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Joshi I, Zemel R. "COVID-19 and the New Hidden Curriculum of Moral Injury and Compassion Fatigue". Am J Hosp Palliat Care 2024:10499091241253283. [PMID: 38768440 DOI: 10.1177/10499091241253283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Medical students are educated through two dichotomous curriculums, the formal, planned curriculum and the hidden curriculum unintentionally taught through socialization within the culture of medicine. As a consequence of shared trauma amongst the physician workforce during the COVID-19 pandemic, moral injury (MoI) and compassion fatigue (CoF) have become prevalent within the health care system, including palliative care medicine, with echoing ramifications on the observing trainee population. Thus, it is imperative to determine risk factors, protective factors and targeted interventions to offset MoI and CoF within the health care workforce and trainee population. Methods of strengthening personal and institutional resilience are vital to developing long-term structural change replacing the hidden curriculum of MoI and CoF with one of resilience and support. As palliative care providers are especially vulnerable to MoI and CoF, this article will examine the impact of the COVID-19 pandemic on MoI, CoF, and resilience within the hidden curriculum through the lens of palliative care.
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Affiliation(s)
- Ishani Joshi
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Rachel Zemel
- Department of Internal Medicine and Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
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McGuinness SL, Eades O, Zhong S, Clifford S, Fisher J, Kelsall HL, Kirkman M, Russell G, Skouteris H, Leder K. A longitudinal qualitative exploration of victorian healthcare workers' and organisations' evolving views and experiences during COVID-19. BMC Health Serv Res 2024; 24:596. [PMID: 38715025 PMCID: PMC11077789 DOI: 10.1186/s12913-024-11067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly impacted individuals, society, and healthcare organisations worldwide. Recent international research suggests that concerns, needs, and experiences of healthcare workers (HCWs) have evolved throughout the pandemic. This longitudinal qualitative study explored the evolving views and experiences of Victorian healthcare workers (HCWs) and organisational key personnel during the coronavirus disease (COVID-19) pandemic. METHODS We recruited participants from the Coronavirus in Victorian Health and Aged care workers (COVIC-HA) study cohort. We conducted two rounds of semi-structured interviews with HCWs and organisational key personnel from three different healthcare settings (hospital, aged care and primary care) in Victoria, Australia, in May-July 2021 and May-July 2022. Data were analysed thematically using trajectory and recurrent cross-sectional approaches, guided by a temporal change framework. RESULTS Twelve HCWs and five key personnel from various professional roles participated in interviews at both timepoints. Expected themes derived from mid-2021 interviews (navigating uncertainty, maintaining service delivery, and addressing staff needs) evolved over time. Concerns shifted from personal health and safety to workforce pressures, contributing to HCW burnout and fatigue and ongoing mental health support needs. New themes emerged from mid-2022 interviews, including managing ongoing COVID-19 impacts and supporting the healthcare workforce into the future. Clear and consistent communication, stable guidelines and forward-looking organisational responses were considered crucial. CONCLUSIONS Our longitudinal qualitative study highlighted the evolving impact of the COVID-19 pandemic on HCWs' perceptions, health and wellbeing and uncovered long-term sector vulnerabilities. Analysing HCW experiences and key personnel insights over time and across different pandemic phases provided crucial insights for policymakers to protect the healthcare workforce. Findings emphasise the need for proactive strategies that prioritise HCWs' wellbeing and workforce sustainability. Policy makers must invest in HCW health and wellbeing initiatives alongside healthcare system improvements to ensure resilience and capacity to meet future challenges. TRIAL REGISTRATION This study was approved through the Victorian Streamlined Ethical Review Process (SERP: Project Number 68,086) and registered with ANZCTR (ACTRN12621000533897) on 6 May 2021.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Alfred Health, Melbourne, VIC, Australia.
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Shannon Zhong
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Sharon Clifford
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen L Kelsall
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
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Girela-Lopez E, Beltran-Aroca CM, Boceta-Osuna J, Aguilera-Lopez D, Gomez-Carranza A, Lopez-Valero M, Romero-Saldaña M. Measuring moral distress in health professionals using the MMD-HP-SPA scale. BMC Med Ethics 2024; 25:41. [PMID: 38570759 PMCID: PMC10993501 DOI: 10.1186/s12910-024-01041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.
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Affiliation(s)
- Eloy Girela-Lopez
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Cristina M Beltran-Aroca
- Section of Legal and Forensic Medicine. Faculty of Medicine and Nursing, University of Córdoba, Av. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Jaime Boceta-Osuna
- Unidad de Cuidados Paliativos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Lopez-Valero
- Dispositivo de Cuidados Críticos y Urgencias, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy. Faculty of Medicine and Nursing, University of Cordoba, Córdoba, Spain
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Houle SA, Ashbaugh AR. Predictors of negative moral appraisals and their association with symptoms of post-traumatic stress and depression in the context of COVID-19 related stressors. Stress Health 2024; 40:e3296. [PMID: 37526521 DOI: 10.1002/smi.3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
Research on moral injury (MI) suggests that negative moral appraisals of stressful events can impact mental health in high-stakes occupational contexts (e.g., military). Few studies have examined these associations in the general population, limiting the generalisability of findings. Furthermore, factors that may predispose an individual to adverse outcomes in the context of moral stressors remain largely unknown. The objectives of this study were to (1) explore the applicability of the MI construct to stressors experienced by the general public during the COVID-19 pandemic; (2) explore how trait differences in sense of duty, religiosity/spirituality, anxiety sensitivity, and guilt, shame, and anger, predict negative moral appraisals of COVID-19 stressors. Participants (n = 355) completed an online survey assessing exposure to and appraisals of COVID-19 stressors, mental health symptoms, and dispositional characteristics (i.e., trait emotions, anxiety sensitivity, sense of duty, religiosity/spirituality). Path analysis revealed specific indirect associations between self-based moral appraisals and posttraumatic stress disorder (PTSD) and depression through guilt, and between both self- and other-based moral appraisals and PTSD and depression through anger. Number of COVID-19 stressors had no influence on associations. Sense of duty, reparative guilt, and anxiety sensitivity best predicted negative moral appraisals. Findings partially support the applicability of the MI construct outside the occupational context.
