1
|
Hor SY, Wyer M, Barratt R, Turnbull M, Rogers K, Murphy M, Urwin R, Jorm C, Gilbert GL. Risk assessment and the use of personal protective equipment in an emergency department: differing perspectives of emergency and infection control clinicians. A video-vignette survey. Am J Infect Control 2024:S0196-6553(24)00557-1. [PMID: 38925501 DOI: 10.1016/j.ajic.2024.06.012] [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: 03/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defence during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. METHODS An online scenario-based video-survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control (IPAC) clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher's exact test. RESULTS Participants agreed that most items were required for both scenarios. Eye protection, mask use and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than IPAC clinicians, to regard items/actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy emergency department. DISCUSSION Our findings likely reflect differences in professional roles, competing priorities and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility and resource constraints. CONCLUSIONS To be feasible, practicable and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflect the complexities of their practice.
Collapse
Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
| | - Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Margo Turnbull
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- School of Public Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Jorm
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Vonderschmitt J, Wöhlke S, Schicktanz S. Scarce resources, public health and professional care: the COVID-19 pandemic exacerbating bioethical conflicts - findings from global qualitative expert interviews. BMC Public Health 2023; 23:2492. [PMID: 38093218 PMCID: PMC10717036 DOI: 10.1186/s12889-023-17249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Since spring 2020, the SARS-CoV-2 virus has spread worldwide, causing dramatic global consequences in terms of medical, care, economic, cultural and bioethical dimensions. Although the resulting conflicts initially appeared to be quite similar in most countries, a closer look reveals a country-specific intensification and differentiation of issues. Our study focused on understanding and highlighting bioethical conflicts that were triggered, exposed or intensified by the COVID-19 pandemic in low and middle-income countries (LMICs) and high-income countries (HICs). METHODS We conducted qualitative interviews with 39 ethics experts from 34 countries (Argentina, Australia, Austria, Brazil, Canada, Colombia, Denmark, Ecuador, Ethiopia, France, Germany, India, Italy, Israel, Japan, Kyrgyzstan, Mexico, Nigeria, Oman, Pakistan, Paraguay, Poland, Romania, Russia, Singapore, South Korea, Spain, Sweden, South Africa, Tunisia, Türkiye, United-Kingdom, United States of America, Zambia) from November 2020 to March 2021. We analysed the interviews using qualitative content analysis. RESULTS The scale of the bioethical challenges between countries differed, as did coping strategies for meeting these challenges. Data analysis focused on: a) Resource scarcity in clinical contexts: Scarcity of medical resources led to the need to prioritize the care of some COVID-19 patients in clinical settings globally. Because this entails the postponement of treatment for other patients, the possibility of serious present or future harm to deprioritized patients was identified as a relevant issue. b) Health literacy: The pandemic demonstrated the significance of health literacy and its influence on the effective implementation of health measures. c) Inequality and vulnerable groups: The pandemic highlighted the context-sensitivity and intersectionality of the vulnerabilities of women and children in LMICs and the aged in HICs. d) Conflicts surrounding healthcare professionals: The COVID-19 outbreak underscored the tough working conditions for nurses and other health professionals, raising awareness of the need for reform. CONCLUSION The pandemic exposed pre-existing structural problems in LMICs and HICs. Without neglecting individual contextual factors in the observed countries, we created a mosaic of different voices of experts in bioethics across the globe, drawing attention to the need for international solidarity in the context of a global crisis.
Collapse
Affiliation(s)
- Jane Vonderschmitt
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36 / 37073, Goettingen, Germany.
