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1.
BMC Med Ethics ; 23(1): 45, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1798405

ABSTRACT

BACKGROUND: Commentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units (ICUs). Our aim was twofold: (1) to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and (2) determine the association between the ethical climate, moral distress, and intention to leave. METHODS: We performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire (EDMCQ) and the Measure of Moral Distress for Healthcare Professionals (MMD-HP) tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave. RESULTS: Nurses perceived the ethical climate for decision-making as less favorable than physicians (p < 0.05). They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/Pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units (3.54 ± 0.66 vs. 3.43 ± 0.81 vs. 3.30 ± 0.69; respectively; both p ≤ 0.05) and also demonstrated lower moral distress scores (both p < 0.05) and lower "intention to leave" scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated (r = -0.58, p < 0.001); moral distress and "intention to leave" was positively correlated (r = 0.52, p < 0.001); and ethical climate and "intention to leave" were negatively correlated (r = -0.50, p < 0.001). CONCLUSIONS: Significant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care.


Subject(s)
Attitude of Health Personnel , Intention , Child , Cross-Sectional Studies , Hospitals , Humans , Infant, Newborn , Intensive Care Units , Job Satisfaction , Morals , Stress, Psychological , Surveys and Questionnaires
2.
SSRN;
Preprint in English | SSRN | ID: ppcovidwho-346228

ABSTRACT

Due to the constraints of the COVID-19 pandemic, healthcare workers have reported acting in ways that are contrary to their moral values, which may result in moral distress and injury. The purpose of this work is to create a digital phenotype profile (DPP) tool to automate and evaluate the distress of participants in the COVID-19 VR Healthcare Simulation for Moral Distress dataset (NCT05001542). The dataset collected passive physiological signals and active mental health questionnaires. This paper focuses on correlating electrocardiogram, respiration, photoplethysmography and galvanic skin response with moral injury outcome scale (Brief MIOS). The DPP tool uses data-driven techniques to create a robust evaluation of distress among participants. To accomplish this, we applied pre-processing techniques which involved normalization, data sanitation, segmentation, and windowing. During feature analysis, we extracted statistical and heart rate variability features, followed by feature selection techniques to rank the importance of features. Prior to classification, we used k-means clustering to cluster the Brief MIOS scores to low, moderate, and high moral distress as the Brief MIOS is yet to have an established cut-off scores. We then classified the separation of the Brief MIOS scores using weighted support vector machine with leave-one-subject-out-cross-validation to achieve an accuracy of 98.67±0.87%. Various machine learning ablation tests were performed to support our results and further enhance the understanding of the predictive model. Our findings suggest that the proposed DPP tool could be used as an automated tool to examine moral distress. With further replication and validation, it could be used as a potential AI-based clinical decision-making tool to expedite and validate mental health treatments.

3.
Dementia (London) ; : 14713012221124995, 2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2079330

ABSTRACT

Healthcare providers caring for people living with dementia may experience moral distress when faced with ethically challenging situations, such as the inability to provide care that is consistent with their values. The COVID-19 pandemic produced conditions in long-term care homes (hereafter referred to as 'care homes') that could potentially contribute to moral distress. We conducted an online survey to examine changes in moral distress during the pandemic, its contributing factors and correlates, and its impact on the well-being of care home staff. Survey participants (n = 227) working in care homes across Ontario, Canada were recruited through provincial care home organizations. Using a Bayesian approach, we examined the association between moral distress and staff demographics and roles, and characteristics of the long-term care home. We performed a qualitative analysis of the survey's free-text responses. More than 80% of care home healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. There was no difference in the severity of distress by age, sex, role, or years of experience. The most common factors associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. At least two-thirds of respondents reported feelings of physical exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the moral distress experienced during the pandemic. Respondents working in not-for-profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for-profit homes. Front-line staff were more likely to report not wanting to work than those in management or administrative positions. Overall, we found that increases in moral distress during the pandemic negatively affected the well-being of healthcare providers in care homes, with preliminary evidence suggesting that individual and systemic factors may intensify the negative effect.

4.
Nurs Ethics ; : 9697330221114329, 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2079277

ABSTRACT

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress.Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political economy might be integrated into the study of moral distress.Research Design: This research draws on interviews and focus groups, the transcripts of which were analyzed using framework analysis.Research Participants and Context: 88 healthcare providers, based in British Columbia Canada, participated virtually.Ethical Considerations: The study received ethical approval from Simon Fraser University.Findings: Healthcare providers experienced moral dilemmas related to ability to provide quality and compassionate care while maintaining COVID-19 protocols. Moral constraints were exacerbated by staffing shortages and lack of access to PPE. Moral conflicts emerged when women tried to engage decision-makers to improve care, and moral uncertainty resulted from lack of clear and consistent information. At home, women experienced moral constraints related to inability to support children's education and wellbeing. Moral conflicts related to lack of flexible work environments and moral dilemmas developed between unpaid care responsibilities and COVID-19 risks. Women healthcare providers resisted moral residue and structural constraints by organizing for better working conditions, childcare, and access to PPE, engaging mental health support and drawing on professional pride.Discussion: COVID-19 has led to new and heightened experiences of moral distress among HCP in response to both paid and unpaid care work. While many of the experiences of moral distress at work were not explicitly gendered, implicit gender norms structured moral events. Women HCP had to take it upon themselves to organize, seek out resources, and resist moral residue.Conclusion: A feminist political economy lens illuminates how women healthcare providers faced and resisted a double layering of moral distress during the pandemic.

