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Looi JCL. Australian specialised mental healthcare labour shortages: Potential interventions for consideration and further research. Australas Psychiatry 2024; 32:446-449. [PMID: 39110758 PMCID: PMC11440790 DOI: 10.1177/10398562241267138] [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: 09/29/2024]
Abstract
OBJECTIVE Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. CONCLUSIONS The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions.
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Affiliation(s)
- Jeffrey CL Looi
- Jeffrey CL Looi, Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Building 4, Level 2, Canberra Hospital, PO Box 11, Garran, ACT 2605, Australia.
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Page B, Irving D, Carthey J, Welch J, Higham H, Vincent C. Strategies for adapting under pressure: an interview study in intensive care units. BMJ Qual Saf 2024:bmjqs-2024-017385. [PMID: 39179378 DOI: 10.1136/bmjqs-2024-017385] [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: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing practical and coordinated strategies for managing under pressure. METHODS We conducted qualitative semi-structured interviews with 20 senior multidisciplinary healthcare professionals from intensive care units (ICUs) in 4 major hospitals in the UK. The interviews explored the everyday pressures faced by intensive care staff and the strategies they use to adapt. A thematic template analysis approach was used to analyse the data based on our previously empirically developed taxonomy of pressures and strategies. RESULTS The principal source of pressure described was a shortage of staff with the necessary skills and experience to care for the increased numbers and complexity of patients which, in turn, increased staff workload and reduced patient flow. Strategies were categorised into anticipatory (in advance of anticipated pressures) and on the day. The dynamic and unpredictable demands on ICUs meant that strategies were mostly deployed on the day, most commonly by flexing staff, prioritisation of patients and tasks and increasing modes of communication and support. CONCLUSIONS ICU staff use a wide variety of adaptive strategies at times of pressure to minimise risk and maintain a reasonable standard of care for patients. These findings provide the foundation for a portfolio of strategies, which can be flexibly employed when under pressure. There is considerable potential for training clinical leaders and teams in the effective use of adaptive strategies.
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Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
- Cicely Saunders Institute, King's College London, London, Greater London, UK
| | - Dulcie Irving
- Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
| | - Jane Carthey
- Human Factors and Patient Safety, Jane Carthey Consulting, Chiswick, UK
| | - John Welch
- National Institute for Health and Care Research Central London Patient Safety Research Collaborative, University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Higham
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
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Van Natta M. Second-Class Care: How Immigration Law Transforms Clinical Practice in the Safety Net. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241254390. [PMID: 39066548 DOI: 10.1177/00221465241254390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
This article examines how U.S. immigration law extends into the health care safety net, enacting medical legal violence that diminishes noncitizens' health chances and transforms clinical practices. Drawing on interviews with health care workers in three U.S. states from 2015 to 2020, I ask how federal citizenship-based exclusions within an already stratified health care system shape the clinical trajectories of noncitizens in safety-net institutions. Focusing specifically on cancer care, I find that increasingly anti-immigrant federal policies often reshape clinical practices toward noncitizens with a complex, life-threatening condition as they approach a "specialty care cliff" by (1) creating time penalties that keep many noncitizens in a protracted state of injury and (2) deterring noncitizens from seeking care through threats of immigration enforcement. Through these processes, medical legal violence also creates the potential for moral injury among health care workers, who must adapt clinical practices in response to socio-legal boundaries of belonging.
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Affiliation(s)
- Meredith Van Natta
- Department of Sociology, University of California Merced, Merced, CA, USA
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Yassaie R, Brooks L. Reassessing 'good' medical practice and the climate crisis. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109713. [PMID: 38871401 DOI: 10.1136/jme-2023-109713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of UK doctors. These updated guidelines offer some environmental considerations that previous standards did not include. This paper explores these latest additions to Good Medical Practice through the healthcare ethics lens of non-maleficence, beneficence, justice and autonomy, alongside trust and physician well-being, to make the case that the latest updates to Good Medical Practice do not go far enough in specifying the duties for doctors in responding to climate and ecological emergencies to be seen as ethically justifiable.The paper argues that given the health implications of the climate crisis and the harms associated with high-emission healthcare, as well as the co-benefits of climate action on health, there must be a stronger commitment from the medical regulator to ensure the groundwork is set for doctors to learn, understand and advocate for the importance and urgency of practicing sustainable healthcare. The case for this is strengthened by also examining the importance of maintaining public trust in the medical profession as advocates for public health, along with the notable societal and generational injustices that continue to deepen as the climate emergency escalates.The paper concludes by arguing that doctors can and should be a part of writing a new chapter for health in the climate era, but our standards for practice need to offer a strengthened starting point of consensus for what is expected of the medical profession for that to come to fruition and raise questions as to what doctors can and should do when they have questions over their own regulators' commitment to maintaining public health in relation to the climate and ecological crisis.
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Affiliation(s)
- Rammina Yassaie
- Sheffield Hallam University College of Health Wellbeing and Life Sciences, Sheffield, UK
| | - Lucy Brooks
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Irving D, Page B, Carthey J, Higham H, Undre S, Vincent C. Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom. Patient Saf Surg 2024; 18:8. [PMID: 38383433 PMCID: PMC10880194 DOI: 10.1186/s13037-024-00390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures. METHODS We conducted interviews with 20 senior multidisciplinary healthcare professionals from surgical teams in four major hospitals in the United Kingdom. The interviews explored the types of everyday pressures staff were experiencing, the strategies they use to adapt, and how these strategies might be taught to others. RESULTS The primary pressures described by senior clinicians in surgery were increased numbers and complexity of patients alongside shortages in staff, theatre space and post-surgical beds. These pressures led to more difficult working conditions (e.g. high workloads) and problems with system functioning such as patient flow and cancellation of lists. Strategies for responding to these pressures were categorised into increasing or flexing resources, controlling and prioritising patient demand and strategies for managing the workload (scheduling for efficiency, communication and coordination, leadership, and teamwork strategies). CONCLUSIONS Teams are deploying a range of strategies and making adaptations to the way care is delivered. These findings could be used as the basis for training programmes for surgical teams to develop coordinated strategies for adapting under pressure and to assess the impact of different combinations of strategies on patient safety and surgical outcomes.