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Elliott M, Khallouf C, Hirsch J, de Camps Meschino D, Zamir O, Ravitz P. Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study. JMIR Form Res 2024; 8:e43875. [PMID: 38180869 PMCID: PMC10941832 DOI: 10.2196/43875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/02/2023] [Accepted: 11/17/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. OBJECTIVE This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. METHODS Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ≥1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. RESULTS We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. CONCLUSIONS The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs.
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Affiliation(s)
- Mary Elliott
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camille Khallouf
- Department of Psychiatry, Sinai Health System, Toronto, ON, Canada
| | - Jennifer Hirsch
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sinai Health System, Toronto, ON, Canada
| | - Diane de Camps Meschino
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Orit Zamir
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sinai Health System, Toronto, ON, Canada
- Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Paula Ravitz
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sinai Health System, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
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Gehrke P, Campbell K, Tsang JLY, Hannon RA, Jack SM. Canadian intensive care unit nurses' responses to moral distress during the COVID-19 pandemic, and their recommendations for mitigative interventions. J Adv Nurs 2024. [PMID: 38459779 DOI: 10.1111/jan.16135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/18/2024] [Accepted: 02/17/2024] [Indexed: 03/10/2024]
Abstract
AIMS To describe intensive care unit nurses' experiences of moral distress during the COVID-19 pandemic, and their recommendations for mitigative interventions. DESIGN Interpretive description. METHODS Data were collected with a purposeful sample of 40 Canadian intensive care unit nurses between May and September 2021. Nurses completed a demographic questionnaire, the Measure of Moral Distress-Healthcare Professionals survey and in-depth interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were categorized and synthesized using reflexive thematic analysis and rapid qualitative analysis. RESULTS Half of the nurses in this sample reported moderate levels of moral distress. In response to moral distress, nurses experienced immediate and long-term effects across multiple health domains. To cope, nurses discussed varied reactions, including action, avoidance and acquiescence. Nurses provided recommendations for interventions across multiple organizations to mitigate moral distress and negative health outcomes. CONCLUSION Nurses reported that moral distress drove negative health outcomes and attrition in response to moral events in practice. To change these conditions of moral distress, nurses require organizational investments in interventions and cultures that prioritize the inclusion of nursing perspectives and voices. IMPLICATIONS FOR THE PROFESSION Nurses engage in a variety of responses to cope with moral distress. They possess valuable insights into the practice issues central to moral distress that have significant implications for all members of the healthcare teams, patients and systems. It is essential that nurses' voices be included in the development of future interventions central to the responses to moral distress. REPORTING METHOD This study adheres to COREQ guidelines. IMPACT What Problem did the Study Address? Given the known structural, systemic and environmental factors that contribute to intensive care unit nurses' experiences of moral distress, and ultimately burnout and attrition, it was important to learn about their experiences of moral distress and their recommendations for organizational mitigative interventions. Documentation of these experiences and recommendations took on a greater urgency during the context of a global health emergency, the COVID-19 pandemic, where such contextual influences on moral distress were less understood. What Were the Main Findings? Over half of the nurses reported a moderate level of moral distress. Nurses who were considering leaving nursing practice reported higher moral distress scores than those who were not considering leaving. In response to moral distress, nurses experienced a variety of outcomes across several health domains. To cope with moral distress, nurses engaged in patterns of action, avoidance and acquiescence. To change the conditions of moral distress, nurses desire organizational interventions, practices and culture changes situated in the amplification of their voices. Where and on Whom Will the Research Have an Impact on? These findings will be of interest to: (1) researchers developing and evaluating interventions that address the complex phenomenon of moral distress, (2) leaders and administrators in hospitals, and relevant healthcare and nursing organizations, and (3) nurses interested in leveraging evidence-informed recommendations to advocate for interventions to address moral distress. What Does this Paper Contribute to the Wider Global Community? This paper advances the body of scientific work on nurses' experiences of moral distress, capturing this phenomenon within the unique context of a global health emergency. Nurses' levels of moral distress using Measure of Moral Distress-Healthcare Professional survey were reported, serving as a comparator for future studies seeking to measure and evaluate intensive care unit nurses' levels of moral distress. Nurses' recommendations for mitigative interventions for moral distress have been reported, which can help inform future interventional studies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Paige Gehrke
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Karen Campbell
- School of Nursing, York University, Toronto, Ontario, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, Ontario, Canada
| | - Ruth A Hannon
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Susan M Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Houle SA, Ein N, Gervasio J, Plouffe RA, Litz BT, Carleton RN, Hansen KT, Liu JJW, Ashbaugh AR, Callaghan W, Thompson MM, Easterbrook B, Smith-MacDonald L, Rodrigues S, Bélanger SAH, Bright K, Lanius RA, Baker C, Younger W, Bremault-Phillips S, Hosseiny F, Richardson JD, Nazarov A. Measuring moral distress and moral injury: A systematic review and content analysis of existing scales. Clin Psychol Rev 2024; 108:102377. [PMID: 38218124 DOI: 10.1016/j.cpr.2023.102377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/03/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. METHOD We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale. RESULTS We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes. CONCLUSIONS Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.
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Affiliation(s)
- Stephanie A Houle
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Research Directorate, Veterans Affairs Canada, Charlottetown, Canada
| | - Natalie Ein
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychiatry, Western University, London, Canada
| | - Julia Gervasio
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada
| | - Rachel A Plouffe
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychology, University of Dundee, Dundee, UK
| | - Brett T Litz
- Department of Psychiatry, Boston University, Boston, USA; Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, USA; Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Kevin T Hansen
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada
| | - Jenny J W Liu
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychiatry, Western University, London, Canada
| | | | - Walter Callaghan
- Department of Anthropology, University of Toronto, Toronto, Canada
| | | | - Bethany Easterbrook
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada
| | | | - Sara Rodrigues
- The Atlas Institute for Veterans and Families, Ottawa, Canada
| | | | | | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Canada
| | - Clara Baker
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada
| | - William Younger
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada
| | | | | | - J Don Richardson
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychiatry, Western University, London, Canada; St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care London, London, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychiatry, Western University, London, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
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Nazarov A, Forchuk CA, Houle SA, Hansen KT, Plouffe RA, Liu JJW, Dempster KS, Le T, Kocha I, Hosseiny F, Heesters A, Richardson JD. Exposure to moral stressors and associated outcomes in healthcare workers: prevalence, correlates, and impact on job attrition. Eur J Psychotraumatol 2024; 15:2306102. [PMID: 38334695 PMCID: PMC10860421 DOI: 10.1080/20008066.2024.2306102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/14/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs' self-reported job attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed.Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p < .001), moral distress (AOR = 1.83; p < .001), and moral injury due to trust violation (AOR = 1.30; p = .022) as significant predictors of the intention to leave one's job.Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors.
