Professionalism and Resilience After COVID-19

Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters.

"Ruptured selves: moral injury and wounded identity"

Moral injury is the trauma caused by violations of deeply held values and beliefs. This paper draws on relational philosophical anthropologies to develop the connection between moral injury and moral identity and to offer implications for moral repair, focusing particularly on healthcare professionals. We expound on the notion of moral identity as the relational and narrative constitution of the self. Moral identity is formed and forged in the context of communities and narrative and is necessary for providing a moral horizon against which to act. We then explore the relationship between moral injury and damaged moral identities. We describe how moral injury ruptures one's sense of self leading to moral disorientation. The article concludes with implications for moral repair. Since moral identity is relationally formed, moral repair is not primarily an individual task but requires the involvement of others to heal one's identity. The repair of moral injury requires the transformation of a moral identity in community.

Repairing moral injury takes a team: what clinicians can learn from combat veterans

Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic's advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing moral injury-particularly its social dimensions. Veterans recognise that complex social factors lead to moral injury, and therefore a community approach is necessary for healing. We argue that similar attention must be given in healthcare, where a team-oriented and multidimensional approach is essential both for ameliorating the suffering faced by health professionals and for addressing the underlying causes that give rise to moral injury.

Resilience resources and coping strategies of COVID-19 female long haulers: A qualitative study

Background

Female long haulers deal with persistent post-acute COVID-19 symptoms that have serious health implications. This study aimed to identify resilience resources at multiple socio-ecological levels for female long haulers and describe how resilience resources affect their responses to long COVID.

Methods

Purposive sampling was adopted to recruit participants through social media from April to June 2021 followed by 15 semi-structured interviews. An inductive analytical approach was adopted to categorize themes by open and axial coding that were verified by peer review.

Results

Female long haulers relied on resources at various socio-ecological levels to foster their resilience in response to long COVID. At the individual level, they utilized cognitive and emotional resources to increase knowledge, learn new skills, set goals, and manage emotions; behavioral resources (e.g., internal motivation and executive functioning) to perform physical, creative, and recreational activities, and adopt healthier eating habits; and spiritual resources to perform spiritual rituals and connect with God. At the social level, the support from existing relationships and/or online social support groups enhanced their social identity and provided material and informational resources. At the health systems level, the guidance from counselors and physicians and availability of clinics, medicines, and health equipment assisted them in symptom management and medication adherence.

Conclusion

The resilience of female long haulers can be enhanced through (1) offering financial and health-related resources, (2) developing online social-support groups, (3) counseling and care service training for healthcare professionals, and (4) implementing more psychosocial interventions by labor organizations.

Moral Injury in Health Care: Identification and Repair in the COVID-19 Era

Frontline health-care workers experienced moral injury long before COVID-19, but the pandemic highlighted how pervasive and damaging this psychological harm can be. Moral injury occurs when individuals violate or witness violations of deeply held values and beliefs. We argue that a continuum exists between moral distress, moral injury, and burnout. Distinguishing these experiences highlights opportunities for intervention and moral repair, and may thwart progression to burnout.

Building Caregiver Resiliency in Global Health: Embodying the Catholic Social Tradition in the Face of COVID-19

For international healthcare NGOs, the impact of the COVID-19 pandemic has been significant. Healthcare workers in both LMICs and high-income countries have described the impact of the pandemic as traumatic. This article focuses on one initiative designed to address this impact: CMMB’s Building Resiliency program. This article provides an overview of the structure and content of program, situating it within the landscape of global mental healthcare disparities and caregiver trauma. Designed to address caregiver mental health in Peru, Haiti, Kenya, South Sudan, and Zambia, the program sought to offset global mental healthcare disparities by bringing needed psycho-social-spiritual support to CMMB staff. It was intentionally shaped by the commitments of Catholic social thought—particularly to the well-being, dignity, and integral human development of CMMB staff members, to envisaging new forms of solidarity, and to prioritizing subsidiarity and participation. Theories of post-traumatic growth provided the theoretical framework for three remotely delivered seminar series, which made space for staff members to share their stories with their colleagues, to build community, to foster creativity and hope, and to intentionally integrate faith and spirituality into both personal self-care as well as the common life of the organization. Thus, this was designed equally to build the organizational resiliency that is the fruit of Catholic social thought. For attending to caregivers’ mental health and well-being is crucial not only for the success of medical missions but for embodying and witnessing the Catholic commitment to the human dignity and the integral development of those who do the work of our organizations.