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Affiliation(s)
- Dulcie Irving
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Cicely Saunders Institute, King's College London, London, UK
| | | | - Helen Higham
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shabnam Undre
- Department of Urology, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Sherratt K, Carnegie AC, Kucharski A, Cori A, Pearson CAB, Jarvis CI, Overton C, Weston D, Hill EM, Knock E, Fearon E, Nightingale E, Hellewell J, Edmunds WJ, Villabona Arenas J, Prem K, Pi L, Baguelin M, Kendall M, Ferguson N, Davies N, Eggo RM, van Elsland S, Russell T, Funk S, Liu Y, Abbott S. Improving modelling for epidemic responses: reflections from members of the UK infectious disease modelling community on their experiences during the COVID-19 pandemic. Wellcome Open Res 2024; 9:12. [PMID: 38784437 PMCID: PMC11112301 DOI: 10.12688/wellcomeopenres.19601.1] [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: 12/10/2023] [Indexed: 05/25/2024] Open
Abstract
Background The COVID-19 pandemic both relied and placed significant burdens on the experts involved from research and public health sectors. The sustained high pressure of a pandemic on responders, such as healthcare workers, can lead to lasting psychological impacts including acute stress disorder, post-traumatic stress disorder, burnout, and moral injury, which can impact individual wellbeing and productivity. Methods As members of the infectious disease modelling community, we convened a reflective workshop to understand the professional and personal impacts of response work on our community and to propose recommendations for future epidemic responses. The attendees represented a range of career stages, institutions, and disciplines. This piece was collectively produced by those present at the session based on our collective experiences. Results Key issues we identified at the workshop were lack of institutional support, insecure contracts, unequal credit and recognition, and mental health impacts. Our recommendations include rewarding impactful work, fostering academia-public health collaboration, decreasing dependence on key individuals by developing teams, increasing transparency in decision-making, and implementing sustainable work practices. Conclusions Despite limitations in representation, this workshop provided valuable insights into the UK COVID-19 modelling experience and guidance for future public health crises. Recognising and addressing the issues highlighted is crucial, in our view, for ensuring the effectiveness of epidemic response work in the future.
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Affiliation(s)
- Katharine Sherratt
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna C Carnegie
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Kucharski
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Carl A B Pearson
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Christopher I Jarvis
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher Overton
- All Hazards Intelligence, Data Analytics and Surveillance, UK Health Security Agency, London, UK
- Department of Mathematical Sciences, University of Liverpool, Liverpool, UK
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - Dale Weston
- Emergency Response Department Science & Technology Behavioural Science, UK Health Security Agency, London, UK
| | - Edward M Hill
- Warwick Mathematics Institute and The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
- Joint UNIversities Pandemic and Epidemiological Research, JUNIPER, https://maths.org/juniper/, UK
| | - Edward Knock
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Elizabeth Fearon
- Institute for Global Health, University College London, London, UK
| | - Emily Nightingale
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Joel Hellewell
- European Molecular Biology Laboratory, European Bioinformatics Institute, Hinxton, UK
| | - W John Edmunds
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Julián Villabona Arenas
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Kiesha Prem
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Li Pi
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Marc Baguelin
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Michelle Kendall
- Warwick Mathematics Institute and The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, University of Warwick, Coventry, UK
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nicholas Davies
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Sabine van Elsland
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Timothy Russell
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute, Hinxton, UK
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
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Thomas K, Russell S. Advance Care Planning in the United Kingdom - A snapshot from the four UK nations. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:150-162. [PMID: 37541912 DOI: 10.1016/j.zefq.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 08/06/2023]
Abstract
The United Kingdom (UK) as a whole has a long-established decades-old history as an early adopter of the concepts of Advance Care Planning (ACP), with significant integration into mainstream national policy and widespread implementation. The ACP term itself, its processes, means, inclusions and implementations vary considerably within the UK and between its four nations, but the overall impression is of a strongly uniting consensus on the positive impact, value and vital importance of ACP in enabling better care for people in the final years of life, and at earlier life stages. Though there is always more work to do and more lessons to learn, those of us who have watched this world-wide movement grow over recent decades, find the overall direction of travel of commitment to mainstreaming ACP in the UK to be inspiring and encouraging, and gives us hope for the future. Across the UK, there is much shared history, policy, objectives, and regulation related to ACP, and at the same time, many variations in approach, tone, emphasis and detail within and between the four nations of the UK. The 2022 Office of National Statistics reports that the four nations of the UK have a combined population of 67 million (England 56.5 million, Scotland 5.5 million, Wales 3.1 million, Northern Ireland 1.9 million). All four nations are prioritising ACP as part of national policy, aiming to deliver more personalised care, particularly but not exclusively for those nearing the end of life, with a wide variety of best practice examples. Here we describe some common areas and variations across the UK history, policy and legal perspectives, some examples of best practice, resources, and exciting developments across all four nations which, although not exhaustive and within the limitations of our brief, reflect the flavour of our shared commitment. We are most grateful to all the contributing authors.
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Affiliation(s)
- Keri Thomas
- Gold Standards Framework Centre, London, UK.
| | - Sarah Russell
- Portsmouth Hospitals University NHS Trust, Hampshire, UK
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Skelton E, Smith A, Harrison G, Rutherford M, Ayers S, Malamateniou C. "It has been the most difficult time in my career": A qualitative exploration of UK obstetric sonographers' experiences during the COVID-19 pandemic. Radiography (Lond) 2023; 29:582-589. [PMID: 37004376 PMCID: PMC10027955 DOI: 10.1016/j.radi.2023.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/28/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Substantial changes were made to the provision of pregnancy ultrasound services during the COVID-19 pandemic with the intention of minimising virus transmission and maintaining service continuity. Published literature describing the impact of the pandemic on obstetric sonographers is predominantly quantitative in nature, however statistics cannot fully convey sonographers' voices. This study aimed to gain a deeper understanding of the lived experiences of UK obstetric sonographers performing pregnancy ultrasound scans during the pandemic. METHODS A UK-wide, online, anonymous cross-sectional survey on Qualtrics XM™ was open to responses between 9th March and 6th May 2021. Whilst this survey contained some quantitative elements, open questions were included to capture additional qualitative detail from respondents about their perceptions and experiences of scanning during the pandemic. Key themes were generated from free text responses using thematic analysis. RESULTS Written responses were received from 111/138 sonographers participating in the survey. Five themes were generated, depicting the impact of the pandemic on obstetric sonographers: 1) continuity in a crisis; 2) decisions about me, without me; 3) battle scars - the lasting damage of COVID-19; 4) what people think I do vs. what I really do; and 5) the human touch. A cross-cutting theme was sonographers' feelings of disconnection from senior figures and expectant parents which created a sense of abandonment and distrust. CONCLUSION Survey respondents' self-reported experiences of ineffective leadership and management, and perceived lack of understanding of the complexity of the sonographer role are potential contributory factors in the high levels of moral injury and occupational burnout reported within the workforce during the pandemic.