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Affiliation(s)
- Anthony Nazarov
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
| | - Callista A. Forchuk
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
| | - Stephanie A. Houle
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
- Research Directorate, Veteran Affairs Canada, Charlottetown, Canada
| | - Kevin T. Hansen
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Rachel A. Plouffe
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Jenny J. W. Liu
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Kylie S. Dempster
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
| | - Tri Le
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
| | - Ilyana Kocha
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
| | | | - Ann Heesters
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, Canada
- The Institute for Education Research, University Health Network, Toronto, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Canada
- The Michener Institute, University Health Network, Toronto, Canada
- The Wilson Centre, University Health Network, Toronto, Canada
| | - J. Don Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
- St. Joseph’s Operational Stress Injury Clinic, St. Joseph’s Health Care London, London, Canada
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D’Alessandro-Lowe AM, Patel H, Easterbrook B, Ritchie K, Brown A, Xue Y, Karram M, Millman H, Sullo E, Pichtikova M, Nicholson A, Heber A, Malain A, O’Connor C, Schielke H, Rodrigues S, Hosseiny F, McCabe RE, Lanius RA, McKinnon MC. The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic. Eur J Psychotraumatol 2024; 15:2299661. [PMID: 38334706 PMCID: PMC10860446 DOI: 10.1080/20008066.2023.2299661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
Background: Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic.Methods: HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the sample when controlling for sex, age, depression, anxiety, stress, and childhood adversity.Results: A structural equation model independently regressing both MI and MD onto PTSD accounted for 74.4% of the variance in PTSD symptoms. Here, MI was strongly and significantly associated with PTSD symptoms (β = .412, p < .0001) to a higher degree than MD (β = .187, p < .0001), after controlling for age, sex, depression, anxiety, stress and childhood adversity. A model regressing a combined MD and MI construct onto PTSD predicted approximately 87% of the variance in PTSD symptoms (r2 = .87, p < .0001), with MD/MI strongly and significantly associated with PTSD (β = .813, p < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity.Conclusion: Our results support a relation between MI and PTSD among HCWs and suggest that a combined MD and MI construct is most strongly associated with PTSD symptoms. Further research is needed better understand the mechanisms through which MD/MI are associated with PTSD.
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Affiliation(s)
| | - Herry Patel
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kim Ritchie
- McMaster University, Hamilton, Ontario, Canada
- Trent University, Peterborough, Ontario, Canada
| | | | - Yuanxin Xue
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Mauda Karram
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Emily Sullo
- McMaster University, Hamilton, Ontario, Canada
| | - Mina Pichtikova
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Andrew Nicholson
- McMaster University, Hamilton, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Alex Heber
- McMaster University, Hamilton, Ontario, Canada
- Canadian Institute for Pandemic Health Education and Response, Regina, Saskatchewan, Canada
| | - Ann Malain
- Homewood Health Centre, Guelph, Ontario, Canada
| | | | | | - Sarah Rodrigues
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
| | - Fardous Hosseiny
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
| | - Randi E. McCabe
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ruth A. Lanius
- University of Western Ontario, London, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Margaret C. McKinnon
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
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10
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Ford JD, Seedat S. On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021-2023. Eur J Psychotraumatol 2023; 14:2281988. [PMID: 38038964 PMCID: PMC10990445 DOI: 10.1080/20008066.2023.2281988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
This Special Issue of the European Journal of Psychotraumatology (EJPT) presents 51 articles published between 2021 and 2023 and follows the Special Issue on pandemic-related traumatic stress research published in 2021 (O'Donnell, M. L., & Greene, T. [2021]. Understanding the mental health impacts of COVID-19 through a trauma lens. European Journal of Psychotraumatology, 12(1), 1982502). Research on traumatic stress during the pandemic has cast the spotlight on vulnerable populations and groups, notably front-line healthcare workers; people faced with major losses including the deaths of loved ones; those who personally survived debilitating and often life-threatening viral infection; and students who were isolated and experienced profound delays in their education, relationships, and emerging independence. The papers in this collection underscore the associations between COVID-19 related stressors and a plethora of adverse mental health sequelae, including posttraumatic stress reactions, and draw attention to the ubiquity of grief and moral injury and their wide-ranging and detrimental impact. Currently, there is a paucity of evidence on interventions to enhance resources, self-efficacy, and hope for affected groups and individuals through societal, organisational, and healthcare systems; however early research on the prevention of COVID-related traumatic stress disorders provides a basis for both hope and preparedness for the future.
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Affiliation(s)
- Julian D. Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Soraya Seedat
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Nazarov A, Fikretoglu D, Liu A, Born J, Michaud K, Hendriks T, Bélanger SA, Do MT, Lam Q, Brooks B, King K, Sudom K, Jetly R, Garber B, Thompson M. Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics. JMIR Res Protoc 2023; 12:e44299. [PMID: 37676877 PMCID: PMC10629501 DOI: 10.2196/44299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19-related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. OBJECTIVE This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. METHODS A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. RESULTS CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. CONCLUSIONS The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF-specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44299.