Kidney Care during COVID-19 in the UK: Perspectives of Healthcare Professionals on Impacts on Care Quality and Staff Well-Being

In light of the rapid changes in healthcare delivery due to COVID-19, this study explored kidney healthcare professionals' (HCPs) perspectives on the impact of these changes on care quality and staff well-being. Fifty-nine HCPs from eight NHS Trusts across England completed an online survey and eight took part in complementary semi-structured interviews between August 2020 and January 2021. Free-text survey responses and interviews were analysed using inductive thematic analysis. Themes described the rapid adaptations, concerns about care quality, benefits from innovations, high work pressure, anxiety and mental exhaustion in staff and the team as a well-being resource. Long-term retention and integration of changes and innovations can improve healthcare access and efficiency, but specification of conditions for its use is warranted. The impact of prolonged stress on renal HCPs also needs to be accounted for in quality planning. Results are further interpreted into a theoretical socio-technical framework.

Effects of the Resilience of Nurses in Long-Term Care Hospitals during on Job Stress COVID-19 Pandemic: Mediating Effects of Nursing Professionalism

Purpose: To investigate nursing professionalism as a mediating factor in the relationship between resilience and job stress levels for nurses working in long-term care hospitals during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted from January to March 2021 in seven long-term care hospitals in the Seoul metropolitan area to measure resilience, nursing professionalism, and job stress among nurses. Simple and multiple regression analyses along with the Sobel test were performed to verify the mediating effect of nursing professionalism. Results: Data from 200 nurses were included in the final analysis. Results showed that individual and occupational characteristics could lead to differences in nurses’ resilience, job stress levels, and nursing professionalism. Nursing professionalism had a significant mediating effect on the relationship between resilience and job stress levels. The effect of resilience on job stress levels was significant (β = −0.16, p = 0.024). After controlling for nursing professionalism, the effect declined and was not statistically significant (β = −0.09, p = 0.251). Conclusion: There is a need to increase individual resilience and nursing professionalism through intervention programs and policy proposals to manage job stress among long-term care hospital nurses during the COVID-19 pandemic.

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients

INTRODUCTION

Use of virtual reality (VR) in healthcare has expanded in recent years. The challenges faced by patients with prolonged COVID-19-related hospitalizations - social isolation, disability, neurologic sequelae, adjustment-related anxiety, depression, and stress - may be mitigated by the novel use of VR as one modality of a comprehensive rehabilitation plan. This descriptive study aimed to understand patient satisfaction and perceived benefit of virtual reality on a COVID-19 recovery unit, as well as the logistical and operational feasibility of providing VR content for patients and staff.

MATERIALS AND METHODS

During the COVID-19 surge in New York City in 2020, the COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and staff to participate in VR sessions with three categories of experience: (1) Guided meditation, (2) Exploration of natural environments, (3) Cognitive stimulation games. Patients and staff were surveyed about satisfaction and perceived benefit.

RESULTS

13 patients and 11 staff were surveyed, with median patient satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," and median staff satisfaction scores of 10. 13/13 patients answered "yes" to recommending the therapy to others, and 12/13 answered "yes" to perceived enhancement of their treatment. 11/11 staff answered "yes" to recommending the therapy to others, and 11/11 answered "yes" to perceived enhancement of their wellbeing.

DISCUSSION

A VR program implemented on a COVID-19 rehabilitation unit for patients and healthcare providers was rated as highly satisfactory with perceived benefit by survey respondents. Participants commented that the use of VR was useful in coping with isolation and loneliness, and could be implemented within the context of clinical care for COVID-19 patients as part of a comprehensive rehabilitation model. The use of VR was also logistically and operationally feasible on the CRU. Future work to compare benefits of VR to standard neuropsychological rehabilitation is needed.