scholarly journals Organizational Impact on Healthcare Workers' Moral Injury During COVID-19

2022 ◽  
Vol 52 (1) ◽  
pp. 57-66
Author(s):  
Katie E. Nelson ◽  
Ginger C. Hanson ◽  
Danielle Boyce ◽  
Cathaleen D. Ley ◽  
Deborah Swavely ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Moral Injury ◽  
Organizational Impact

scholarly journals Ethical and psychosocial considerations for hospital personnel in the Covid-19 crisis: Moral injury and resilience

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249609
Author(s):  
Alexander Kreh ◽  
Rachele Brancaleoni ◽  
Sabina Chiara Magalini ◽  
Daniela Pia Rosaria Chieffo ◽  
Barbara Flad ◽  
...  
Keyword(s):  
Mental Health Professionals ◽  
Healthcare Workers ◽  
Psychosocial Support ◽  
Integrated Approach ◽  
Essential Elements ◽  
Moral Injury ◽  
Psychosocial Effects ◽  
Organisational Justice ◽  
Decentralized Decision Making ◽  
Stress Experience

This study aims at investigating the nature of resilience and stress experience of health care workers during the COVID-19 pandemic. Thirteen healthcare workers from Italian and Austrian hospitals specifically dealing with COVID-19 patients during the first phase of the pandemic were interviewed. Data was analysed using grounded theory methodology. Psychosocial effects on stress experience, stressors and resilience factors were identified. We generated three hypotheses. Hypothesis one is that moral distress and moral injury are main stressors experienced by healthcare workers. Hypothesis two states that organisational resilience plays an important part in how healthcare workers experience the crisis. Organisational justice and decentralized decision making are essential elements of staff wellbeing. Hypothesis three refers to effective psychosocial support: Basic on scene psychosocial support based on the Hobfoll principles given by trusted and well-known mental health professionals and peers in an integrated approach works best during the pandemic.

scholarly journals Lived experiences of healthcare workers on the front line during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053680
Author(s):  
Kate Grailey ◽  
Adam Lound ◽  
Stephen Brett
Keyword(s):  
Lived Experiences ◽  
Healthcare Workers ◽  
Psychological Safety ◽  
Qualitative Interview ◽  
Psychological Effects ◽  
Moral Injury ◽  
Team Dynamics ◽  
Front Line ◽  
Qualitative Interview Study ◽  
The Impact

ObjectivesThis study aimed to investigate the presence of perceived stressors, psychological safety and teamwork in healthcare professionals. As the timeframe for this study spanned the first wave of the COVID-19 pandemic, data were captured demonstrating the impact of the pandemic on these factors.DesignQualitative interview study.SettingAll staff working within the emergency and critical care departments of one National Health Service Trust in London, UK.ParticipantsForty-nine participants were recruited using a purposive sampling technique and interviewed when the first wave of the COVID-19 pandemic had subsided.Main outcome measuresEvaluation of changes in perceived stressors, psychological safety and teamwork in individuals working during the COVID-19 pandemic.ResultsThe thematic analysis relating to a participant’s lived experiences while working during COVID-19 led to the construction of five key themes, including ‘psychological effects’ and ‘changes in team dynamics’. Several psychological effects were described, including the presence of psychological distress and insights into the aetiology of moral injury. There was marked heterogeneity in participants’ response to COVID-19, particularly with respect to changes in team dynamics and the perception of a psychologically safe environment. Descriptions of improved team cohesiveness and camaraderie contrasted with stories of new barriers, notably due to the high workload and the impact of personal protective equipment. Building on these themes, a map of key changes arising due to the pandemic was developed, highlighting potential opportunities to provide targeted support.ConclusionsWorking on the front line of a pandemic can have significant implications for healthcare workers, putting them at risk of psychological distress and moral injury, as well as affecting team dynamics. There is striking heterogeneity in the manifestation of these challenges. Team leaders can use the themes and qualitative data from this study to help identify areas for management focus and individual and team support.

scholarly journals The psychosocial impact of the COVID-19 pandemic on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

2021 ◽  
Author(s):  
Danielle Lamb ◽  
Sam Gnanapragasam ◽  
Neil Greenberg ◽  
Rupa Bhundia ◽  
Ewan Carr ◽  
...  
Keyword(s):  
Mental Health ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Healthcare Workers ◽  
Alcohol Misuse ◽  
Common Mental Disorders ◽  
Moral Injury ◽  
List Type ◽  
Post Traumatic Stress ◽  
Post Traumatic

AbstractObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety (GAD-7), depression (PHQ-9), Post-Traumatic Stress Disorder (PTSD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES).ResultsAnalyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression (27.3%, 95%CI 25.3 to 29.4), anxiety (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of CMDs, anxiety, depression, PTSD symptoms, and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.HighlightsWhat is already known about this subject?Large-scale population studies report increased prevalence of depression, anxiety, and psychological distress during the COVID-19 pandemic.Evidence from previous epidemics indicates a high and persistent burden of adverse mental health outcomes among healthcare workers.What are the new findings?Substantial levels of probable common mental disorders and post-traumatic stress disorder were found among healthcare workers.Groups at increased risk of adverse mental health outcomes included women, nurses, and younger staff, as well as those who reported higher levels of moral injury.How might this impact on policy or clinical practice in the foreseeable future?The mental health offering to healthcare workers must consider the interplay of demographic, social, and occupational factors.Additional longitudinal research that emphasises methodological rigor, namely with use of standardised diagnostic interviews to establish mental health diagnoses, is necessary to better understand the mental health burden, identify those most at risk, and provide appropriate support without pathologizing ordinary distress responses.