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Affiliation(s)
- Anthony Nazarov
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- HumanSystems Inc, Guelph, ON, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Aihua Liu
- HumanSystems Inc, Guelph, ON, Canada
| | - Jennifer Born
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Kathy Michaud
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Tonya Hendriks
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | | | - Minh T Do
- Directorate of Mental Health, Canadian Forces Health Services, Department of National Defence, Ottawa, ON, Canada
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quan Lam
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Brenda Brooks
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Kristen King
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Department of National Defence, Ottawa, ON, Canada
| | - Bryan Garber
- Directorate of Mental Health, Canadian Forces Health Services, Department of National Defence, Ottawa, ON, Canada
| | - Megan Thompson
- Defence Research and Development Canada, Department of National Defence, Toronto, ON, Canada
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12
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Campbell BM, Knipp MA, Anwar SS, Hoopsick RA. Moral injury and substance use among United States healthcare workers. Stress Health 2023. [PMID: 37786303 DOI: 10.1002/smi.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/08/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
Moral injury (i.e., perpetrating, witnessing, failing to prevent, or being a victim of acts that transgress one's moral beliefs, values, or ethics) has largely been studied in military-connected populations and is associated with a range of adverse psychological sequelae. Emerging literature suggests that healthcare workers also experience moral injury, particularly in the context of the ongoing COVID-19 pandemic. However, it is not known if moral injury contributes to substance use among healthcare workers or whether these effects might differ by gender, race/ethnicity, or occupational level. In March 2022, we collected self-reported pilot data from a diverse sample of US healthcare workers (N = 200) We examined the cross-sectional relationships between moral injury and several measures of substance use (i.e., current non-medical use of prescription drugs [NMUPD], current cannabis use, current use of other illicit drugs, and hazardous drinking) using separate logistic regression models. Next, we used separate interaction models to examine if any of these relations differed by gender, race/ethnicity, or occupational level. In main effects models, healthcare workers reporting greater moral injury had greater odds of current NMUPD (adjusted odds ratio (aOR) = 1.07; p < 0.001), current use of other illicit drugs (aOR = 1.09; p < 0.01), and hazardous drinking (aOR = 1.07; p < 0.01). These relations did not differ by race/ethnicity or occupational level (ps > 0.05); however, men were more likely to report current NMUPD and hazardous drinking (ps < 0.05) in the presence of high moral injury than women healthcare workers. Our findings suggest that healthcare workers experience substantial distress related to morally injurious events, which may affect their likelihood of NMUPD, cannabis use, use of other illicit drugs, and hazardous drinking, and that men in healthcare may be particularly at risk. Healthcare organizations should address systemic issues driving moral injury (e.g., resource shortages, lack of psychosocial support) to prevent substance-related harms among healthcare workers.
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Affiliation(s)
- Benjamin M Campbell
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Michael A Knipp
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Sinan S Anwar
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Rachel A Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
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13
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Plouffe RA, Nazarov A, Heesters AM, Dickey CC, Foxcroft L, Hosseiny F, Le T, Lum PA, Nouri MS, Smith P, Richardson JD. The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic. Front Psychol 2023; 14:1235211. [PMID: 37842704 PMCID: PMC10570733 DOI: 10.3389/fpsyg.2023.1235211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs' perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress. Methods A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress. Results Associations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment. Discussion To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment.
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Affiliation(s)
- Rachel A. Plouffe
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychology, University of Dundee, Dundee, United Kingdom
| | - Anthony Nazarov
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Ann M. Heesters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Institute for Education Research (TIER), Unviersity Health Network, Toronto, ON, Canada
| | - Chandlee C. Dickey
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Laura Foxcroft
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Tri Le
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada
| | - P. Andrea Lum
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Maede S. Nouri
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada
| | - Patrick Smith
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada
| | - J. Don Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychology, University of Dundee, Dundee, United Kingdom
- Parkwood Institute, London, ON, Canada
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14
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Ducharlet K, Weil J, Gock H, Philip J. Kidney Clinicians' Perceptions of Challenges and Aspirations to Improve End-Of-Life Care Provision. Kidney Int Rep 2023; 8:1627-1637. [PMID: 37547531 PMCID: PMC10403660 DOI: 10.1016/j.ekir.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/26/2023] [Accepted: 04/10/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction End-of-life care is an essential part of integrated kidney care. However, renal clinicians' experiences of care provision and perceptions of end-of-life care needs are limited. This study explored renal clinicians' experiences of providing end-of-life care and developed recommendations to improve experiences. Methods An exploratory qualitative study using semistructured focus groups and 1 interview was undertaken at 5 kidney services in Victoria, Australia. The transcripts were analyzed thematically. Results Between February and December 2017, 54 renal clinicians (21 doctors and 33 nurses) participated in the study. Clinicians reported multiple challenges of end-of-life care experiences resulting in compromised treatment planning and decision making and highlighted priorities to guide better care experiences. Challenges of providing end-of-life care were underpinned by mismatches in illness and treatment expectations, limited engagement in advance care planning, medical complexity, and differences between clinicians and patients in what constituted quality of life. These challenges were associated with compromised end-of-life care planning, which resulted in care experiences that were rushed with a prolonged treatment focus, risking limited preparation for death and moral distress. Clinicians aspired for positive end-of-life care experiences, including patient control and consensus in decision making, and a coordinated and collaborative approach across healthcare providers. Conclusions Renal clinicians highlighted multiple factors and circumstances which resulted in experiences of compromised end-of-life care for patients with kidney disease. To improve care experiences, clinician-directed priorities included more training and support to facilitate systematic and earlier discussions about illness expectations and end-of-life care planning and greater communication and collaboration across healthcare providers is required.
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Affiliation(s)
- Kathryn Ducharlet
- Department of Palliative Medicine, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Nephrology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Weil
- Department of Palliative Medicine, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Hilton Gock
- Department of Nephrology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Palliative Medicine, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Lathan EC, Powers A, Kottakis A, Guelfo A, Siegle GJ, Turner JA, Turner MD, Yakkanti V, Jain J, Mekawi Y, Teer AP, Currier JM, Fani N. Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples. Psychol Med 2023; 53:5136-5145. [PMID: 37650341 PMCID: PMC10476056 DOI: 10.1017/s003329172200215x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). METHODS Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. RESULTS Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). CONCLUSIONS Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.