| | - Sabine Wöhlke
- Department of Health Sciences, Hamburg University of Applied Sciences, Ulmenliet 20 / 21033, Hamburg, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36 / 37073, Goettingen, Germany
| |
Collapse
|
3
|
White BM, Walsh E, Willgerodt M. The Resilience of Pediatric Nurses in Context: A Mixed Methods Study. West J Nurs Res 2023; 45:1085-1093. [PMID: 37882413 DOI: 10.1177/01939459231204693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Resilience, an individual's ability to cope with and recover from stressors, is supported by contextually specific factors. Factors in the work environment may support or hinder nurses' resilience to the specific stressors present in pediatric nursing, an understudied population. OBJECTIVE We aimed to explore the contextual factors in the work environment of pediatric nurses with varying levels of resilience, including social support, the work environment, and opportunities for coping from an individual approach. METHODS This study is a secondary mixed-methods analysis using ordinal logistic regression and a meta-matrix of survey responses and semi-structured interview transcripts from 30 pediatric nurses. RESULTS 5 themes, 3 supporting and 2 hindering resilience, emerged from the interviews. Nurses described their resilience as supported by sharing the burden, support from administration, and taking a break. Participants described resilience as hindered when they found it challenging to provide quality nursing care and when they felt unappreciated or undervalued. No theme significantly changed the odds of having higher resilience. CONCLUSIONS Our findings suggest that nurses recognize resources and conditions within their work environment as influencing their resilience. However, workplace resources and conditions are only one contributor to pediatric nurse resilience. Encouraging breaks and informal opportunities for nurses to support each other may support resilience in pediatric nurses. In addition, nursing leaders can support pediatric nurse resilience by regularly spending time connecting with nurses. Finally, health care organizations should consider how changes in the work environment may hinder nurse resilience by adding stress or changing access to supportive factors.
Collapse
|
4
|
Fatima M, Imran N, Aamer I, Iqtadar S, Shabbir B. When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan. Front Psychiatry 2023; 14:1244055. [PMID: 37795516 PMCID: PMC10545959 DOI: 10.3389/fpsyt.2023.1244055] [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] [Received: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Moral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distress, and impairment in social and occupational functioning. The COVID-19 pandemic predisposed healthcare providers to moral dilemmas, potentially morally injurious events (PMIEs), and MI. We aimed to assess the prevalence and predictors of MI in healthcare providers during the COVID-19 pandemic in Pakistan. Materials and methods This cross-sectional study was conducted in July-October 2021 among physician/clinician staff working at teaching hospitals in Lahore. The Moral Injury Symptoms Scale-Health Professionals (MISS-HP) was used to collect data. SPSS 26 was used for data analysis applying Wilcoxon Mann-Whitney U and Kruskal-Wallis tests on non-normally distributed data at α = 0.05. Predictors of MI were ascertained through Binary Logistic Regression analysis. Results Four hundred and twenty physicians responded to the questionnaires. The Median (IQR) MI scores were 37(28-47). Guilt, moral concerns, and shame were higher-scoring MI dimensions. 40.8% (n = 171) suffered from clinically significant distress and impaired functioning while 14.3% (n = 60) from severe distress. Gender, department, and history of psychiatric illness predicted higher levels of distress which were 1.9 times higher in females than males and 2.5 times higher with a history of psychiatric illness. Working on the front lines did not predict MI. Conclusion Our findings highlight the substantial burden of MI in our sample during COVID-19, having implications for healthcare providers' well-being, healthcare quality, and service delivery. This calls for concerted efforts from all stakeholders to better prepare for future disasters through effective human-resource policies, pre-trauma exposure soft-skills training, effective teamwork and communication strategies; self-stewardship and resilience modules, and mental health support for healthcare providers. The dimensional construct of MI may vary across cultures; hence we recommend further cross-cultural research on MI in healthcare providers, particularly in the context of public health disasters.
Collapse
Affiliation(s)
- Madah Fatima
- Academic Department of Psychiatry and Behavioral Sciences, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Nazish Imran
- Child and Family Psychiatry Department, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Irum Aamer
- Academic Department of Psychiatry and Behavioral Sciences, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Somia Iqtadar
- Department of Medicine, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Bilquis Shabbir
- Department of Medicine, Sir Ganga Ram Hospital, Fatima Jinnah Medical University, Lahore, Pakistan
| |
Collapse
|
5
|
Muaygil R, Aldekhyyel R, AlWatban L, Almana L, Almana RF, Barry M. Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre. JOURNAL OF MEDICAL ETHICS 2023; 49:275-282. [PMID: 36600609 DOI: 10.1136/jme-2022-108369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.