scholarly journals Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

2021 ◽  
pp. oemed-2020-107276
Author(s):  
Danielle Lamb ◽  
Sam Gnanapragasam ◽  
Neil Greenberg ◽  
Rupa Bhundia ◽  
Ewan Carr ◽  
...  
Keyword(s):  
Mental Health ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Healthcare Workers ◽  
Alcohol Misuse ◽  
Stress Disorder ◽  
Moral Injury ◽  
Health Questionnaire ◽  
Post Traumatic Stress ◽  
Post Traumatic

ObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April–June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale.ResultsAnalyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

scholarly journals COVID-19 pandemic causing medical and public health ethical dilemmas: A case report and review of literature

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Jarelys Hernandez ◽  
Barbara Lubrano di Ciccone ◽  
Sarah Thirlwell ◽  
Margaret Booth-Jones ◽  
Sadaf Aslam ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare Workers ◽  
Hematological Malignancy ◽  
Ethical Dilemmas ◽  
Standard Of Care ◽  
Moral Injury ◽  
Review Of Literature ◽  
Ethical Challenges ◽  
Advanced Directive ◽  
The Public

The COVID-19 pandemic presented myriad of unprecedented and daunting ethical dilemmas to healthcare workers, patients, their families, and the public health. Here we present a case of a 42-years-old Hispanic female with underlying hematological malignancy that developed severe SARS-COV-2 infection amidst the pandemic. This case illustrates some remarkable ethical dilemmas during pandemic times, including the lack of advanced directive planning, the repercussions of restricting family visits, and what ethics in crisis and moral injury entails. Identifying the ethical challenges emerging from the pandemic will assist physicians and other providers in making proper decisions and maintaining the best standard of care.

scholarly journals Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Doron Amsalem ◽  
Amit Lazarov ◽  
John C. Markowitz ◽  
Aliza Naiman ◽  
Thomas E. Smith ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Healthcare Workers ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
Moral Injury ◽  
Generalized Anxiety ◽  
Anxiety Depression

Abstract Background Emerging cross-sectional data indicate that healthcare workers (HCWs) in the COVID-19 era face particular mental health risks. Moral injury – a betrayal of one’s values and beliefs, is a potential concern for HCWs who witness the devastating impact of acute COVID-19 illness while too often feeling helpless to respond. This study longitudinally examined rates of depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and moral injury among United States HCWs in the COVID-19 era. We anticipated finding high levels of clinical symptoms and moral injury that would remain stable over time. We also expected to find positive correlations between clinical symptoms and moral injury. Methods This three-wave study assessed clinical symptoms and moral injury among 350 HCWs at baseline, 30, and 90 days between September and December 2020. Anxiety, depression, PTSD, and moral injury were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Primary Care PTSD Screen (PC-PTSD), and Moral Injury Events Scale (MIES). Results Of the 350 HCWs, 72% reported probable anxiety, depression, and/or PTSD disorders at baseline, 62% at day 30, and 64% at day 90. High level of moral injury was associated with a range of psychopathology including suicidal ideation, especially among healthcare workers self-reporting COVID-19 exposure. Conclusions Findings demonstrate broad, persisting, and diverse mental health consequences of the COVID-19 pandemic among United States HCWs. This study is the first to longitudinally examine the relationships between moral injury and psychopathology among HCWs, emphasizing the need to increase HCWs’ access to mental healthcare.

scholarly journals Ethical and psychosocial considerations for hospital personnel in the Covid-19 crisis: Moral injury and resilience

2020 ◽  
Author(s):  
Alexander Kreh ◽  
Rachele Brancaleoni ◽  
Sabina Chiara Magalini ◽  
Daniela Pia Rosaria Chieffo ◽  
Barbara Flad ◽  
...  
Keyword(s):  
Mental Health Professionals ◽  
Healthcare Workers ◽  
Psychosocial Support ◽  
Integrated Approach ◽  
Essential Elements ◽  
Moral Injury ◽  
Psychosocial Effects ◽  
Organisational Justice ◽  
Decentralized Decision Making ◽  
Stress Experience

AbstractThis study aims at investigating the nature of resilience and stress experience of health care workers during the COVID-19 pandemic. Thirteen healthcare workers from Italian and Austrian hospitals specifically dealing with COVID-19 patients during the first phase of the pandemic were interviewed. Data was analysed using grounded theory methodology. Psychosocial effects on stress experience, stressors and resilience factors were identified. We generated three hypotheses. Hypothesis one is that moral distress and moral injury are main stressors experienced by healthcare workers. Hypothesis two states that organisational resilience plays an important part in how healthcare workers experience the crisis. Organisational justice and decentralized decision making are essential elements of staff wellbeing. Hypothesis three refers to effective psychosocial support: Basic on scene psychosocial support based on the Hobfoll principles given by trusted and well-known mental health professionals and peers in an integrated approach works best during the pandemic.

The Organizational Impact of Presenteeism among Key Healthcare Workers due to the COVID-19 Pandemic

2021 ◽  
pp. 003464462110651
Author(s):  
Shelley I. White-Means ◽  
Carol L. Warren ◽  
Ahmad Reshad Osmani
Keyword(s):  
Healthcare Workers ◽  
Organizational Impact

scholarly journals Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic

2021 ◽  
Vol 18 (2) ◽  
pp. 488
Author(s):  
Stella E. Hines ◽  
Katherine H. Chin ◽  
Danielle R. Glick ◽  
Emerson M. Wickwire
Keyword(s):  
Healthcare Workers ◽  
Tertiary Care ◽  
Moral Injury ◽  
Poor Sleep ◽  
Care Hospital ◽  
Convenience Sample ◽  
Psychiatric Distress ◽  
Resilience Factors ◽  
Resiliency Factors ◽  
The Impact

The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.

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