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Affiliation(s)
- Emma C. Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Kottakis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Matthew D. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Vijwala Yakkanti
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jahnvi Jain
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Andrew P. Teer
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph M. Currier
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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16
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Maunder RG, Heeney ND, Greenberg RA, Jeffs LP, Wiesenfeld LA, Johnstone J, Hunter JJ. The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey. BMC Nurs 2023; 22:243. [PMID: 37496000 PMCID: PMC10369708 DOI: 10.1186/s12912-023-01407-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Previous research suggests that moral distress contributes to burnout in nurses and other healthcare workers. We hypothesized that burnout both contributed to moral distress and was amplified by moral distress for hospital workers in the COVID-19 pandemic. This study also aimed to test if moral distress was related to considering leaving one's job. METHODS A cohort of 213 hospital workers completed quarterly surveys at six time-points over fifteen months that included validated measures of three dimensions of professional burnout and moral distress. Moral distress was categorized as minimal, medium, or high. Analyses using linear and ordinal regression models tested the association between burnout and other variables at Time 1 (T1), moral distress at Time 3 (T3), and burnout and considering leaving one's job at Time 6 (T6). RESULTS Moral distress was highest in nurses. Job type (nurse (co-efficient 1.99, p < .001); other healthcare professional (co-efficient 1.44, p < .001); non-professional staff with close patient contact (reference group)) and burnout-depersonalization (co-efficient 0.32, p < .001) measured at T1 accounted for an estimated 45% of the variance in moral distress at T3. Moral distress at T3 predicted burnout-depersonalization (Beta = 0.34, p < .001) and burnout-emotional exhaustion (Beta = 0.38, p < .008) at T6, and was significantly associated with considering leaving one's job or healthcare. CONCLUSION Aspects of burnout that were associated with experiencing greater moral distress occurred both prior to and following moral distress, consistent with the hypotheses that burnout both amplifies moral distress and is increased by moral distress. This potential vicious circle, in addition to an association between moral distress and considering leaving one's job, suggests that interventions for moral distress may help mitigate a workforce that is both depleted and burdened with burnout.
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Baskwill A, Hay P, Calleri F, Fiddes L, Barnett R, Fogarty S. The paradox of the impact of the COVID-19 pandemic on massage therapists in Australia and Canada: The reporting of a qualitative strand of a mixed methods study. J Bodyw Mov Ther 2023; 35:371-377. [PMID: 37330795 PMCID: PMC10148715 DOI: 10.1016/j.jbmt.2023.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 03/12/2023] [Accepted: 04/22/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION In both Australia and Canada, healthcare providers considered essential were allowed to operate during the COVID-19 pandemic. The impact of the global pandemic on professional identity included opportunities for role expansion, a focus on ethical principles and social accountability, and professional pride. These results were found only for those considered to be essential and do not likely resonate with those classified as non-essential, such as massage therapists, leaving a gap in understanding. MATERIALS AND METHODS This qualitative strand of a sequential explanatory mixed methods study used qualitative description. Individuals who expressed interest were purposefully selected, based on age, gender, type of practice, and experience with the four key phenomena of interest. Data collected through semi-structured interviews was analyzed using qualitative content analysis. Member checking enhanced the trustworthiness of the results. RESULTS Thirty-one (16 Australian and 15 Canadian) participants were interviewed. The main theme described was the pandemic paradox. At some point during the pandemic, most participants were labelled by government agencies as a non-essential service. However, participants reported feeling both essential and non-essential. Two subthemes were also described: factors contributing to creating the paradox and consequences of the paradox. CONCLUSION A number of pre-existing factors around professional identity, such as patient relationships combined with the conditions instituted to manage the COVID-19 pandemic included designating health care services as essential or non-essential, created the paradox experienced by respondents and the subsequent experience of moral distress. Further research into moral distress experienced by massage therapists is needed.
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Affiliation(s)
- Amanda Baskwill
- Faculty of Health Sciences and Wellness, Humber College, Canada; School of Health, Human and Justice Studies, Loyalist College, Canada.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Australia; Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Felicia Calleri
- Faculty of Health Sciences and Wellness, Humber College, Canada
| | | | | | - Sarah Fogarty
- School of Medicine, Western Sydney University, Australia
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18
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Kalani Z, Barkhordari-Sharifabad M, Chehelmard N. Correlation between moral distress and clinical competence in COVID-19 ICU nurses. BMC Nurs 2023; 22:107. [PMID: 37029367 PMCID: PMC10080174 DOI: 10.1186/s12912-023-01277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Nurses' clinical competence is one of the fundamental necessities for providing safe and effective care. Moral distress, as one type of occupational stressors, can affect various aspects of clinical competence, especially under conditions of complicated medical settings such as the coronavirus disease 2019 (COVID-19) epidemic. This study was conducted with the aim of determining the relationship between moral distress and clinical competence in nurses working in COVID-19 intensive care units (ICUs). METHODS The study was a cross-sectional study. A total of 194 nurses working in COVID-19 ICU affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, central Iran, participated in the study. Data were collected using Demographic Information Questionnaire, Moral Distress Scale, and Clinical Competence Checklist. Data were analyzed with SPSS20 using descriptive and analytical statistics. RESULTS The mean score of moral distress, clinical competence, and skills application were 1.79 ± 0/68, 65.16 ± 15.38, and 145.10 ± 38.20, respectively. Based on Pearson correlation coefficient, there was an inverse and significant relationship between the moral distress score and its dimensions with clinical competence and skills application (P < 0.001). Moral distress was a significant negative predictor that accounted for 17.9% of the variance in clinical competence (R2 = 0.179, P < 0.001) and 16% of the variance in utilization of clinical competence (R2 = 0.160, P < 0.001). CONCLUSION Considering the relationship between moral distress, clinical competence and skills application, to maintain the quality of nursing services, nursing managers can strengthen clinical competence and skills application by using strategies to deal with and reduce moral distress in nurses, especially in critical situations.
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Affiliation(s)
- Zohreh Kalani
- Department of Nursing, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Niloufar Chehelmard
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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19
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Morley G, Dierckx de Casterlé B, Kynoch K, Ramis MA, Suhonen R, Ventura C, Arries-Kleyenstuber E. Ethical challenges faced by nurses during the COVID-19 pandemic: a scoping review protocol. JBI Evid Synth 2023; 21:970-976. [PMID: 36692443 PMCID: PMC10173941 DOI: 10.11124/jbies-22-00247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this scoping review is to describe the literature reporting on ethical challenges faced by nurses during the COVID-19 pandemic, including the contextual characteristics of ethical challenges, and strategies to address reported challenges. INTRODUCTION The COVID-19 pandemic presented many ethical challenges to nurses, ranging from allocating scarce resources, to balancing a duty of care with self-preservation and implementing visitation restrictions. Internationally, there has been a range of reported issues, but few studies describe strategies to overcome these challenges. INCLUSION CRITERIA Studies that report on ethical challenges faced by nurses while caring for patients during the COVID-19 pandemic will be included. Studies that report on strategies to address these challenges will also be considered for inclusion. METHODS This scoping review will be conducted in accordance with methods outlined by JBI and reported on using PRISMA-ScR guidance. The following databases will be searched for eligible studies from November 2019 to present day: PubMed, CINAHL, Ovid, PsycINFO, the Cochrane Library, and Scopus. No language restrictions will be applied. Studies will be reviewed for inclusion by 2 independent reviewers and a data extraction form developed specifically for this review will be used to extract data relevant to the review questions. Results will be analyzed and presented according to the concepts of interest, using tables, figures, images, and supporting narrative synthesis.