Collapse
Affiliation(s)
- Ruaim Muaygil
- Department of Medical Education, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raniah Aldekhyyel
- Department of Medical Education, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lemmese AlWatban
- Department of Family and Community Medicine, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lyan Almana
- The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rana F Almana
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Mazin Barry
- Infectious Diseases Unit, Department of Internal Medicine, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Delany C, McDougall R. Support for clinicians with moral loss after the pandemic. BMJ 2023; 380:e072629. [PMID: 36997198 DOI: 10.1136/bmj-2022-072629] [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: 04/01/2023]
Affiliation(s)
- Clare Delany
- Department of Medical Education, School of Medicine, University of Melbourne, Melbourne, Australia
- Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rosalind McDougall
- Centre for Health Equity, School of Population and Global Health, University of Melbourne
- Clinical Ethics Unit, Department of Surgery Austin Precinct, University of Melbourne
| |
Collapse
|
7
|
Affdal A, Malo MF, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Suri RS, Fortin MC. Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. KIDNEY360 2023; 4:188-197. [PMID: 36821610 PMCID: PMC10103388 DOI: 10.34067/kid.0004252022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Key Points Hemodialysis workers' well-being and work were affected by the COVID-19 pandemics. Effective communication strategies and taking into account psychological distress are ways to mitigate the challenges faced by health care workers. Background The COVID-19 pandemic has disrupted health systems and created numerous challenges in hospitals worldwide for patients and health care workers (HCWs). Hemodialysis centers are at risk of COVID-19 outbreaks given the difficulty of maintaining social distancing and the fact that hemodialysis patients are at higher risk of being infected with COVID-19. During the COVID-19 pandemic, HCWs have had to face many challenges and stressors. Our study was designed to gain HCWs' perspectives on their experiences of the impacts of the COVID-19 pandemic in hemodialysis units. Methods Semistructured interviews were conducted with 22 HCWs (nurses, nephrologists, pharmacists, social workers, patient attendants, and security agents) working in five hemodialysis centers in Montreal, between November 2020 and May 2021. The content of the interviews was analyzed using thematic analysis. Results Four themes were identified during the interviews. The first was the impact of COVID-19 on work organization, regarding which participants reported an increased workload, a need for a consistent information strategy, and positive innovations such as telemedicine. The second theme was challenges associated with communicating and caring for dialysis patients during the pandemic. The third theme was psychological distress experienced by hemodialysis staff and the psychosocial impact of COVID-19 on their personal lives. The fourth theme was recommendations made by participants for future public health emergencies, such as maintaining public health measures, ensuring an adequate supply of protective equipment, and developing a consistent communication strategy. Conclusions During the first and second waves of the COVID-19 pandemic, HCWs working in hemodialysis units faced multiple challenges that affected their well-being and their work. To minimize challenges for HCWs in hemodialysis during a future pandemic, the health care system should provide an adequate supply of protective equipment, develop effective communication strategies, and take into account the psychological distress related to HCWs' professional and personal lives.
Collapse
Affiliation(s)
- Aliya Affdal
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Line Caron
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
8
|
Isaksson Rø K, Magelssen M, Bååthe F, Miljeteig I, Bringedal B. Duty to treat and perceived risk of contagion during the COVID-19 pandemic: Norwegian physicians' perspectives and experiences-a questionnaire survey. BMC Health Serv Res 2022; 22:1509. [PMID: 36503432 PMCID: PMC9742031 DOI: 10.1186/s12913-022-08905-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic actualised the dilemma of how to balance physicians´ obligation to treat patients and their own perceived risk of being infected. To discuss this in a constructive way we need empirical studies of physicians´ views of this obligation. METHODS A postal questionnaire survey was sent to a representative sample of Norwegian physicians in December 2020. We measured their perceived obligation to expose themselves to infection, when necessary, in order to provide care, concerns about being infected themselves, for spreading the virus to patients or to their families. We used descriptive statistics, chi-square tests and logistic regression analyses. RESULTS The response rate was 1639/2316 (70.9%), 54% women. Of doctors < 70, 60,2% (95% CI 57.7-62.7) acknowledged to some or a large degree an obligation to expose themselves to risk of infection, and 42.0% (39.5-44.5) held this view despite a scarcity of personal protective equipment (PPE). Concern about being infected oneself to some or to a large extent was reported by 42.8% (40.3-45.3), 47.8% (45.3-50.3) reported concern about spreading the virus to patients, and 63.9% (61.5-66.3) indicated worry about spreading it to their families. Being older increased the odds of feeling obligated (ExpB = 1.02 p < 0.001), while experiencing scarcity of PPE decreased the odds (ExpB = 0.74, p = 0.01). The odds of concern about spreading virus to one´s family decreased with higher age (Exp B = 0.97, p < 0.001), increased with being female (Exp B = 1.44, p = 0.004), and perceived lack of PPE (Exp B = 2.25, p < 0.001). Although more physicians working in COVID-exposed specialties experienced scarcity of PPE and reported perceived increased risks for health personnel, the odds of concern about being infected themselves or spreading the virus to their families were not higher than for other doctors. CONCLUSION These empirical findings lead to the question if fewer physicians in the future will consider the duty to treat their top priority. This underscores the need to revisit and revitalise existing ethical codes to handle the dilemma between physicians´ duty to treat versus the duty to protect physicians and their families. This is important for the ability to provide good care for the patient and the provider in a future pandemic situation.