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Affiliation(s)
- E Skelton
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, University of London, EC1V 0HB, UK.
| | - A Smith
- Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - G Harrison
- Society and College of Radiographers, London, SE1 2EW, UK
| | - M Rutherford
- Perinatal Imaging and Health, King's College London, SE1 7EH, UK
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, University of London, EC1V 0HB, UK
| | - C Malamateniou
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, University of London, EC1V 0HB, UK; Haute Ecole de Santé Vaud, Lausanne, Switzerland
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Frich JC, Allwood D, Busari JO, Chan MK, Compagni A, Gemine R, Joshi I, Klaber R, Laker B, Loh E, Lyons O, Molloy A, Mountford J, Nigam A, Moses R, Noël JL, Smith I, St John-Matthews J, Stoddart C, Williams CE. Looking back, leading forward: BMJ Leader 5 years on. BMJ LEADER 2023; 7:1-2. [PMID: 37013872 DOI: 10.1136/leader-2023-000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Jan C Frich
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Dominique Allwood
- Medical Directors Office, Imperial College Healthcare NHS Trust, London, UK
| | - Jamiu O Busari
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Pediatrics, Horacio Oduber Hospital, Oranjestad, Aruba
| | - Ming-Ka Chan
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amelia Compagni
- Center for Research on Health and Social Care Management (CeRGAS), Bocconi University, Milano, Italy
| | - Rachel Gemine
- DHCW, National Health Service Wales Digital Health and Care Wales, Swansea, UK
| | - Indra Joshi
- NHS England and NHS Improvement London, London, UK
| | | | - Benjamin Laker
- University of Reading Henley Business School - Greenlands Campus, Henley-on-Thames, UK
| | - Erwin Loh
- St Vincent's Health Australia, Melbourne, Victoria, Australia
| | - Oscar Lyons
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Amit Nigam
- Bayes Business School, City University of London, London, UK
| | - Rachael Moses
- Head of Clinical Leadership Development, NHS Leadership Academy, Leeds, UK
| | - Julie-Lyn Noël
- Eurospine, The Spine Society of Europe, Zurich, Switzerland
| | - Iain Smith
- NHS England Sustainable Improvement Team, Newcastle upon Tyne, UK
| | | | - Catherine Stoddart
- Health Department, Northern Territory Department of Health and Families, Casuarina, Australian Capital Territory, Australia
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Development of Moral Injury in ICU Professionals During the COVID-19 Pandemic: A Prospective Serial Interview Study. Crit Care Med 2023; 51:231-240. [PMID: 36661451 PMCID: PMC9847689 DOI: 10.1097/ccm.0000000000005766] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, ICU professionals have faced moral problems that may cause moral injury. This study explored whether, how, and when moral injury among ICU professionals developed in the course of the COVID-19 pandemic. DESIGN This is a prospective qualitative serial interview study. SETTING Two hospitals among which one university medical center and one teaching hospital in the Netherlands. SUBJECTS Twenty-six ICU professionals who worked during the COVID-19 pandemic. INTERVENTIONS None. MEASUREMENTS MAIN RESULTS In-depth interviews with follow-up after 6 and 12 months. In total, 62 interviews were conducted. ICU professionals narrated about anticipatory worry about life and death decisions, lack of knowledge and prognostic uncertainty about COVID-19, powerlessness and failure, abandonment or betrayal by society, politics, or the healthcare organization, numbness toward patients and families, and disorientation and self-alienation. Centrally, ICU professionals describe longitudinal processes by which they gradually numbed themselves emotionally from patients and families as well as potentially impactful events in their work. For some ICU professionals, organizational, societal, and political responses to the pandemic contributed to numbness, loss of motivation, and self-alienation. CONCLUSIONS ICU professionals exhibit symptoms of moral injury such as feelings of betrayal, detachment, self-alienation, and disorientation. Healthcare organizations and ICU professionals themselves should be cognizant that these feelings may indicate that professionals might have developed moral injury or that it may yet develop in the future. Awareness should be raised about moral injury and should be followed up by asking morally injured professionals what they need, so as to not risk offering unwanted help.
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Ryu MY, Martin MJ, Jin AH, Tabor HK, Wren SM. Characterizing Moral Injury and Distress in US Military Surgeons Deployed to Far-Forward Combat Environments in Afghanistan and Iraq. JAMA Netw Open 2023; 6:e230484. [PMID: 36821112 PMCID: PMC9951040 DOI: 10.1001/jamanetworkopen.2023.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Moral injury and distress (MID), which occurs when individuals have significant dissonance with their belief system and overwhelming feelings of being powerless to do what is believed to be right, has not been explored in the unique population of military surgeons deployed far forward in active combat settings. Deployed military surgeons provide care to both injured soldiers and civilians under command-driven medical rules of engagement (MROE) in variably resourced settings. This practice setting has no civilian corollary for comparison or current specific tool for measurement. OBJECTIVE To characterize MID among military surgeons deployed during periods of high casualty volumes through a mixed-methods approach. DESIGN, SETTING, AND PARTICIPANTS This qualitative study using convergent mixed methods was performed from May 2020 to October 2020. Participants included US military surgeons who had combat deployments to a far-forward role 2 treatment facility during predefined peak casualty periods in Iraq (2003-2008) and Afghanistan (2009-2012), as identified by purposeful snowball sampling. Data analysis was performed from October 2020 to May 2021. MAIN OUTCOMES AND MEASURES Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey and individual, semistructured interviews were conducted to thematic saturation. RESULTS The total cohort included 20 surgeons (mean [SD] age, 38.1 [5.2] years); 16 (80%) were male, and 16 (80%) had 0 or 1 prior deployment. Deployment locations were Afghanistan (11 surgeons [55%]), Iraq (9 surgeons [45%]), or both locations (3 surgeons [15%]). The mean (SD) MMD-HP score for the surgeons was 104.1 (39.3). The primary thematic domains for MID were distressing outcomes (DO) and MROE. The major subdomains of DO were guilt related to witnessing horrific injuries; treating pregnant women, children, and US soldiers; and second-guessing decisions. The major subdomains for MROE were forced transfer of civilian patients, limited capabilities and resources, inexperience in specialty surgical procedures, and communication with command. Postdeployment manifestations of MID were common and affected sleep, medical practice, and interpersonal relationships. CONCLUSIONS AND RELEVANCE In this qualitative study, MID was ubiquitous in deployed military surgeons. Thematic observations about MID, specifically concerning the domains of DO and MROE, may represent targets for further study to develop an evaluation tool of MID in this population and inform possible programs for identification and mitigation of MID.