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Affiliation(s)
- Georgina Morley
- Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, OH, USA
| | | | - Kathryn Kynoch
- The Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Mater Hospital, Brisbane, QLD, Australia
| | - Mary-Anne Ramis
- The Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Mater Hospital, Brisbane, QLD, Australia
| | - Riitta Suhonen
- University of Turku, Department of Nursing Science and Director of Nursing (part-time), Turku University Hospital and City of Turku, Welfare Services Division
| | - Carla Ventura
- University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
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20
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D’Alessandro-Lowe AM, Ritchie K, Brown A, Xue Y, Pichtikova M, Altman M, Beech I, Millman H, Levy Y, Asma S, Hassall K, Foster F, Rodrigues S, Hosseiny F, O’Connor C, Heber A, Malain A, Schielke H, Lanius RA, McCabe RE, McKinnon MC. Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic. Eur J Psychotraumatol 2023; 14:2171751. [PMID: 36880459 PMCID: PMC9990694 DOI: 10.1080/20008066.2023.2171751] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023] Open
Abstract
Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units.Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units.Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05).Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs.
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Affiliation(s)
| | - Kimberly Ritchie
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | | | - Yuanxin Xue
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Mina Pichtikova
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Max Altman
- McMaster University, Hamilton, Ontario, Canada
| | - Isaac Beech
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | | | - Yarden Levy
- McMaster University, Hamilton, Ontario, Canada
| | - Senay Asma
- McMaster University, Hamilton, Ontario, Canada
| | - Kelly Hassall
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Fatima Foster
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sara Rodrigues
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Ottawa Institute for Mental Health at the Royal, Ottawa, Ontario, Canada
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Ottawa Institute for Mental Health at the Royal, Ottawa, Ontario, Canada
| | | | - Alexandra Heber
- McMaster University, Hamilton, Ontario, Canada
- Veterans Affairs Canada
| | - Ann Malain
- Homewood Health Centre, Guelph, Ontario, Canada
| | | | - Ruth A. Lanius
- University of Western Ontario, London, Ontario, Canada
- Lawson Research Institute, London, Ontario, Canada
| | - Randi E. McCabe
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret C. McKinnon
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
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21
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Siddiqui I, Gupta J, Collett G, McIntosh I, Komodromos C, Godec T, Ng S, Maniero C, Antoniou S, Khan R, Kapil V, Khanji MY, Gupta AK. Perceived workplace support and mental health, well-being and burnout among health care professionals during the COVID-19 pandemic: a cohort analysis. CMAJ Open 2023; 11:E191-E200. [PMID: 36854456 PMCID: PMC9981163 DOI: 10.9778/cmajo.20220191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Little is known about the relationship between workplace support and mental health and burnout among health care professionals (HCPs) during the COVID-19 pandemic. In this cohort study, we sought to evaluate the association between perceived level of (and changes to) workplace support and mental health and burnout among HCPs, and to identify what constitutes perceived effective workplace support. METHODS Online surveys at baseline (July-September 2020) and follow-up 4 months later assessed the presence of generalized anxiety disorder (using the 7-item Generalized Anxiety Disorder scale [GAD-7]), clinical insomnia, major depressive disorder (using the 9-item Patient Health Questionnaire), burnout (emotional exhaustion and depersonalization) and mental well-being (using the Short Warwick-Edinburgh Mental Wellbeing Score). Both surveys assessed self-reported level of workplace support (single-item Likert scale). For baseline and follow-up, independently, we developed separate logistic regression models to evaluate the association of the level of workplace support (tricohotomized as unsupported, neither supported nor unsupported and supported) with mental health and burnout. We also developed linear regression models to evaluate the association between the change in perceived level of workplace support and the change in mental health scores from baseline and follow-up. We used thematic analyses on free-text entries of the baseline survey to evaluate what constitutes effective support. RESULTS At baseline (n = 1422) and follow-up (n = 681), HCPs who felt supported had reduced risk of anxiety, depression, clinical insomnia, emotional exhaustion and depersonalization, compared with those who felt unsupported. Among those who responded to both surveys (n = 681), improved perceived level of workplace support over time was associated with significantly improved scores on measures of anxiety (adjusted β -0.13, 95% confidence interval [CI] -0.25 to -0.01), depression (adjusted β -0.17, 95% CI -0.29 to -0.04) and mental well-being (adjusted β 0.19, 95% CI 0.10 to 0.29), independent of baseline level of support. We identified 5 themes constituting effective workplace support, namely concern or understanding for welfare, information, tangible qualities of the workplace, leadership and peer support. INTERPRETATION We found a significant association between perceived level of (and changes in) workplace support and mental health and burnout of HCPs, and identified potential themes that constitute perceived workplace support. Collectively, these findings can inform changes in guidance and national policies to improve mental health and burnout among HCPs. Trial registration: ClinicalTrials.gov, no. NCT04433260.