Collapse
Affiliation(s)
| | - Morten Magelssen
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway ,Norwegian School of Theology, Religion and Society, Oslo, Norway
| | - Fredrik Bååthe
- Institute for Studies of the Medical Profession, Oslo, Norway ,Institute of Stress Medicine -ISM at Region VGR, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ingrid Miljeteig
- grid.7914.b0000 0004 1936 7443Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,Department of Research and Development, Helse Bergen Health Trust, Bergen, Norway
| | - Berit Bringedal
- Institute for Studies of the Medical Profession, Oslo, Norway
| |
Collapse
|
9
|
Lawrence W, Hine J, Watson D, Smedley J, Walker-Bone K. How to improve hospital employees' health and well-being: a staff consultation. BMC Health Serv Res 2022; 22:1488. [PMID: 36474241 PMCID: PMC9727936 DOI: 10.1186/s12913-022-08621-y] [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: 03/08/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Explore perspectives from healthcare workers in a large public hospital (11,000 staff) on employers supporting their health and well-being. METHODS Heads of departments/services were invited to convene focus groups, facilitated by a moderator using a semi-structured discussion guide. RESULTS: Over 450 members of staff participated in 28 focus groups. Themes identified were: 1)unique nature of working in a large hospital, 2)hospital management agenda and relationship with staff, 3)working environment, and 4)staff health and well-being initiatives. CONCLUSIONS Optimal uptake of health-promoting initiatives was hindered in part due to lack of staff awareness and a range of barriers. Key requirements for improving staff health were perceived to be sufficient staffing, time and space to work safely and comfortably. Engaging with staff to hear their views, build trust and identify their needs is an essential first step.
Collapse
Affiliation(s)
- Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK. .,NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Jasmine Hine
- grid.7445.20000 0001 2113 8111Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniella Watson
- grid.5491.90000 0004 1936 9297School of Human Development and Health, Faculty of Medicine, Global Health Research Institute, University of Southampton, Southampton, UK
| | - Julia Smedley
- grid.430506.40000 0004 0465 4079Occupational Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Karen Walker-Bone
- grid.123047.30000000103590315Medical Research Council Lifecourse Epidemiology Centre, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK ,grid.5491.90000 0004 1936 9297MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK ,grid.1002.30000 0004 1936 7857Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, VIC Australia
| |
Collapse
|
10
|
Shin H, Kim KH, Kim JS, Kwak YH. Nurses' duty to care during the COVID-19 pandemic: a cross-sectional survey. BMC Nurs 2022; 21:293. [PMID: 36324125 PMCID: PMC9628139 DOI: 10.1186/s12912-022-01064-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background Despite the increased demand for nurses worldwide, discussion of nurses’ duty to care is lacking. This study aimed to examine nurses’ duty to care during the coronavirus disease 2019 (COVID-19) pandemic and to identify the influencing factors. Methods This was a cross-sectional descriptive research study that used a structured online questionnaire. Registered Korean nurses answered a demographic questionnaire and the Nash Duty to Care Scale. Results Age and employment at tertiary hospitals increased nurses’ duty to care. Male sex, a highly educated status, and employment at tertiary hospitals increased the perceived risk. Male sex and employment at tertiary or general hospitals increased confidence in the employer, while a high level of education and a longer total clinical career decreased the same. Age and a higher monthly wage increased perceived obligation. Age, lack of religious beliefs, and clinical experience of 3–7 years increased professional preparedness. Conclusion Without enough nursing manpower, the disaster response system could prove to be inefficient. Considering that adequate nurse staffing is essential in disaster management, it is crucial to ensure that nurses have a will to provide care in the case of disaster. In the future, a more active discussion on nurses’ duty to care and additional research on factors that may hinder and facilitate the same are needed.
