Mitigating Moral Distress in Leaders of Healthcare Organizations: A Scoping Review.

GOAL: Moral distress literature is firmly rooted in the nursing and clinician experience, with a paucity of literature that considers the extent to which moral distress affects clinical and administrative healthcare leaders. Moreover, the little evidence that has been collected on this phenomenon has not been systematically mapped to identify key areas for both theoretical and practical elaboration. We conducted a scoping review to frame our understanding of this largely unexplored dynamic of moral distress and better situate our existing knowledge of moral distress and leadership. METHODS: Using moral distress theory as our conceptual framework, we evaluated recent literature on moral distress and leadership to understand how prior studies have conceptualized the effects of moral distress. Our search yielded 1,640 total abstracts. Further screening with the PRISMA process resulted in 72 included articles. PRINCIPAL FINDINGS: Our scoping review found that leaders-not just their employees- personally experience moral distress. In addition, we identified an important role for leaders and organizations in addressing the theoretical conceptualization and practical effects of moral distress. PRACTICAL APPLICATIONS: Although moral distress is unlikely to ever be eliminated, the literature in this review points to a singular need for organizational responses that are intended to intervene at the level of the organization itself, not just at the individual level. Best practices require creating stronger organizational cultures that are designed to mitigate moral distress. This can be achieved through transparency and alignment of personal, professional, and organizational values.

Public Health and Health Sector Crisis Leadership During Pandemics: A Review of the Medical and Business Literature.

The global scale and unpredictable nature of the current COVID-19 pandemic have put a significant burden on health care and public health leaders, for whom preparedness plans and evidence-based guidelines have proven insufficient to guide actions. This article presents a review of empirical articles on the topics of "crisis leadership" and "pandemic" across medical and business databases between 2003 (since SARS) and-December 2020 and has identified 35 articles for detailed analyses. We use the articles' evidence on leadership behaviors and skills that have been key to pandemic responses to characterize the types of leadership competencies commonly exhibited in a pandemic context. Task-oriented competencies, including preparing and planning, establishing collaborations, and conducting crisis communication, received the most attention. However, people-oriented and adaptive-oriented competencies were as fundamental in overcoming the structural, political, and cultural contexts unique to pandemics.

Boundary work as a buffer against burnout: Evidence from healthcare workers during the COVID-19 pandemic.

Burnout represents a significant problem for many modern-day workers, but perhaps none more acutely than those in healthcare. Imbued with the chronic stressors that often accompany high-risk, interpersonal work, the healthcare industry is rife with stories of burnout, and the addition of a pandemic has intensified the challenges of an already demanding work environment. With an aim toward understanding the root causes of pandemic-exacerbated burnout, we document the experiences of 93 healthcare workers during the COVID-19 pandemic and, in doing so, explore an important link between burnout and work-nonwork boundaries. We find the contextual shock of the pandemic resulted in an increased incidence of boundary violations-undesired disruptions between work and other important life domains such as personal and family life. These boundary violations-which we classify as physical, temporal, or knowledge-based-frequently corresponded to greater reports of burnout manifested by exhaustion, detachment, and inefficacy. We detail specific patterns within the broader context of boundary violations whereby intrusion events are associated with increased job-related demands and distancing events are associated with reduced job-related resources. In addition to documenting the connection between burnout and boundary violations, we also reveal how workers utilized specific boundary work tactics in response to specific types of boundary violations to redefine boundaries and forestall burnout. Our grounded theorizing points to theoretical and practical implications for the impact of boundary work tactics on burnout and other stress-related phenomena. (PsycInfo Database Record (c) 2021 APA, all rights reserved).