Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources.

BACKGROUND: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS: Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS: MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.

Is it time to rethink education and training? Learning how to perform under pressure: An observational study.

Emergency medicine workers are exposed daily to various stressors, especially work-related stress, which have been aggravated by the current SARS-CoV 2 pandemic and impact their physical and mental wellbeing. Nonetheless, although the efficacy of programs and strategies to improving the health of medical staff and patient care has been demonstrated, such programs and strategies are scarce. To assess the prevalence, types and consequences of stress in emergency medical workers in healthcare institutions and explore tools to cope with stressful situations at workplace. Two surveys were conducted. Survey 1 assessed the subjective stress levels and stressors of 21 emergency medicine professionals. Survey 2 was conducted amongst 103 healthcare workers at 3 hospitals in Germany. It comprised selected aspects of the German Mental Risk Assessment and a validated workload scale. None. The answer frequencies on Likert scales were descriptively evaluated. Survey 1: Emergency medical professionals experienced and reported the following high stress levels in acute situations: multitasking during a complex situation; factors associated with the work environment; fear of not appropriately controlling the situation; and lack of sleep. Survey 2: The highest stress levels were experienced in the areas "work environment" and "work organization." The highest scores on the workload scale were obtained for statements on work division, exhaustion, insufficient patient care due to time constraints, regulations, and lack of information. Approximately 80% of healthcare workers had experienced emotionally stressful situations at the workplace, and > 30% had lost a colleague to suicide. There are effective and proven methods to learn how to deal with stress that can easily be established in everyday clinical practice. Healthcare workers are subjected to numerous stressors in their work environment and observe the consequences of these stressors on their own and their colleagues' wellbeing. Coping strategies for high-pressure reduces and resists the job- immanent pressure and stress in healthcare workers.

Analysis of severe hand trauma injury frequency during "Munich's Oktoberfest" within the last 9 years in comparison to years with absence due to the COVID-19 pandemic.

INTRODUCTION: Within its 2 week period, the Oktoberfest attracts around 6 million visitors yearly to Munich, Germany. Due to alcohol intake, congested halls, and disorderly activities, numerous accidents occur. Although many hand injuries are observed, the impact of Oktoberfest on severe hand trauma injury frequency is under investigated. MATERIALS AND METHODS: Data from the regional emergency medical service (EMS) was analyzed over a 9 year period regarding the frequency of severe hand injuries during the world's largest fair and compared to the corresponding period in the years 2020 and 2021 where the event was cancelled due to the world-wide COVID-19 pandemic. Additionally, we compared the patient numbers during the same period in one Emergency Department of a level-1-trauma and hand trauma center located close to the venue. RESULTS: An exploratory description is made from data collected over a 9 year period (2013-2021) with focus on hand injuries before, during and after the "Oktoberfest". A total of 4017 hand injuries were allocated to hospitals by EMS. There was an increase in severe hand injuries by 66% during the 2-weeks-Oktoberfest-period compared to years where the Oktoberfest did not take place. Pre-pandemic statistics show an increasing severe hand trauma frequency of 57.5% in September, compared to EMS-referrals during the remanding year. CONCLUSION: The risk of injuring relevant structures of the hand during Oktoberfest is extremely high as compared to other parts of the body due to beer stein and fall-associated injuries. These injuries can lead to lifelong impairments. Our data are the first that quantifies and pinpoints the risk of severe injury to the hand during Oktoberfest and therefore, it is of great interest for visitors, hand surgeons, paramedics and emergency department healthcare workers.