Collapse
Affiliation(s)
- Hyerine Shin
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea
| | - Kyung Hee Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea.
| | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea
| | - Yeun-Hee Kwak
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea
| |
Collapse
|
11
|
Wild CEK, Wells H, Coetzee N, Grant CC, Sullivan TA, Derraik JGB, Anderson YC. Learning from healthcare workers' experiences with personal protective equipment during the COVID-19 pandemic in Aotearoa/New Zealand: a thematic analysis and framework for future practice. BMJ Open 2022; 12:e061413. [PMID: 36241354 PMCID: PMC9577277 DOI: 10.1136/bmjopen-2022-061413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Safety and welfare are critical as pandemic-related demands on the healthcare workforce continue. Access to personal protective equipment (PPE) has been a central concern of healthcare workers throughout the COVID-19 pandemic. Against the backdrop of an already strained healthcare system, our study aimed to explore the experiences of healthcare workers with PPE during the first COVID-19 surge (February-June 2020) in Aotearoa/New Zealand (NZ). We also aimed to use these findings to present a strengths-based framework for supporting healthcare workers moving forward. DESIGN Web-based, anonymous survey including qualitative open-text questions. Questions were both closed and open text, and recruitment was multimodal. We undertook inductive thematic analysis of the dataset as a whole to explore prominent values related to healthcare workers' experiences. SETTING October-November 2020 in New Zealand. PARTICIPANTS 1411 healthcare workers who used PPE during surge one of the COVID-19 pandemic. RESULTS We identified four interactive values as central to healthcare workers' experiences: transparency, trust, safety and respect. When healthcare workers cited positive experiences, trust and safety were perceived as present, with a sense of inclusion in the process of stock allocation and effective communication with managers. When trust was low, with concerns over personal safety, poor communication and lack of transparency resulted in perceived lack of respect and distress among respondents. Our proposed framework presents key recommendations to support the health workforce in terms of communication relating to PPE supply and distribution built on those four values. CONCLUSIONS Healthcare worker experiences with PPE access has been likened to 'the canary in the coalmine' for existing health system challenges that have been exacerbated during the COVID-19 pandemic. The four key values identified could be used to improve healthcare worker experience in the future.
Collapse
Affiliation(s)
- Cervantée E K Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hailey Wells
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicolene Coetzee
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of General Paediatrics, Starship Children's Health, Auckland, New Zealand
| | - Trudy A Sullivan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
12
|
Borek AJ, Pilbeam C, Mableson H, Wanat M, Atkinson P, Sheard S, Martindale AM, Solomon T, Butler CC, Gobat N, Tonkin-Crine S. Experiences and concerns of health workers throughout the first year of the COVID-19 pandemic in the UK: A longitudinal qualitative interview study. PLoS One 2022; 17:e0264906. [PMID: 35294450 PMCID: PMC8926177 DOI: 10.1371/journal.pone.0264906] [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: 08/31/2021] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To identify the experiences and concerns of health workers (HWs), and how they changed, throughout the first year of the COVID-19 pandemic in the UK. METHODS Longitudinal, qualitative study with HWs involved in patient management or delivery of care related to COVID-19 in general practice, emergency departments and hospitals. Participants were identified through snowballing. Semi-structured telephone or video interviews were conducted between February 2020 and February 2021, audio-recorded, summarised, and transcribed. Data were analysed longitudinally using framework and thematic analysis. RESULTS We conducted 105 interviews with 14 participants and identified three phases corresponding with shifts in HWs' experiences and concerns. (1) Emergency and mobilisation phase (late winter-spring 2020), with significant rapid shifts in responsibilities, required skills, and training, and challenges in patient care. (2) Consolidation and preparation phase (summer-autumn 2020), involving gradual return to usual care and responsibilities, sense of professional development and improvement in care, and focus on learning and preparing for future. (3) Exhaustion and survival phase (autumn 2020-winter 2021), entailing return of changes in responsibilities, focus on balancing COVID-19 and non-COVID care (until becoming overwhelmed with COVID-19 cases), and concerns about longer-term impacts of unceasing pressure on health services. Participants' perceptions of COVID-19 risk and patient/public attitudes changed throughout the year, and tiredness and weariness turned into exhaustion. CONCLUSIONS Results showed a long-term impact of the COVID-19 pandemic on UK HWs' experiences and concerns related to changes in their roles, provision of care, and personal wellbeing. Despite mobilisation in the emergency phase, and trying to learn from this, HWs' experiences seemed to be similar or worse in the second wave partly due to many COVID-19 cases. The findings highlight the importance of supporting HWs and strengthening system-level resilience (e.g., with resources, processes) to enable them to respond to current and future demands and emergencies.
