Moral Injury, Traumatic Stress, and Threats to Core Human Needs in Health-Care Workers: The COVID-19 Pandemic as a Dehumanizing Experience

2022 ◽  
pp. 216770262110575
Author(s):  
Sarah L. Hagerty ◽  
Leanne M. Williams

The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.

Author(s):  
М.А. Падун

Анализируются риски психической травматизации у работников сферы здравоохранения в период пандемии COVID-19. Рассматриваются два источника психической травмы у медицинских работников: (1) переживание угрозы собственному здоровью и жизни, а также заражения родных и близких; (2) моральная травматизация в связи с перегрузкой системы здравоохранения и гибелью большого числа пациентов; моральными дилеммами при распределении ресурсов между пациентами; переживанием оставленности в опасной ситуации со стороны системы здравоохранения в условиях дефицита средств индивидуальной защиты; отсутствием солидарности со стороны несоблюдающих карантин граждан. Обсуждается уязвимость самоуважения к воздействию моральной травмы, а также указывается на его роль при совладании с ситуациями, представляющими угрозу жизни. Приводятся результаты зарубежных исследований психологических последствий пандемии для медицинских работников. Анализируются механизмы дополнительного дистресса, связанного с дискурсом героизации и дегероизации медработников. Утверждается, что навязывание социальной роли героя может привести к саморастрачиванию, ощущению себя жертвой, дистрессу и психическому истощению. Указывается на наличие противоречия между проводимой информационной политикой героизации медработников в условиях пандемии и недостатком реальной заботы об их безопасности в российских регионах. Наряду с негативными, обсуждаются возможные позитивные психологические последствия переживания кризиса. Обсуждаются меры профилактики негативных психологических последствий деятельности медработников в условиях эпидемии, которые разделяются на четыре уровня: (1) государства; (2) организации; (3) руководителей конкретных подразделений; (4) горизонтального взаимодействия между коллегами: врачами, медсестрами, санитарами. The risks of psychological trauma in health care workers during the COVID-19 pandemic are analyzed. Two sources of psychological traumatization in health care workers were considered: (1) experiencing the threat to one 's health and life, as well as infection of relatives and family members; (2) moral injury due to the collapse of health care systems and the death of many patients; moral dilemma in the allocation of resources among patients; leaving by the health care system with the lack of personal protective equipment; lack of solidarity of citizens resisted to quarantine. The vulnerability of self-esteem to moral injury and its role in dealing with dangerous situations was discussed. The results of international studies of the psychological consequences of the pandemic for health care workers were given. Mechanisms of additional distress associated with the discourse of heroization and deheroization of health care workers are analyzed. It was argued that imposing a hero 's social role can lead to victimization, distress, and exhaustion. It was pointed out that there was a contradiction between the information policy of the medical workers' glorification and the lack of their real security in Russian regions. In addition to the negative, the possible positive psychological consequences of experiencing the crisis were discussed. Measures to prevent the negative psychological effects on health care workers in the epidemic were discussed. These measures were divided into four levels: (1) states; (2) organizations; (3) heads of specific units; (4) horizontal interaction between colleagues: doctors, nurses, hospital attendants.


2021 ◽  
Author(s):  
Zahra Zarei Jelyani ◽  
Sadra Valiee ◽  
Mohammad Kia ◽  
Ali jajarmizadeh ◽  
Sajad Delavari

Abstract Introduction: Generally, in Epidemics, such as COVID-19, health care workers (HCWs) faces many problems which lead to a shortage and weakening of human resources in the health system. Therefore, using effective strategies to retain human resources is one of the most important issues during outbreaks. This study aims to collect and classify the proposed interventions to strengthen human health resources and their sustainability during epidemics through scoping review.Methods: In this scoping review study, 2300 studies were retrieved through searching international databases –PubMed, Embase, Scopus and Web of Science. The retrieved studies were screened, and finally, 50 studies were included for analysis. The strategies were classified using inductive qualitative content analysis.Results: Most of the studies were conducted in the United States and the United Kingdom. The target population in 39 studies was all health workers; five studies were on physicians, five studies on nurses, and only one study on dentists. The proposed interventions were classified into five categories: preparation, protection, support, treatment, and feedback. Discussion: Most studies focused on providing interventions in one or two dimensions of human resources, but these interventions were summarized and categorized in this review. Therefore, this study has a holistic view of various dimensions of strengthening and maintaining human health resources during epidemics by providing a thematic map. Considering that human beings are multidimensional, policymakers and managers of the health system should use a set of interventions that simultaneously cover different aspects of their needs to strengthen and maintain HCWs.


2006 ◽  
Vol 21 (2) ◽  
pp. 181-184 ◽  
Author(s):  
William D. King ◽  
Steffie J. Woolhandler ◽  
Arleen F. Brown ◽  
Luohua Jiang ◽  
Kristine Kevorkian ◽  
...  

Author(s):  
Rajni Rai ◽  
Sonia El-Zaemey ◽  
Nidup Dorji ◽  
Lin Fritschi

Background: Collection of reliable and valid occupational history data is of utmost importanceto assess work-related exposures and their health effects. Few standardized questionnairesare available for the collection of occupational history data in low-and-middle incomecountries. Objective: To adapt and test a validated questionnaire developed in the United States by theNational Institute of Safety and Health, in order to assess occupational chemical exposuresamong health care workers in Bhutan. Methods: The questionnaire was first adapted to suit the Bhutanese context with the adviceof an expert review committee. 30 health care workers then completed the questionnaire atbaseline and 10–14 days later. Test-retest reliability was assessed by calculating Cohen's κand percentage agreement. Results: The questionnaire had high test-retest reliability. Cohen's κ ranged from 0.61 to1.00, and percentage agreement ranged from 86.7% to 100%. Further adaptations includedomitting questions on chemicals not available in Bhutan. Conclusion: The adapted questionnaire is appropriate for assessing occupational chemicalexposures among health care workers in Bhutan.