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Affiliation(s)
- Madeline Y. Ryu
- Stanford University School of Medicine, Stanford, California
| | - Matthew J. Martin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles County and USC Medical Center, Los Angeles, California
| | | | - Holly K. Tabor
- Stanford Center for Biomedical Ethics, Department of Medicine, Stanford University, Stanford, California
| | - Sherry M. Wren
- Surgical Service, Palo Alto Veterans Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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Emergency department leadership considerations for the next phase of the COVID-19 pandemic. CAN J EMERG MED 2023; 25:110-114. [PMID: 36689189 PMCID: PMC9869826 DOI: 10.1007/s43678-022-00436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/03/2022] [Indexed: 01/24/2023]
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Singhal K, Chukkali S. Psychometric Properties of the Moral Injury Symptom Scale Among Indian Healthcare Professionals. Psychol Res Behav Manag 2023; 16:1439-1444. [PMID: 37124074 PMCID: PMC10143678 DOI: 10.2147/prbm.s404094] [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: 01/09/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
The spread of the novel coronavirus has led to a rise in morally conflicting situations for healthcare professionals. Doctors and nurses who were serving as frontline workers, require special attention to alleviate the long-lasting impact of the potentially morally injurious events. The current study aims to validate the Moral Injury Symptom Scale-Healthcare Professionals (MISS- HP) among Indian healthcare workers. The 10-item MISS was administered to 150 doctors and 150 nurses using the purposive sampling method. Firstly, reliability was assessed using internal consistency measure. Secondly, item discrimination index was assessed by calculating the point biserial correlation for each item. Cronbach alpha indicated high internal consistency (0.77). The point biserial correlation value for each item indicated good discrimination. Finally, confirmatory factor analysis (CFA) was performed to replicate the factor structure. CFA results suggested a good fit to the data. In conclusion, MISS-HP is a reliable and valid tool to assess moral injury among Indian healthcare professionals in India.
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Affiliation(s)
- Kirti Singhal
- Department of Psychology, CHRIST (Deemed to be University), Ghaziabad, Delhi NCR, India
| | - Surekha Chukkali
- Department of Psychology, CHRIST (Deemed to be University), Ghaziabad, Delhi NCR, India
- Correspondence: Surekha Chukkali, Department of Psychology, CHRIST (Deemed to be University), Mariam Nagar, Meerut Road, Ghaziabad, Delhi NCR, 201003, India, Tel +91 9901775477, Email
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14
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Gilbert-Ouimet M, Zahiriharsini A, Biron C, Langlois L, Ménard C, Lebel M, Pelletier J, Duchaine C, Beaulieu M, Truchon M. Predict, prevent and manage moral injuries in Canadian frontline healthcare workers and leaders facing the COVID-19 pandemic: Protocol of a mixed methods study. SSM - MENTAL HEALTH 2022; 2:100124. [PMID: 35669531 PMCID: PMC9158246 DOI: 10.1016/j.ssmmh.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 11/20/2022] Open
Abstract
Moral injuries can occur when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. The COVID-19 crisis highlighted the fact that psychosocial stressors at work, such as high emotional demands, are placing Canadian healthcare workers at risk of moral injuries. Evidence linking psychosocial stressors at work to moral injuries are needed to better predict, prevent and manage moral injuries, as these stressors are frequent and modifiable occupational risk factors. This protocol presents a study aiming to: 1) understand workplace events having the potential to either cause or reduce moral injuries, 2) predict the risk and severity of moral injuries using a disease prevention model, 3) identify biological signatures (biomarkers) associated with psychosocial stressors at work and moral injuries and 4) elaborate preliminary guidelines of organizational practices for frontline healthcare workers to reduce and manage moral injuries. This study is a mixed methods research with three components: qualitative, quantitative and biological. The data collection has been completed and because of the COVID-19 pandemic, it was adjusted to allow for gathering qualitative and quantitative data remotely. Frontline healthcare workers and leaders were included. Through focus groups and individual interviews, and an online questionnaire, events and psychosocial working conditions that may increase the risk of moral injuries will be documented. In addition, blood samples which were collected from a sub-sample of volunteer participants will measure an innovative set of biomarkers associated with vulnerability to stress and mental health. Data analyses are ongoing. We anticipate to identify workplace events that may trigger moral injuries. We expect that potential predictors of moral injury risk occurrence and severity will be identified from psychosocial stressors at work that can be improved by implementing organizational practices. We also expect to observe a different mental health state and biological inflammation signature across workers exposed compared to workers not exposed to psychosocial stressors at work. Based on these future findings, we intend to develop preliminary recommendations of organizational practices for managers. This research will contribute to expand our knowledge of the events in the workplace likely to generate or lessen the impact moral injuries, to build a model for predicting the risk of moral injuries at work, all in the specific context of the COVID-19 health crisis among healthcare workers.
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Affiliation(s)
- Mahée Gilbert-Ouimet
- Department of Health Sciences, Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A6, Canada
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada
| | - Azita Zahiriharsini
- Department of Health Sciences, Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A6, Canada
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada
| | - Caroline Biron
- Department of Management, Laval University, Quebec City, QC, G1V 0A6, Canada
| | | | - Caroline Ménard
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University and CERVO Brain Research Center, Quebec City, QC, G1V 0A6, Canada
| | - Manon Lebel
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University and CERVO Brain Research Center, Quebec City, QC, G1V 0A6, Canada
| | - Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A6, Canada
| | - Caroline Duchaine
- Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC, G1V 0A6, Canada
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada
| | | | - Manon Truchon
- School of Psychology, Laval University, Quebec City, QC, G1V 0A6, Canada
- Centre de recherche interdisciplinaire en réadaptation et intégration sociale(CIRRIS), Quebec City, QC, G1M 2S8, Canada
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15
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Looi JC, Maguire PA, Kisely SR, Allison S. Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services. Australas Psychiatry 2022; 31:121-123. [PMID: 36417318 DOI: 10.1177/10398562221142448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic. CONCLUSIONS Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.4 and BA.5). Acute hospital inpatient services were already facing extraordinary stresses in the context of increasingly depleted infrastructure and staffing related to the pandemic. These stresses have a high potential to be morally injurious. It is essential to immediately fund additional staff and resources and address workplace health and safety, to seek to arrest a spiral of moral injury and burnout amongst psychiatrists and trainees. We discuss recommended support strategies.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, 1974The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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16
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Hanna P, Erickson M, Walker C. UK Higher Education staff experiences of moral injury during the COVID-19 pandemic. HIGHER EDUCATION 2022; 86:1-18. [PMID: 36407876 PMCID: PMC9650171 DOI: 10.1007/s10734-022-00956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
Jonathan Shay argued that social, relational, and institutional contexts were central to understanding moral injury and conceptualised moral injury as a normative response to the betrayal of an individual's understanding of what is right by a more senior/authoritative "other". Using the conceptual lens of moral injury, this paper investigates academic staff experiences of HE during the COVID-19 pandemic and explores the rapid transition back to face-to-face teaching that took place in autumn 2020. To collect data, we used an online survey that opened in January 2021 and ran until the end of March 2021. A total of 663 complete questionnaires were received across the survey period. The questionnaire was comprised of ten topic-related questions, each of which included follow-up sub-questions and also invited participants to write in additional information. The majority of participants felt that during the course of the COVID-19 pandemic, they had acted in ways that put their own health and wellbeing at risk. Of those who had acted in ways that put their health and wellbeing at risk, they believed that their senior management were the most responsible for them acting in such ways, followed by the UK government. Qualitative data showed a systemic absence of leadership in the sector during the time, a sense of betrayal of staff and students by senior management and the government, and feelings of compulsion to act in ways which put lives at risk. On the basis of these results, we argue that there could be synergies between the situation facing healthcare staff and academics during the pandemic. Many of the experiences of HE academic staff during the pandemic reported to us in this research are resonant with the concepts of betrayal and moral injury and resulted in affective responses which we understand here in relation to feelings of guilt, shame, and anger, leading ultimately to poor mental health and wellbeing. This paper discusses implications for the HE sector going forward.