Collapse
Affiliation(s)
- Aleksandra J. Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Caitlin Pilbeam
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Hayley Mableson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Atkinson
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Sally Sheard
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Anne-Marie Martindale
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, United Kingdom
| |
Collapse
|
13
|
Good Care during COVID-19: A Narrative Approach to Care Home Staff’s Experiences of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042106. [PMID: 35206293 PMCID: PMC8872056 DOI: 10.3390/ijerph19042106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
Due to its major impact on Dutch care homes for older people, the COVID-19 pandemic has presented care staff with unprecedented challenges. Studies investigating the experiences of care staff during the COVID-19 pandemic have shown its negative impact on their wellbeing. We aimed to supplement this knowledge by taking a narrative approach. We drew upon 424 personal narratives written by care staff during their work in a Dutch care home during the COVID-19 pandemic. Firstly, our results show that care staff have a relational-moral approach to good care. Residents’ wellbeing is their main focus, which they try to achieve through personal relationships within the triad of care staff–resident–significant others (SOs). Secondly, our results indicate that caregivers experience the COVID-19 mitigation measures as obstructions to relational-moral good care, as they limit residents’ wellbeing, damage the triadic care staff–residents–SOs relationship and leave no room for dialogue about good care. Thirdly, the results show that care staff experiences internal conflict when enforcing the mitigation measures, as the measures contrast with their relational-moral approach to care. We conclude that decisions about mitigation measures should be the result of a dialogic process on multiple levels so that a desired balance between practical good care and relational-moral good care can be determined.
Collapse
|
14
|
Qureshi I, Gogoi M, Wobi F, Chaloner J, Al-Oraibi A, Hassan O, Pan D, Nellums LB, Pareek M. Healthcare Workers From Diverse Ethnicities and Their Perceptions of Risk and Experiences of Risk Management During the COVID-19 Pandemic: Qualitative Insights From the United Kingdom-REACH Study. Front Med (Lausanne) 2022; 9:930904. [PMID: 35847806 PMCID: PMC9285103 DOI: 10.3389/fmed.2022.930904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Healthcare workers (HCWs) are at higher risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies have examined factors relating to infection amongst HCWs, including those from ethnic minority groups, but there is limited data regarding the lived experiences of HCWs in relation to self-protection and how they deal with SARS-CoV-2 infection prevention. In this study, we presented data from an ethnically diverse sample of HCWs in the United Kingdom (UK) to understand their perceptions of risks and experiences with risk management whilst working throughout the COVID-19 pandemic. Methods We undertook a qualitative study as part of the United Kingdom Research study into Ethnicity and COVID-19 outcomes among Healthcare workers (United Kingdom-REACH) conducting semi-structured interviews and focus groups which were recorded with participants' permission. Recordings were transcribed and thematically analyzed. Findings A total of 84 participants were included in the analysis. Five broad themes emerged. First, ethnic minority HCWs spoke about specific risks and vulnerabilities they faced in relation to their ethnicity. Second, participants' experience of risk assessments at work varied; some expressed satisfaction while many critiqued it as a "tick-box" exercise. Third, most participants shared about risks related to shortages, ambiguity in guidance, and inequitable distribution of Personal Protective Equipment (PPE), particularly during the start of the pandemic. Fourth, participants reported risks resulting from understaffing and inappropriate redeployment. Finally, HCWs shared the risk mitigation strategies which they had personally employed to protect themselves, their families, and the public. Conclusion Healthcare workers identified several areas where they felt at risk and/or had negative experiences of risk management during the pandemic. Our findings indicate that organizational shortcomings may have exposed some HCWs to greater risks of infection compared with others, thereby increasing their emotional and mental burden. Ethnic minority HCWs in particular experienced risks stemming from what they perceived to be institutional and structural racism, thus leading to a loss of trust in employers. These findings have significance in understanding staff safety, wellbeing, and workforce retention in multiethnic staff groups and also highlight the need for more robust, inclusive, and equitable approaches to protect HCWs going forward.