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Affiliation(s)
- Imrana Siddiqui
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Jaya Gupta
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - George Collett
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Iris McIntosh
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Christina Komodromos
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Thomas Godec
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Sher Ng
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Carmela Maniero
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Sotiris Antoniou
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Rehan Khan
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Vikas Kapil
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Mohammed Y Khanji
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
| | - Ajay K Gupta
- Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG (Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute (Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute (A.K. Gupta), Imperial College London, London, UK
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Wentlandt K, Wolofsky KT, Weiss A, Hurlburt L, Fan E, Zimmermann C, Isenberg SR. Physician perceptions of restrictive visitor policies during the COVID-19 pandemic: a qualitative study. CMAJ Open 2023; 11:E110-E117. [PMID: 36750247 PMCID: PMC9911125 DOI: 10.9778/cmajo.20220048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Little is understood of the consequences of restrictive visitor policies that were implemented in hospitals to minimize risk of infection during the COVID-19 pandemic. The objective of this study was to describe physician experiences with these policies and reflections of their effects. METHODS We conducted semistructured phone interviews from September 2020 to March 2021 with physicians practising in Ontario hospitals, recruited via professional networks and snowball sampling. We audio-recorded, transcribed and analyzed interviews to describe and interpret overarching themes by thematic analysis. RESULTS We interviewed 21 physicians (5 intensivists, 5 internists, 11 specialists in palliative care). Four main thematic categories emerged, including provider, system, patient and caregiver effects. Provider-related factors included increased time and effort on communication with a need to establish limits; increased effort to develop rapport with caregivers; lack of caregiver input on patient care; the need to act as a caregiver surrogate; and the emotional toll of being a gatekeeper or advocate for visitors, exacerbated by lack of evidence for restrictions and inconsistent enforcement. System effects included the avoidance of hospital admission and decreased length of stay, leading to readmissions, increased deaths at home and avoidance of transfer to other facilities with similar policies. Patient-related factors included isolation and dying alone; lack of caregiver advocacy; and prioritization of visitor presence that, at times, resulted in a delay or withdrawal of aspects of care. Caregiver-related factors included inability to personally assess patient health, leading to poor understanding of patient status and challenging decision-making; perceived inadequate communication; difficulty accessing caregiver supports; and increased risk of complicated grief. Participants highlighted a disproportionate effect on older adults and people who did not speak English. INTERPRETATION Our study highlights substantial negative consequences of restrictive visitor policies, with heightened effects on older adults and people who did not speak English. Research is required to identify whether the benefits of visitor restrictions on infection control outweigh the numerous deleterious consequences to patients, families and care providers.
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Affiliation(s)
- Kirsten Wentlandt
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont.
| | - Kayla T Wolofsky
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Andrea Weiss
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Lindsay Hurlburt
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Eddy Fan
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Camilla Zimmermann
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
| | - Sarina R Isenberg
- Department of Supportive Care (Wentlandt, Wolofsky, Weiss, Hurlburt, Zimmerman), University Health Network; Department of Family and Community Medicine (Wentlandt, Weiss, Isenberg), University of Toronto; Department of Medicine (Wolofsky, Hurlburt), University of Toronto; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation (Fan), University of Toronto; Division of Palliative Medicine, Department of Medicine (Zimmermann), University of Toronto, Toronto, Ont.; Department of Medicine, University of Ottawa (Isenberg); Bruyère Research Institute (Isenberg), Ottawa, Ont
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23
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Kerman N, Ecker J, Tiderington E, Aykanian A, Stergiopoulos V, Kidd SA. “Systems trauma”: A qualitative study of work-related distress among service providers to people experiencing homelessness in Canada. SSM - Mental Health 2022. [DOI: 10.1016/j.ssmmh.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kapil V, Collett G, Godec T, Gupta J, Maniero C, Ng SM, McIntosh I, Kumar A, Nair S, Kotecha A, Janmohamed A, Antoniou S, Khan R, Khanji MY, Siddiqui I, Gupta A. Longitudinal comparisons of mental health, burnout and well-being in patient-facing, non-patient-facing healthcare professionals and non-healthcare professionals during the COVID-19 pandemic: findings from the CoPE-HCP study. BJPsych Open 2022; 8:e173. [PMID: 36164721 PMCID: PMC9530379 DOI: 10.1192/bjo.2022.579] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic may disproportionately affect the mental health of healthcare professionals (HCPs), especially patient-facing HCPs. AIMS To longitudinally examine mental health in HCPs versus non-HCPs, and patient-facing HCPs versus non-patient-facing HCPs. METHOD Online surveys were distributed to a cohort at three phases (baseline, July to September 2020; phase 2, 6 weeks post-baseline; phase 3, 4 months post-baseline). Each survey contained validated assessments for depression, anxiety, insomnia, burnout and well-being. For each outcome, we conducted mixed-effects logistic regression models (adjusted for a priori confounders) comparing the risk in different groups at each phase. RESULTS A total of 1574 HCPs and 147 non-HCPs completed the baseline survey. Although there were generally higher rates of various probable mental health issues among HCPs versus non-HCPs at each phase, there was no significant difference, except that HCPs had 2.5-fold increased risk of burnout at phase 2 (emotional exhaustion: odds ratio 2.50, 95% CI 1.15-5.46, P = 0.021), which increased at phase 3 (emotional exhaustion: odds ratio 3.32, 95% CI 1.40-7.87, P = 0.006; depersonalisation: odds ratio 3.29, 95% CI 1.12-9.71, P = 0.031). At baseline, patient-facing HCPs (versus non-patient-facing HCPs) had a five-fold increased risk of depersonalisation (odds ratio 5.02, 95% CI 1.65-15.26, P = 0.004), with no significant difference in the risk for other outcomes. The difference in depersonalisation reduced over time, but patient-facing HCPs still had a 2.7-fold increased risk of emotional exhaustion (odds ratio 2.74, 95% CI 1.28-5.85, P = 0.009) by phase 3. CONCLUSIONS The COVID-19 pandemic had a huge impact on the mental health and well-being of both HCPs and non-HCPs, but there is disproportionately higher burnout among HCPs, particularly patient-facing HCPs.
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Affiliation(s)
- Vikas Kapil
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, UK; William Harvey Research Institute, Queen Mary University of London, UK; and Department of Clinical Pharmacology, The Royal London Hospital, Barts Health NHS Trust, UK
| | - George Collett
- William Harvey Research Institute, Queen Mary University of London, UK
| | - Thomas Godec
- William Harvey Research Institute, Queen Mary University of London, UK
| | - Jaya Gupta
- Child and Adolescent Mental Health Service, South West London and St George's Mental Health NHS Trust, UK
| | - Carmela Maniero
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, UK; and William Harvey Research Institute, Queen Mary University of London, UK
| | - Sher M Ng
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, UK
| | - Iris McIntosh
- Islington Learning Disability Partnership, Camden & Islington Foundation Trust, UK
| | - Abhishek Kumar
- Department of Cardiology, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - Satheesh Nair
- Department of Cardiology, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, UK
| | - Ashish Kotecha
- Department of Cardiology, Royal Devon and Exeter Hospital, UK
| | - Azara Janmohamed
- Department of Clinical Pharmacology, St George's University Hospitals NHS Foundation Trust, UK
| | - Sotiris Antoniou
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, UK; and Cardiovascular Health, UCLPartners, UK
| | - Rehan Khan
- Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, UK
| | - Mohammed Y Khanji
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, UK; William Harvey Research Institute, Queen Mary University of London, UK; Cardiovascular Health, UCLPartners, UK; and Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, UK
| | - Imrana Siddiqui
- Wellbeing Hub, Newham Training Hub, UK; NHS North East London Integrated Care Board (ICB), UK; and Woodgrange Medical Practice, UK
| | - Ajay Gupta
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, UK; William Harvey Research Institute, Queen Mary University of London, UK; and Department of Clinical Pharmacology, The Royal London Hospital, Barts Health NHS Trust, UK
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Sonis J, Pathman DE, Read S, Gaynes BN. A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic. PLoS One 2022; 17:e0268375. [PMID: 35576206 PMCID: PMC9109912 DOI: 10.1371/journal.pone.0268375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress. Methods We conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales. Results The response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care. Conclusions The intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.