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17
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Martin D, Leslie N, Graham W. Policing the pandemic: Frontline officers’ perspectives on organisational justice. INTERNATIONAL JOURNAL OF POLICE SCIENCE & MANAGEMENT 2022. [PMCID: PMC9629051 DOI: 10.1177/14613557221132492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Much of the literature on the policing of the coronavirus pandemic reflects research that has been extra-organisationally focused, examining the prospective impact of the police approach to applying the public health legislation on relationships with the public and the potential impact on police legitimacy. Less research has been intra-organisationally focused; investigating the potential affect on police officers of policing during an extraordinary public health crisis, which has required them to navigate an ambiguous and constantly fluctuating legislative and policy landscape that has driven significant changes to internal working practices and operational procedures within their organisational environment. Using original empirical data from a small multi-method study within one Division of a United Kingdom police force, we examined the issue from an organisational justice perspective; exploring perceptions of intra-organisational fairness, and how these may have directly impacted upon the responses of frontline officers during the pandemic. We argue that in this period, both organisational processes and their resultant outcomes did not meet normative expectations, as they discriminated against officers with public-facing (frontline) roles. This directly impacted upon the officers’ experience of the ‘organisational climate’. The resulting sense of organisational injustice felt by frontline officers reduced their morale, impacted upon relationships with senior officers, and nurtured feelings that they were not being treated with respect, dignity and trust. We conclude by discussing the potential implications of the study for police organisations and their leaders, outlining opportunities for organisational learning and consider the need for the development of policy that complements notions of organisational justice.
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Affiliation(s)
- Denise Martin
- Denise Martin, Division of Sociology, School of Business Law and Social Sciences, Abertay University, Dundee, UK.
| | - Neil Leslie
- Division of Sociology, School of Business Law and Social Sciences, Abertay University, UK
| | - William Graham
- Division of Sociology, School of Business Law and Social Sciences, Abertay University, UK
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18
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Zahiriharsini A, Gilbert-Ouimet M, Langlois L, Biron C, Pelletier J, Beaulieu M, Truchon M. Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study. J Psychiatr Res 2022; 155:269-278. [PMID: 36162193 PMCID: PMC9477440 DOI: 10.1016/j.jpsychires.2022.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
Healthcare workers (HCWs) on the frontline of the COVID-19 pandemic exhibit a high prevalence of depression and psychological distress. Moral injury (MI) can lead to such mental health problems. MI occurs when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. Since the start of the pandemic, psychosocial stressors at work (PSWs) might have been exacerbated, which might in turn have led to an increased risk of MI in HCWs. However, research into the associations between PSWs and MI is lacking. Considering these stressors are frequent and most of them are modifiable occupational risk factors, they may constitute promising prevention targets. This study aims to evaluate the associations between a set of PSWs and MI in HCWs during the third wave of the COVID-19 pandemic in Quebec, Canada. Furthermore, our study aims to explore potential differences between urban and non-urban regions. The sample of this study consisted of 572 HCWs and leaders from the Quebec province. Prevalence ratios (PR) of MI and their 95% confidence intervals (CI) were modelled using robust Poisson regressions. Several covariates were considered, including age, sex, gender, socio-economic indicators, and lifestyle factors. Results indicated HCWs exposed to PSWs were 2.22-5.58 times more likely to experience MI. Low ethical culture had the strongest association (PR: 5.58, 95% CI: 1.34-23.27), followed by low reward (PR: 4.43, 95% CI: 2.14-9.16) and high emotional demands (PR: 4.32, 95% CI: 1.89-9.88). Identifying predictors of MI could contribute to the reduction of mental health problems and the implementation of targeted interventions in urban and non-urban areas.
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Affiliation(s)
- Azita Zahiriharsini
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada; CHU de Québec-Laval University Research Center, Quebec, Canada; Réseau intersectoriel de recherche en santé de l'Université du Québec (RISUQ), Quebec, Canada.
| | - Mahée Gilbert-Ouimet
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada; CHU de Québec-Laval University Research Center, Quebec, Canada; Réseau intersectoriel de recherche en santé de l'Université du Québec (RISUQ), Quebec, Canada
| | - Lyse Langlois
- Faculty of Social Sciences, Department of Industrial Relations, Laval University, Quebec, Canada
| | - Caroline Biron
- Department of Management, Laval University, Quebec, Canada
| | - Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada
| | | | - Manon Truchon
- School of Psychology, Laval University, Quebec, Canada; Centre de recherche interdisciplinaire en réadaptation et intégration sociale (CIRRIS), Quebec, Canada
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19
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Pathman DE, Sonis J, Rauner TE, Alton K, Headlee AS, Harrison JN. Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study. BMJ Open 2022; 12:e061369. [PMID: 36008061 PMCID: PMC9421917 DOI: 10.1136/bmjopen-2022-061369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic. DESIGN Cross-sectional survey in late 2020, employing quantitative and qualitative analyses. SETTING Safety net practices in 20 US states. PARTICIPANTS 2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes. MEASURES Ordinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress. RESULTS Weighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported 'mild' or 'uncomfortable' levels and 26.8% characterised their moral distress as 'distressing', 'intense' or 'worst possible'. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress. CONCLUSIONS During the pandemic's first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study's clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians' moral distress from witnessing inequities and other injustices for their patients and communities.
