences of an intercalated degree in emergency care. BMC MEDICAL EDUCATION 2019; 19:188. [PMID: 31170966 PMCID: PMC6554867 DOI: 10.1186/s12909-019-1579-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/26/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND One third of UK medical students undertake an intercalated degree, typically in traditional academic disciplines. It is less usual for students to undertake intercalated degrees that are directly aligned to a clinical speciality with longitudinal placements. This cross sectional survey aims to explore the self-reported experiences of students, alumni and supervisors associated with a clinically oriented intercalated degree in emergency care featuring a longitudinal placement in a hospital emergency department over a 9-month academic year. Themes for exploration include student clinical and academic development, effect on career choice, supervisor experience and the effect on host institutions. METHODS Current students, previous alumni, and clinical placement supervisors associated with a single intercalated degree programme in urgent and emergency care since 2005 were identified from records and using social media. Separate online surveys were then developed and distributed to current students/ previous alumni and consultant physician supervisors, between May and August 2016. Results are presented using basic descriptive statistics and selected free text comments. RESULTS Responses were obtained from 37 out of 46 contactable students, and 14 out of 24 supervisors (80 and 63%, respectively). Students self-reported increased confidence in across a range of clinical and procedural competencies. Supervisors rated student competence in clinical, inter-professional and academic writing skills to be commensurate with, or in many cases exceeding, the level expected of a final year medical student. Supervisors reported a range of benefits to their own professional and personal development from supervising students, which included improved teaching and mentoring skills, providing intellectual challenge, and helping with the completion of audits and service improvement projects. CONCLUSIONS Students report the acquisition of a range of clinical, academic, and inter-professional skills following their intercalated BSc year. A positive experience was reported by supervisors, extending to host institutions. Students reported feeling more enthusiastic about emergency medicine careers on completion. However, as students embarking on this degree naturally bring pre-existing interest in the area, it is not possible to attribute causation to these associations. Further investigation is also required to determine the longer term effect of clinically oriented intercalated degrees on career choice.
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Affiliation(s)
- Blair Graham
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Hadir Elbeltagi
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Pam Nelmes
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Annie Jenkin
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
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