Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients

One factor potentially driving healthcare and hospital worker (HHW)'s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others' pandemic-related responses and behaviors. We investigated whether HHWs' betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

Zika and Flint Water Public Health Emergencies: Disaster Training Tool Kits Relevant to Pregnant Women and Children

Pregnant women and children and individuals suffering from chronic illness are disproportionally impacted by public health emergencies. To meet the healthcare needs of these populations, the nursing workforce must be capable of responding in a timely and appropriate manner. The goal of this project was to create interactive and engaging evidence-based educational tool kits to advance healthcare provider readiness in the management of population health in response to the Zika and Flint Water crises. A multipronged, mixed-methods approach was used to identify essential education needs and required core competencies. Data were synthesized from discussion with key informants, review of relevant documents, and surveys of schools of nursing, public health, and medicine. The ADDIE model was used to integrate results into the development of the online learning tool kits using the ThingLink software program. An innovative online educational program to prepare healthcare providers to rapidly identify, mitigate, and manage the impact of the Zika and Flint Water crises upon pregnant women and children was implemented by the Society for the Advancement of Disaster Nursing. Innovative online learning tool kits can advance healthcare provider readiness by increasing knowledge and understanding of key components of specific public health emergencies.

Health systems and maternal and child survival in Central Asian Republics

PURPOSE

To describe the status of health care systems in five Central Asian Republics (CAR): Kyrgzstan, Kazakhstan, Uzbekistan, Turkmenistan, and Tajikistan, with particular attention to women's and children's health.

ORGANIZING CONSTRUCT

Changing mortality profiles are investigated using the "protracted-polarized" model of epidemiologic transition.

SOURCES

Empirical evidence was drawn from the World Health Organization (WHO) database for the region, along with additional evidence presented at a maternal-child health conference held in Bishkek, Kyrgyzstan, on November 11-14, 1998. The conference was sponsored by the Albert Schweitzer Institute and the Soros Foundation. This evidence is evaluated for completeness, validity, and reliability. Trends are identified using the 1998 and 1999 World Health Reports and 1999/2000 World Bank Development Report.

FINDINGS

Incomplete data prohibited comprehensive analysis. Available data indicated high but variable rates of maternal and child mortality and overall declines in health status and the health care infrastructure in the 1990s.

CONCLUSIONS

Data collection and analysis from this part of the world are often incomplete and unreliable. Future research should focus on improving maternal and child health indicators by enhancing resource sharing and opportunities for international collaboration.

Still falling: a community-wide infant walker injury prevention initiative

Despite the well-known risk of injury associated with use of infant walkers, they remain popular, leading to large numbers of walker-related injuries. A coalition of health care providers and educators, with the assistance of retailers and medical and human service agencies, undertook an intensive multifaceted, community-wide intervention to educate the general and health care public regarding the dangers of infant walker use and thereby reduce the number of walker-related injuries in our community. Following this intervention, 28% fewer children presented annually at the two area pediatric emergency departments for walker-related falls down stairs than during the 30 months before the intervention. The magnitude of this reduction attributable to the intervention, however, is uncertain, as national trends during the study period revealed a similar decrease in walker-related injuries. Educational interventions alone may significantly reduce but not eliminate walker-related injuries; national policy measures are likely also necessary.

An evidence-based curriculum to prepare students for global nursing practice

This article describes a curriculum designed to prepare nurses for global public health practice. Designed to be adapted to meet the needs of either undergraduate or graduate students, the curriculum uses the Internet to provide the knowledge and skills needed by nurses to effectively practice in areas around the globe. This course offering integrates the disciplines of nursing and public health with state-of-the-art technology to teach nurses how to identify the health care needs of populations, prioritize national and international responses, and design health care delivery services to meet these needs.

Children's exposure to community violence

PURPOSE

To analyze the effects of exposure to chronic community violence on children and adolescents.

DESIGN

An integrative review of the literature was conducted on reports of studies about children's exposure to community violence.

SOURCES

Studies for analysis were identified through a literature search of relevant topics in Medline, CINAHL, and PsycINFO.

CONCLUSIONS

Exposure to community violence is related to significant stress and depression in children. Evidence on how exposure to violence affects children's growth patterns, intellectual growth, school performance, decision-making ability, or their hope for a future is needed.

Implementation of a disease-specific care plan changes clinician behaviors

The study objective was to determine the impact on quality of care, resource use, and outcomes by developing an emergency department (ED)-based asthma-specific care plan. The design was a time based, prospective cohort and set at an urban university/trauma center, EM residency site, combined adult/pediatric department. Best practice was defined prospectively for ED asthma patients, leading to an asthma care plan (ACP). Triage nurses were instructed to begin use of ACP when patients presented with asthma as the primary complaint. Charts of all patients diagnosed with asthma during 3-month study period were retrospectively reviewed against predefined outcomes. Results were analyzed with chi2 or student's t tests. After ACP introduction, the timeliness of beta agonist treatments (three beta agonist treatments within 90 minutes; 86% versus 63%, P < .05) and ED length of stay (LOS) (3.39 +/- 1.88 hrs versus 3.87 +/- 2.12 hrs, P < .05) improved. After introduction of ACP, only 55% of patients diagnosed with asthma had care documented on the ACP (ACP+ group). ACP+ group had more timely beta agonist treatment (93% versus 74%, P < .01), shorter LOS (3.29 +/- 1.90 vs. 3.53 +/- 1.86 hrs, P < 0.5) more appropriate steroid dosages (67% versus 41%, P < .01), and fewer tests (41% versus 59%, P < .05). No improvements were noted in admission or relapse rates. In conclusion, care plans can improve quality of care and decrease LOS, but may have limited impact on outcomes of admission/discharge or relapse rates.