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Affiliation(s)
- Donald E Pathman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Jeffrey Sonis
- Departments of Social Medicine and Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Thomas E Rauner
- Office of Rural Health, Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, USA
| | - Kristina Alton
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna S Headlee
- College of Architecture, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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20
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Laher Z, Robertson N, Harrad-Hyde F, Jones CR. Prevalence, Predictors, and Experience of Moral Suffering in Nursing and Care Home Staff during the COVID-19 Pandemic: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9593. [PMID: 35954948 PMCID: PMC9368354 DOI: 10.3390/ijerph19159593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022]
Abstract
(1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual's moral beliefs and elicits adverse emotional responses. (2) Method: A systematic review was conducted to explore the prevalence, predictors, and psychological experience of MI and MD in the aforementioned population during the COVID-19 pandemic. The databases CINAHL, APA PsychINFO, APA PsychArticles, Web of Science, Medline, and Scopus were systematically searched for original research studies of all designs, published in English, with no geographical restrictions, and dating from when COVID-19 was declared a public health emergency on the 30 January 2020 to the 3 January 2022. Out of 531 studies screened for eligibility, 8 studies were selected for review. A thematic analysis was undertaken to examine the major underpinning themes. (3) Results: MI, MD, and related constructs (notably secondary traumatic stress) were evidenced to be present in staff, although most studies did not explore the prevalence or predictors. The elicited major themes were resource deficits, role challenges, communication and leadership, and emotional and psychosocial consequences. (4) Conclusions: Our findings suggest that moral injury and moral distress were likely to be present prior to COVID-19 but have been exacerbated by the pandemic. Whilst studies were generally of high quality, the dearth of quantitative studies assessing prevalence and predictors suggests a research need, enabling the exploration of causal relationships between variables. However, the implied presence of MI and MD warrants intervention developments and workplace support for nursing and care home staff.
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Affiliation(s)
- Zainab Laher
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK
| | - Fawn Harrad-Hyde
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Ceri R. Jones
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK
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21
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Nieuwsma JA, O'Brien EC, Xu H, Smigelsky MA, Meador KG. Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers. J Gen Intern Med 2022; 37:2033-2040. [PMID: 35381899 PMCID: PMC8982664 DOI: 10.1007/s11606-022-07487-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Moral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic. OBJECTIVE To compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans and healthcare workers (HCWs) surveyed during the COVID-19 pandemic. DESIGN Cross-sectional surveys of veterans (2015-2019) and HCWs (2020-2021) in the USA. PARTICIPANTS 618 military veterans who were deployed to a combat zone after September 11, 2001, and 2099 HCWs working in healthcare during the COVID-19 pandemic. MAIN MEASURES Other-induced PMI (disturbed by others' immoral acts) and self-induced PMI (disturbed by having violated own morals) were the primary outcomes. Sociodemographic variables, combat/COVID-19 experience, depression, quality of life, and burnout were measured as correlates. KEY RESULTS 46.1% of post-9/11 veterans and 50.7% of HCWs endorsed other-induced PMI, whereas 24.1% of post-9/11 veterans and 18.2% of HCWs endorsed self-induced PMI. Different types of PMI were significantly associated with gender, race, enlisted vs. officer status, and post-battle traumatic experiences among veterans and with age, race, working in a high COVID-19-risk setting, and reported COVID-19 exposure among HCWs. Endorsing either type of PMI was associated with significantly higher depressive symptoms and worse quality of life in both samples and higher burnout among HCWs. CONCLUSIONS The potential for moral injury is relatively high among combat veterans and COVID-19 HCWs, with deleterious consequences for mental health and burnout. Demographic characteristics suggestive of less social empowerment may increase risk for moral injury. Longitudinal research among COVID-19 HCWs is needed. Moral injury prevention and intervention efforts for HCWs may benefit from consulting models used with veterans.
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Affiliation(s)
- Jason A Nieuwsma
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA. .,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. .,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.
| | | | - Haolin Xu
- Duke Clinical Research Institute, Durham, NC, USA
| | - Melissa A Smigelsky
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | | | | | - Keith G Meador
- Integrative Mental Health, Department of Veterans Affairs, Durham, NC, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Preventative Medicine, Center for Biomedical Ethics and Society, & Graduate Department of Religion, Vanderbilt University, Nashville, TN, USA
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22
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Choudhary V, Balhara YPS, Lal R. How Could I Do Something So Wrong? Restirring concept of Moral Injury & healing within health care context of COVID-19 pandemic. Asian J Psychiatr 2022; 70:103017. [PMID: 35121330 PMCID: PMC8801264 DOI: 10.1016/j.ajp.2022.103017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Vandana Choudhary
- Department of Psychiatry (Clinical Psychology), All India institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Yatan Pal Singh Balhara
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Rakesh Lal
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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23
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Wailling J, Kooijman A, Hughes J, O'Hara JK. Humanizing harm: Using a restorative approach to heal and learn from adverse events. Health Expect 2022; 25:1192-1199. [PMID: 35322513 PMCID: PMC9327844 DOI: 10.1111/hex.13478] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/06/2022] [Accepted: 03/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Healthcare is not without risk. Despite two decades of policy focus and improvement efforts, the global incidence of harm remains stubbornly persistent, with estimates suggesting that 10% of hospital patients are affected by adverse events. Methods We explore how current investigative responses can compound the harm for all those affected—patients, families, health professionals and organizations—by neglecting to appreciate and respond to the human impacts. We suggest that the risk of compounded harm may be reduced when investigations respond to the need for healing alongside system learning, with the former having been consistently neglected. Discussion We argue that incident responses must be conceived within a relational as well as a regulatory framework, and that this—a restorative approach—has the potential to radically shift the focus, conduct and outcomes of investigative processes. Conclusion The identification of the preconditions and mechanisms that enable the success of restorative approaches in global health systems and legal contexts is required if their demonstrated potential is to be realized on a larger scale. The policy must be co‐created by all those who will be affected by reforms and be guided by restorative principles. Patient or Public Contribution This viewpoint represents an international collaboration between a clinician academic, safety scientist and harmed patient and family members. The paper incorporates key findings and definitions from New Zealand's restorative response to surgical mesh harm, which was co‐designed with patient advocates, academics and clinicians.
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Affiliation(s)
- Jo Wailling
- School of Government, Te Ngāpara Centre for Restorative Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Allison Kooijman
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Jane K O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
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24
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Raiff EM, D’Antonio KM, Mai C, Monk C. Mental Health in Obstetric Patients and Providers During the COVID-19 Pandemic. Clin Obstet Gynecol 2022; 65:203-215. [PMID: 34857681 PMCID: PMC8767924 DOI: 10.1097/grf.0000000000000668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychiatric morbidity is the most common childbirth complication with 1 in 5 women experiencing a perinatal mood or anxiety disorder. The cost of this psychiatric morbidity is pervasive, contributing to devastating maternal health, child developmental, and economic consequences. The coronavirus disease 2019 (COVID-19) pandemic, and associated changes to perinatal experiences, resulted in profound psychological reactions including increased anxiety, depression, stress disorders, and sleep disturbance, further impacting obstetric patients. Providers' mental health has been challenged by moral injury and shared trauma. This article reviews mental health outcomes in regard to the COVID-19 pandemic for obstetric patients and their providers.