2020 ◽  
Vol 11 ◽  
pp. 215145932093055 ◽  
Author(s):  
Timothy T. Wills ◽  
Wilhelm A. Zuelzer ◽  
Bryant W. Tran

Background: The novel coronavirus disease (COVID-19) has afflicted millions of people worldwide since its first case was reported in December 2019. Personal protective equipment (PPE) has been tailored accordingly, but as of April 2020, close to 10 000 health care workers in the United States have contracted COVID-19 despite wearing recommended PPE. As such, standard guidelines for PPE may be inadequate for the health care worker performing high-risk aerosolizing procedures such as endotracheal intubation. In this brief technical report, we describe the integration of an orthopedic hood cover as an item for full barrier protection against COVID-19 transmission. Technical Description: The Coronavirus Airway Task Force at Virginia Commonwealth University Medical Center approved this initiative and went live with the full barrier suit during the last week of March 2020. The PPE described in this report includes a Stryker T4 Hood, normally used in conjunction with the Stryker Steri-Shield T4 Helmet. Instead of the helmet, the hood is secured to the head via a baseball cap and binder clip. This head covering apparatus is to be used as an accessory to other PPE items that include an N95 mask, waterproof gown, and disposable gloves. The motor ventilation system is not used in order to prevent airborne viral entry into the hood. Discussion: An advantage of the full barrier suit is an additional layer of droplet protection during intubation. The most notable disadvantage is the absence of a ventilation system within the hood covering. Conclusion: Modification of existing PPE may provide protection for health care workers during high-risk aerosolizing procedures such as endotracheal intubation. Although the integration of this medical equipment meets the immediate needs of an escalating crisis, further innovation is on the horizon. More research is needed to confirm the safety of modified PPE.


SARS ◽  
2005 ◽  
pp. 96-106 ◽  
Author(s):  
Robert Maunder ◽  
William J. Lancee ◽  
Sean B. Rourke ◽  
Jonathan Hunter ◽  
David S. Goldbloom ◽  
...  

2021 ◽  
Author(s):  
Aboobacker Mohamed Rafi ◽  
Maglin Monica Lisa Joseph Tomy ◽  
Ronnie Thomas ◽  
Chithra Valsan ◽  
U G Unnikrishnan ◽  
...  

AbstractBackgroundKerala was the first state to have the confirmed case of COVID-19 in the country and it was first confirmed in Thrissur district on 30 January2020.Our institute being in the heart of the city had to take adequate measures to mitigate the spread and treat the required patients by keeping its staff safe & Healthy. The hallmark of COVID 19 infection is high infectivity, pre-symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalizations, and deaths. Kerala was the first state to confirm community transmission in July 2020.Health care workers being in the forefront in the war against COVID19 are very prone in acquiring the infection and are possible to be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV2 antibodies in the population contributes to the epidemiological understanding of the disease. The intent of the study is to do an antibody testing in our hospital to find the serosurveillance of SARS CoV 2 among the healthcare workers in our hospital.AimTo estimate the seropositivity of SARS CoV 2 among the healthcare workers at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, six months after revoking the lockdownMethodologyA cross sectional study among the health care workers of the medical college. Multistage Sampling was done with the hospital block as the first stage and departments as the second stage. In the final stage of sampling the test individuals were selected on a first come first served basis after the antibody test availability was declared open and free for all staff. A consent form and a Google form were given to all staff who volunteered for participating in the study. Each consented participant recruited into the investigation completed a questionnaire which covers details regarding demographics, exposure history, Residence & travel. Blood sample was collected and Anti-SARS COV2 IgG antibody testing which targets the Spike Protein 1(SP1) was done using the VITROS chemiluminescence platform (Orthoclinical diagnostics, USA). Sampling & testing ranged over a time frame from September 5th to December 15th, 2020ResultsJubilee Mission Medical College has 2785 working staff at the time of study. A total of 420 staff consented and their samples were tested. 37 staff members tested positive for COVID-19 antibody, yielding an overall prevalence of 8.75% (95% CI, 6.23–11.86). 86.5 % (32/37) of them were having a history of COVID-19 Antigen / RT PCR Positivity. We identified a statistically significant linear trend (p value =0.00001), between seropositivity and the degree of severity of COVID 19. Among the various factors which increase the risk of seroconversion, history of undergoing quarantine (p value < 0.001), contact with a confirmed case (p value = 0.002), contact with a caregiver for COVID 19 (p value =0.001) and history of Upper respiratory symptoms (p value =0.001), were found to be significantly associated with positive serology.ConclusionsThe overall seropositivity in the current study was found to be 8.75% which is comparable to seroprevalence studies conducted in the United States and Wuhan in China. The pattern of seropositivity across the different category of health workers observed in the present study showed a higher prevalence among nurses. This result is also in agreement with a recent published report from united states. Various measures advised by the national and state health authorities were adequately adhered to. Keeping track of the pattern of development of immunity in the community is part of understanding the illness and forecasting the spread. For the tested HCW, it will boost up morale by ending uncertainty. For the hospital administration it will help in decision making about relative focusing of interventions on patients in general and HCWs. By knowing the immunity status of HCWs, the Institution will be able to contribute authentically to the development of intervention strategies and guidelines from time to time, besides following the available guidelines. Being an educational institution, it is obligatory to train all the elements of care delivery to the future generation of health care workers. Getting experienced from a small but relevant sample was expected to facilitate larger community study envisaged in peripheral areas Jubilee served


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