Collapse
Affiliation(s)
- Irtiza Qureshi
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Jonathan Chaloner
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Osama Hassan
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Pan
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Laura B Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| |
Collapse
|
15
|
Charron M, Bélisle-Pipon JC, Couture V, Williams-Jones B, Ravitsky V, Dupras C. Impacts of the Early COVID-19 Pandemic on the Work of Bioethicists in Canada. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1094693ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
16
|
Delany C, Milch V, Keefe D, Wong ZW. COVID-19 recovery: implications for cancer care clinicians. Support Care Cancer 2021; 30:1003-1006. [PMID: 34626251 PMCID: PMC8501333 DOI: 10.1007/s00520-021-06600-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
The wellbeing of clinicians delivering cancer care needs to be considered and included in recovery roadmaps from the COVID-19 pandemic. In this paper, we refer to a report undertaken by Cancer Australia to review and reflect on the impact of COVID-19 in the delivery of cancer care. The report focused on post COVID-19 recovery and asked 3 questions: What changed? What has been the impact of that change? And how can high-value changes be embedded or enhanced? We suggest the same three questions should also be asked of cancer care clinicians. Using the three Cancer Australia questions, we draw from clinicians’ insights collected through the Victorian COVID-19 Cancer Network (VCCN) and from the wider health professional literature. We summarise key features of the COVID-19 experience for cancer care clinicians, highlighting moral distress, fatigue and disrupted practice. We then discuss how pandemic-related ethical values might guide health leaders and administrators to balance support for clinician wellbeing with ongoing delivery of cancer care for patients.
Collapse
Affiliation(s)
- Clare Delany
- Peter MacCallum Cancer Centre, 305 Grattan st Parkville, Melbourne, 3010, Australia. .,Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, Australia.
| | | | | | - Zee Wan Wong
- Peninsula Clinical School, Monash University, Clayton, VIC, Australia.,Southern Melbourne Integrated Cancer Service, Melbourne, Australia.,Oncology Unit, Peninsula Health, Melbourne, Australia
| |
Collapse
|
17
|
Ni'matuzahroh, Ningrum V, Widayat, Dyah Artaria M, Suen MW. The COVID-19 pandemic and healthcare workers psychological well-being: a cross-sectional survey in Indonesia. Nurs Open 2021; 8:3212-3221. [PMID: 34427392 PMCID: PMC8510726 DOI: 10.1002/nop2.1034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/25/2021] [Accepted: 07/25/2021] [Indexed: 11/09/2022] Open
Abstract
Aim This study was conducted to investigate the relationships amongst psychological well‐being (PWB), emotional intelligence and coping strategies. Design This study employed a cross‐sectional survey design. Method A total of 146 healthcare workers (HCWs) were enrolled in this study. They were asked to finish several questionnaires, including the Wong and Law Emotional Intelligence Scale, the Brief‐Coping Orientation to Problems Experienced Scale and the PWB Scale. The obtained data were analysed using partial least squares structural equation modelling, employee SmartPLS, to estimate the contributions of influencing factors and evaluate the moderating effect of coping strategy (CS) on the relationship between emotional intelligence and PWB. Results Results revealed that emotional intelligence influenced PWB, and CS moderated both emotional intelligence and PWB. Furthermore, CS plays an essential role in improving PWB related to emotional intelligence amongst HCWs during the COVID‐19 outbreak.
Collapse
Affiliation(s)
- Ni'matuzahroh
- Department of Psychology, Asia University, Taiwan.,Department of Healthcare Administration Specialty in Psychology, Asia University, Taiwan.,Faculty of Psychology, University of Muhammadiyah Malang, Indonesia
| | - Valendriyani Ningrum
- Department of Dental Public Health, Faculty of Dentistry, Baiturrahmah University, Indonesia
| | - Widayat
- Department Management Faculty of Economics and Business, University of Muhammadiyah Malang, Indonesia
| | - Myrtati Dyah Artaria
- Department of Anthropology, Faculty of Social and Political Sciences, Universitas Airlangga, Indonesia
| | - Mein-Woei Suen
- Department of Psychology, Asia University, Taiwan.,Gender Equality Education and Research Center, Asia University, Taichung, Taiwan.,Department of Medical Research, Asia University Hospital, Asia University, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan
| |
Collapse
|
18
|
Dunsford J. Nursing violent patients: Vulnerability and the limits of the duty to provide care. Nurs Inq 2021; 29:e12453. [PMID: 34398479 PMCID: PMC9286030 DOI: 10.1111/nin.12453] [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: 06/21/2021] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, “reasonableness” remains undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care.