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Affiliation(s)
| | | | - Christine Mai
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Catherine Monk
- Departments of Obstetrics and Gynecology
- Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
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25
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Mody L, Akinboyo IC, Babcock HM, Bischoff WE, Cheng VCC, Chiotos K, Claeys KC, Coffey KC, Diekema DJ, Donskey CJ, Ellingson KD, Gilmartin HM, Gohil SK, Harris AD, Keller SC, Klein EY, Krein SL, Kwon JH, Lauring AS, Livorsi DJ, Lofgren ET, Merrill K, Milstone AM, Monsees EA, Morgan DJ, Perri LP, Pfeiffer CD, Rock C, Saint S, Sickbert-Bennett E, Skelton F, Suda KJ, Talbot TR, Vaughn VM, Weber DJ, Wiemken TL, Yassin MH, Ziegler MJ, Anderson DJ. Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology. Infect Control Hosp Epidemiol 2022; 43:156-166. [PMID: 33487199 PMCID: PMC8160487 DOI: 10.1017/ice.2021.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
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Affiliation(s)
- Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Geriatrics Research Education and Clinical Center, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Ibukunoluwa C. Akinboyo
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
| | - Hilary M. Babcock
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Werner E. Bischoff
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Kathleen Chiotos
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kimberly C. Claeys
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States
| | - K. C. Coffey
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Daniel J. Diekema
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Curtis J. Donskey
- Infectious Diseases Section, Louis Stokes Cleveland Veterans’ Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Katherine D. Ellingson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, United States
| | - Heather M. Gilmartin
- Veterans’ Affairs Eastern Colorado Healthcare System, Aurora, Colorado, United States
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States
| | - Shruti K. Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, United States
- Epidemiology and Infection Prevention, UC Irvine Health, Irvine, California, United States
| | - Anthony D. Harris
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Sara C. Keller
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Eili Y. Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, Unites States
| | - Sarah L. Krein
- Veterans’ Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Jennie H Kwon
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Adam S. Lauring
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Daniel J. Livorsi
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Eric T. Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States
| | | | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Elizabeth A. Monsees
- Children’s Mercy Kansas City, Kansas City, Missouri, United States
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States
| | - Daniel J. Morgan
- University of Maryland School of Medicine, Baltimore, Maryland, United States
- Veterans’ Affairs Maryland Healthcare System, Baltimore, Maryland, United States
| | - Luci P. Perri
- Infection Control Results, Wingate, North Carolina, United States
| | - Christopher D. Pfeiffer
- Veterans’ Affairs Portland Health Care System, Portland, Oregon, United States
- Oregon Health & Science University, Portland, Oregon, United States
| | - Clare Rock
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina, United States
| | - Felicia Skelton
- Michael E. DeBakey Veterans’ Affairs Medical Center, Houston, Texas, United States
- H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, Veterans’ Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Thomas R. Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Valerie M. Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - David J. Weber
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Timothy L. Wiemken
- Division of Infectious Diseases, Allergy, and Immunology, Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri, United States
| | - Mohamed H. Yassin
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Matthew J. Ziegler
- Infectious Diseases Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina, United States
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Alexopoulos P, Roukas D, Efkarpidis A, Konstantopoulou G, Soldatos R, Karaivazoglou K, Kontogianni E, Assimakopoulos K, Iliou T, Εconomou P, Gourzis P, Politis A. Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study. Eur Arch Psychiatry Clin Neurosci 2022; 272:95-105. [PMID: 33904979 PMCID: PMC8078092 DOI: 10.1007/s00406-021-01262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece.
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany.
| | - Dimitrios Roukas
- Department of Psychiatry, 417 Army Equity Fund Hospital (NIMTS) Hospital, Athens, Greece
| | - Apostolos Efkarpidis
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Ermoupolis, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, Patras, Greece
| | - Rigas Soldatos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Karaivazoglou
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Evagellia Kontogianni
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Assimakopoulos
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Theodoros Iliou
- Medical Informatics Laboratory, Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Polychronis Εconomou
- Department of Civil Engineering (Statistics), University of Patras, Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
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27
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Grailey K, Lound A, Brett S. Lived experiences of healthcare workers on the front line during the COVID-19 pandemic: a qualitative interview study. BMJ Open 2021; 11:e053680. [PMID: 35258477 PMCID: PMC8719006 DOI: 10.1136/bmjopen-2021-053680] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the presence of perceived stressors, psychological safety and teamwork in healthcare professionals. As the timeframe for this study spanned the first wave of the COVID-19 pandemic, data were captured demonstrating the impact of the pandemic on these factors. DESIGN Qualitative interview study. SETTING All staff working within the emergency and critical care departments of one National Health Service Trust in London, UK. PARTICIPANTS Forty-nine participants were recruited using a purposive sampling technique and interviewed when the first wave of the COVID-19 pandemic had subsided. MAIN OUTCOME MEASURES Evaluation of changes in perceived stressors, psychological safety and teamwork in individuals working during the COVID-19 pandemic. RESULTS The thematic analysis relating to a participant's lived experiences while working during COVID-19 led to the construction of five key themes, including 'psychological effects' and 'changes in team dynamics'. Several psychological effects were described, including the presence of psychological distress and insights into the aetiology of moral injury. There was marked heterogeneity in participants' response to COVID-19, particularly with respect to changes in team dynamics and the perception of a psychologically safe environment. Descriptions of improved team cohesiveness and camaraderie contrasted with stories of new barriers, notably due to the high workload and the impact of personal protective equipment. Building on these themes, a map of key changes arising due to the pandemic was developed, highlighting potential opportunities to provide targeted support. CONCLUSIONS Working on the front line of a pandemic can have significant implications for healthcare workers, putting them at risk of psychological distress and moral injury, as well as affecting team dynamics. There is striking heterogeneity in the manifestation of these challenges. Team leaders can use the themes and qualitative data from this study to help identify areas for management focus and individual and team support.
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Affiliation(s)
- Kate Grailey
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam Lound
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Stephen Brett
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
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28
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Hayes MM, Cocchi MN. Critical care leadership during the COVID-19 pandemic. J Crit Care 2021; 67:186-188. [PMID: 34635389 PMCID: PMC8499091 DOI: 10.1016/j.jcrc.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic taxed critical care and its leaders in unprecedented ways. Medical directors, nursing directors, division chiefs and department chairs were forced to lead their staff through a pandemic wrought with personal and professional safety concerns, uncertainty, and more death than most critical care practitioners had ever seen. No leader was fully prepared for the COVID-19 pandemic. Herein, we describe what we believe are the three most important qualities of a leader in times of crisis: presence, transparency, and empathy.