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Affiliation(s)
- Jeffrey Sonis
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Donald E. Pathman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Susan Read
- Research Center, American College of Physicians, Philadelphia, Pennsylvania, United States of America
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Simm K, Zameska J, Lubi K. Frontline Healthcare Professionals’ Views Regarding the Impact of COVID-19 on Ethical Decision-Making: A Multicentre Mixed-Methods Study from Estonia. Healthcare (Basel) 2022; 10:711. [PMID: 35455888 PMCID: PMC9032527 DOI: 10.3390/healthcare10040711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background: The objective of the study was to investigate frontline healthcare professionals’ experiences and attitudes in relation to the COVID-19 pandemic’s ethical and psychosocial aspects in Estonia. There were two research foci: first, ethical decision-making related to treating patients in the context of potential medical resource scarcity, and second, other psychosocial factors for healthcare professionals pertaining to coping, role conflicts, and the availability of institutional support. Methods: An online survey was conducted in the fall of 2020 amongst the frontline healthcare professionals working in the three most impacted hospitals; respondents were also drawn from two ambulance services. The focus of the survey was on the first wave of COVID-19 (spring 2020). A total of 215 respondents completed the quantitative survey and qualitative data were gathered from open comments. Results: Over half of the surveyed healthcare professionals in Estonia expressed confidence in their roles during the pandemic. More than half cited the complex ethical aspects related to their decisions as their main source of doubt and uncertainty. In response to this uncertainty, Estonian healthcare professionals drew on their previous training and experience, the policies and guidelines of their institution, and support from their colleagues, to aid their decision-making during the pandemic. Conclusions: Although frontline healthcare professionals faced difficult decisions during the first wave of the pandemic, overall, most agreed that experiencing the pandemic reconfirmed that their work mattered greatly.
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Gibney RN, Blackman C, Gauthier M, Fan E, Fowler R, Johnston C, Jeremy Katulka R, Marcushamer S, Menon K, Miller T, Paunovic B, Tanguay T. COVID-19 pandemic: the impact on Canada’s intensive care units. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.
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Affiliation(s)
- R.T. Noel Gibney
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Cynthia Blackman
- Dr. Cynthia Blackman and Associates, Edmonton, AB M5R 3R8, Canada
| | - Melanie Gauthier
- Faculty of Nursing, McGill University, Montréal, QC Canada
- President, Canadian Association of Critical Care Nurses, Quebec, QC, Canada
| | - Eddy Fan
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert Fowler
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, ON M5S 1A1, Canada
| | - Curtis Johnston
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - R. Jeremy Katulka
- Department of Medicine, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Samuel Marcushamer
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - Kusum Menon
- Paediatric Intensive Care Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON K1N 6N5, Canada
- Paediatric Intensive Care Unit, Department of Pediatrics, University of Ottawa, Ottawa, ON T6G 2R3, Canada
| | - Tracey Miller
- Intensive Care Unit, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
| | - Bojan Paunovic
- Department of Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- President, Canadian Critical Care Society, Winnipeg, MB R3T 2N2, Canada
| | - Teddie Tanguay
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
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Smith-MacDonald L, Lusk J, Lee-Baggley D, Bright K, Laidlaw A, Voth M, Spencer S, Cruikshank E, Pike A, Jones C, Bremault-Phillips S. Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic. Front Psychiatry 2021; 12:801680. [PMID: 35115972 PMCID: PMC8805113 DOI: 10.3389/fpsyt.2021.801680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION In the context of the global pandemic of the SARS-CoV-2 coronavirus (COVID-19), healthcare providers (HCPs) have experienced difficult moral and ethical dilemmas. Research is highlighting the importance of moral injury (MI)-a trauma syndrome related to transgressing personal morals and values-in understanding the psychological harm and occupational impairment experienced by HCPs. To date, MI treatments have largely been developed for military personnel and veterans and rely on in-person one-on-one psychotherapy. PURPOSE This project aims to explore the feasibility and acceptability of an evidence-informed online Acceptance and Commitment Therapy-based group therapy for MI in HCPs called "Accepting Moral Pain and Suffering for Healthcare Providers" (AMPS-HCP). METHOD This feasibility and acceptability study included three separate phases with the first two phases focused on the development of the psychotherapeutic intervention and the third phase focused on the evaluation of the psychotherapeutic intervention. Eight participants (including registered nurses, practical nurses and respiratory therapists) completed seven 90-min sessions in an online group format. The focus of these sessions included ACT and MI psychoeducation and experientials. Qualitative semi-structured interview data was thematically analyzed while demographic and quantitative self-reported outcome data underwent descriptive analysis and non-parametric testing. RESULTS Results show that the intervention was highly feasible and acceptable to healthcare providers who worked on the frontline during COVID-19. Feasibility (referrals, eligibility, retention, participation engagement) was strong (8 out of 10 participants; 80% vs. desired >70% eligibility) and overall, 80% of participants completed 71% of the intervention. Data further supported the applicability and acceptability of the intervention. Preliminary data suggests that AMPS-HCP may supports HCPs to address MI. DISCUSSION This study is the first to report on the development and evaluation of an online MI group intervention for registered nurses, registered practical nurses, and respiratory therapists working during COVID-19. Results showed the use of both the online and group components of the intervention were acceptable and feasible during the third wave of COVID-19.
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Affiliation(s)
| | - Jaimie Lusk
- Department of Veterans Affairs, Portland Medical Center, Portland, OR, United States
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Katherine Bright
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Alexa Laidlaw
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Melissa Voth
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Shaylee Spencer
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Emily Cruikshank
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Ashley Pike
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Chelsea Jones
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Medical Centre, Department of Psychiatry, Leiden University, Leiden, Netherlands
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