Collapse
Affiliation(s)
- Jennifer Dunsford
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
19
|
Franklin P, Gkiouleka A. A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2453. [PMID: 33801517 PMCID: PMC7967576 DOI: 10.3390/ijerph18052453] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
The Covid-19 pandemic has exposed health workers to a diverse set of hazards impacting their physical, psychological and social wellbeing. This review aims to provide an overview of the categories of the psychosocial risk factors and hazards affecting HCWs during the Covid-19 pandemic and the recommendations for prevention. We used the scoping review methodology to collate categories of psychosocial risks, the related health outcomes, interventions, and data gaps. The review was conducted on global peer-reviewed academic and authoritative grey literature, published between 1. January-26. October 2020; in total, 220 articles were included into the review and the subsequent analysis. Analysis of the extracted data found PSRs related to four sources: personal protective equipment (PPE), job content, work organisation, and social context. is. Women health workers and nurses reported worst health outcomes. Majority of the research to date concerns health workers in secondary care, while data on psychosocial risks at primary and community-based settings are scarce. However, the emerging research implies that the pandemic creates psychosocial risks also to non-clinical health workers. The intervention and mitigation measures address individual and organisational levels. Preventative and mitigating measures for social and societal risks-such as staff shortages, intersecting inequalities, and financial stressors require further research.
Collapse
Affiliation(s)
- Paula Franklin
- Occupational Safety & Health and Working Conditions Unit, European Trade Union Institute (ETUI), Boulevard du Roi Albert II, 1210 Brussels, Belgium
| | - Anna Gkiouleka
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK;
| |
Collapse
|
20
|
Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020488. [PMID: 33435300 PMCID: PMC7826570 DOI: 10.3390/ijerph18020488] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/19/2022]
Abstract
The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.
Collapse
|
21
|
Fritz Z, Huppert JL, Liddell K, Holton R, Fuld JP. Ethical principles and a practical approach to support policy making through the next phases of the COVID-19 pandemic and beyond. Clin Med (Lond) 2020; 21:e122-e125. [PMID: 33376107 DOI: 10.7861/clinmed.2020-0843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is an urgent need for an ethical framework to help us address the local and national challenges that we face as clinicians during the COVID-19 pandemic. We propose four key commitments from which a practical and consistent ethical approach can be derived. These commitments are to articulate the needs, rights and interests of the different stakeholders affected by any policy; to be accountable and transparent, recognising that people are autonomous individuals with values and concerns of their own; to consider the impact of our actions on the sustainability of the NHS, infrastructure, service demands and staff welfare; and to treat everybody equitably, with all deserving of consideration and care. Implementing these commitments will require a number of specific actions. We must put in place frameworks enabling clear advocacy for each competing objective; communicate policy and practice effectively to the public; promote integration of decision-making among social, primary, secondary and tertiary care and reduce or stop unnecessary or inefficient interventions; minimise health inequalities; and build spare capacity into the system.In this article, we expand on these actions, and note the legal context in which this would be delivered.
Collapse
Affiliation(s)
- Zoë Fritz
- The Healthcare Improvement Studies (THIS) Institute, Cambridge, UK and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Julian L Huppert
- Jesus College, Cambridge; visiting professor in the Policy Institute, King's College London
| | - Kathleen Liddell
- Medicine and Life Sciences and reader in intellectual property and medical law, University of Cambridge, Cambridge, UK
| | | | - Jonathan P Fuld
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
22
|
Sabeghi H, Afshar L, Foroutan SA, Yazdani S. Medical students' value-rich exposures in clinical setting during the COVID-19 pandemic. J Med Ethics Hist Med 2020; 13:26. [PMID: 34055242 PMCID: PMC8141096 DOI: 10.18502/jmehm.v13i26.4957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Exposing medical students to real-world situations and clinical practice experiences during their education years can help them build their professional value frameworks. The COVID-19 pandemic is one of the most challenging conditions that medical students have experienced; however, this pandemic have provided value-rich opportunities assisting in development and enhancement of their professional identity. This commentary aimed to emphasize the importance of medical students’ exposure to clinical practice during the pandemic and the potential that such encounters provide for internalizing values.
Collapse
Affiliation(s)
- Hakimeh Sabeghi
- PhD Candidate, Virtual School of Medical Education and Management, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Afshar
- Associate Professor, Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Foroutan
- Associate Professor, Permanent Member, Academy of Medical Sciences of Iran, Tehran, Iran
| | - Shahram Yazdani
- Professor, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|