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Affiliation(s)
- Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America.
| | - Michael N Cocchi
- Department of Emergency Medicine, Department of Anesthesia, Division of Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, United States of America
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29
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Khetrapal P, Skarbek S, Tapper L, Mason C, Davis S, Henderson D, Riley B, Price L, Cumby C, Kennedy C, Woodcock H, Jain N, Ziser S, Yates T, Mehta J, Amphlett A, Dinneen D, Aziz U, Parekh V, Fernando B, Dilworth P, Jehangir A, Connolly J, Negus R, Murch N, Molloy A, Hui C, Burns A. Setting up an emergency medical task force to manage the demands of COVID-19: experiences of a London teaching hospital. BMJ LEADER 2021; 6:222-227. [DOI: 10.1136/leader-2021-000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/07/2021] [Indexed: 11/04/2022]
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30
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Naqvi SSB, Davis J, Pickles RW, Loewenthal MR. "Concerns and Psychological Wellbeing of Health Care Workers During the COVID-19 Pandemic in a Tertiary Care Hospital in NSW". Intern Med J 2021; 51:1407-1413. [PMID: 34346147 PMCID: PMC8447026 DOI: 10.1111/imj.15465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/12/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
Background In early 2020, the impending COVID‐19 pandemic placed a once‐in‐a‐generation professional and personal challenge on healthcare workers. Publications on direct physical disease abound. The authors wanted to focus on doctors' psychological well‐being. Aims To assess the impact of the COVID‐19 pandemic on doctors' well‐being and evaluate their concerns as the pandemic progressed. Methods A mixed‐methods, hospital‐based survey was sent to doctors at the 650‐bed tertiary referral hospital in NSW at two different periods (late‐March and early May 2020). A validated mental well‐being tool (Short Warwick Edinburgh Mental Well‐being Scale (SWEMWBS)) was combined with COVID‐19‐specific questions. Results Two hundred and thirty‐five responses were obtained from 450 doctors, with a response rate of 32% in the first survey and 20% in the second. The majority (35%) of respondents were doctors‐in‐training, followed by staff‐specialists (23%). The highest response was from frontline workers in both surveys, including the intensive care unit (27%), anaesthesia (21%) and emergency department (13%). ‘Extreme concern’ regarding personal protective equipment (PPE) shortage dropped from 22.6% to 2.2% and ‘extreme concern’ of contracting COVID‐19 fell from 22.6% to 3.4% in the second survey. The proportion of respondents with a ‘low’ psychological well‐being score improved from 38% to 27% between the two surveys. The resulting mean improvement in the SWEMWBS was 3.49 (95% confidence interval = 3.06–3.91, P < 0.001). Conclusion Both COVID‐19 specific concerns and psychological well‐being improved greatly in the second survey. Possible explanations are the fall in COVID‐19 cases in the district, improvements in PPE supply and supportive measures communicated to doctors during this period.
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Affiliation(s)
- Syeda Shaher Bano Naqvi
- Infectious Diseases Department, John Hunter Hospital, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Joshua Davis
- Infectious Diseases Department, John Hunter Hospital, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Global and Tropical Health Division, Menzies School of Health Research, Darwin
| | - Robert W Pickles
- Infectious Diseases Department, John Hunter Hospital, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Mark R Loewenthal
- Infectious Diseases Department, John Hunter Hospital, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, New South Wales
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31
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Best J. Undermined and undervalued: how the pandemic exacerbated moral injury and burnout in the NHS. BMJ 2021; 374:n1858. [PMID: 34326061 DOI: 10.1136/bmj.n1858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Day P, Lawson J, Mantri S, Jain A, Rabago D, Lennon R. Physician moral injury in the context of moral, ethical and legal codes. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107225. [PMID: 34290114 DOI: 10.1136/medethics-2021-107225] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to 'burnout', there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how-if at all-this changes anything.The current research seeks to develop the construct of moral injury outside military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics.
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Affiliation(s)
- Philip Day
- Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer Lawson
- Department of Pediatrics and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University of School Medicine, Durham, North Carolina, USA
| | - Sneha Mantri
- Department of Neurology and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Abhi Jain
- St Mark's School of Texas, Dallas, Texas, USA
| | - David Rabago
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robert Lennon
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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33
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Oliver D. David Oliver: Has the term "front line" had its day? BMJ 2021; 373:n1634. [PMID: 34193443 DOI: 10.1136/bmj.n1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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35
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Liberati E, Richards N, Willars J, Scott D, Boydell N, Parker J, Pinfold V, Martin G, Dixon-Woods M, Jones PB. A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic. BMC Psychiatry 2021; 21:250. [PMID: 33980215 PMCID: PMC8113793 DOI: 10.1186/s12888-021-03261-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. METHODS The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. RESULTS Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be "non-essential", deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants' working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. CONCLUSIONS Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.
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Affiliation(s)
- Elisa Liberati
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Natalie Richards
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Scott
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Nicola Boydell
- Centre for Biomedicine Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Graham Martin
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, Cambridgeshire & Peterborough NHS Foundation Trust, University of Cambridge, Cambridge, CB2 0SZ, UK.
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36
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White SM. Mental health, moral injury - and mandatory psychological assessment? Anaesthesia 2021; 76:879-882. [PMID: 33721911 DOI: 10.1111/anae.15447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Affiliation(s)
- S M White
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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37
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Goddard AF, Patel M. The changing face of medical professionalism and the impact of COVID-19. Lancet 2021; 397:950-952. [PMID: 33636125 PMCID: PMC7906722 DOI: 10.1016/s0140-6736(21)00436-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
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38
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White SM. Donating our "Christmas bonus". BMJ 2021; 372:n203. [PMID: 33495208 DOI: 10.1136/bmj.n203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Stuart M White
- Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 4DN, UK
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39
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Ananda-Rajah M, Veness B, Berkovic D, Parker C, Kelly G, Ayton D. Hearing the voices of Australian healthcare workers during the COVID-19 pandemic. BMJ LEADER 2020. [DOI: 10.1136/leader-2020-000386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe statistics of healthcare worker (HCW) COVID-19 infections do not convey the lived experience of HCWs during the pandemic. This study explores the working conditions and issues faced by Australian HCWs.MethodsQualitative analysis of free-text responses from Australian HCWs from 3 August to 26 October 2020 from an open letter calling for better respiratory protection for HCWs, transparent reporting of HCW COVID-19 infections and diversity in national infection control policy development. The open letter was sent to an email list of 23 000 HCWs from a previous campaign and promoted on social media.ResultsAmong 3587 HCWs who signed the open letter during the study period, 569 free-text responses were analysed. Doctors and nurses accounted for 58% and 33% of respondents, respectively. Most respondents came from Victoria (48%), New South Wales (20%), Queensland (12%) or Western Australia (11%). Dominant themes included concerns about: work health and safety standards; guidelines on respiratory protection including the omission of fit-testing of P2/N95 respirators; deficiencies in the availability, quality, appropriateness and training of personal protective equipment; and a command-and-control culture that enabled bullying in response to concerns about safety that culminated a loss of trust in leadership, self-reported COVID-19 infections in some respondents and moral injury.ConclusionDeficiencies in work health and safety, respiratory protection, personal protective equipment and workplace culture have resulted in a loss of psychological and physical safety at work associated with an occupational moral injury. The challenge for healthcare leaders is to repair trust by addressing HCW concerns and fast track solutions in collaboration with them.
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