5.
Healthcare (Basel) ; 10(10)2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2065806

ABSTRACT

Background: The early COVID-19-pandemic was characterized by changes in decision making, decision-relevant value systems and the related perception of decisional uncertainties and conflicts resulting in decisional burden and stress. The vulnerability of clinical care professionals to these decisional dilemmas has not been characterized yet. Methods: A cross-sectional questionnaire study (540 patients, 322 physicians and 369 nurses in 11 institutions throughout Germany) was carried out. The inclusion criterion was active involvement in clinical treatment or decision making in oncology or psychiatry during the first year of COVID-19. The questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, and the perception of consequences for patients). Data analysis was performed using ANOVA, Pearson rank correlations, and the Chi²-test, and for inferential analysis, nominal logistic regression and tree classification were conducted. Results: Professionals reported changes in clinical management (27.5%) and a higher workload (29.2%), resulting in decisional uncertainty (19.2%) and decisional conflicts (22.7%), with significant differences between professional groups (p < 0.005), including anxiety, depression, loneliness and stress in professional subgroups (p < 0.001). Nominal regression analysis targeting "Decisional Uncertainty" provided a highly significant prediction model (LQ p < 0.001) containing eight variables, and the analysis for "Decisional Conflicts" included six items. The classification rates were 64.4% and 92.7%, respectively. Tree analysis confirmed three levels of determinants. Conclusions: Decisional uncertainty and conflicts during the COVID-19 pandemic were independent of the actual pandemic load. Vulnerable professional groups for the perception of a high number of decisional dilemmas were characterized by individual perception and the psychological framework. Coping and management strategies should target vulnerability, enable the handling of the individual perception of decisional dilemmas and ensure information availability and specific support for younger professionals.

6.
Crit Care ; 26(1): 310, 2022 10 13.
Article in English | MEDLINE | ID: covidwho-2064834

ABSTRACT

Shortage of nurses on the ICU is not a new phenomenon, but has been exacerbated by the COVID-19 pandemic. The underlying reasons are relatively well-recognized, and include excessive workload, moral distress, and perception of inappropriate care, leading to burnout and increased intent to leave, setting up a vicious circle whereby fewer nurses result in increased pressure and stress on those remaining. Nursing shortages impact patient care and quality-of-work life for all ICU staff and efforts should be made by management, nurse leaders, and ICU clinicians to understand and ameliorate the factors that lead nurses to leave. Here, we highlight 10 broad areas that ICU clinicians should be aware of that may improve quality of work-life and thus potentially help with critical care nurse retention.


Subject(s)
Burnout, Professional , Nurses , Nursing Staff, Hospital , Physicians , Humans , COVID-19 , Intensive Care Units , Pandemics , Surveys and Questionnaires , Psychological Distress , Leadership
7.
J Nurs Manag ; 2022 Oct 04.
Article in English | MEDLINE | ID: covidwho-2052810

ABSTRACT

AIM: We aim to investigate the interplay between moral distress and moral injury among nurses working in palliative and oncology wards and to assess its impact on nursing leadership. BACKGROUND: The past 2 years have been particularly challenging for nurses and nursing leaders in Croatia. The coronavirus disease pandemic and the subsequent earthquakes in the country significantly impacted the work of nurses. Moral distress has been well-known to nursing professionals, but recent studies warn about cofounding it with moral injury and their possible intercorrelation, deserving more attention from an empirical perspective. METHODS: We conducted quantitative cross-sectional research in palliative and oncology wards in 11 Croatian health care facilities on 162 nurses, using a questionnaire and paper/pencil method over 6 months (1 January 2021 to 1 July 2021). The questionnaire consisted of three parts: sociodemographic data, a Measure of moral distress for health care professionals and Moral injury symptoms scale for health care professionals. The research protocol was approved by the Ethics committee of the Catholic University of Croatia under no. 1-21-04. RESULTS: The findings of our study demonstrated that the current average levels of moral distress might be characterized as low, but the moral injury symptoms are severe. The results of our study bring interesting novel insights, such as the strong correlation between moral distress and moral injury, but also in terms of nurses' decision to leave or consider leaving their position. The nurses who experience higher levels of moral distress experience severe symptoms of moral injury, while nurses who score higher in moral distress and moral injury have left, considered or consider leaving their positions. CONCLUSIONS: This study highlighted the need to pay attention to the emerging phenomenon of moral injury that has been unaddressed and overshadowed by moral distress, their intercorrelation, and the importance of addressing them timely and adequately within health care organizations with their leadership and management. IMPLICATIONS FOR NURSING MANAGEMENT: These findings provide a significant insight that may assist nursing managers and leaders to act and respond in time to develop various prevention and mitigation measures and help resolve situations leading to moral distress or moral injury.

8.
Palliat Support Care ; : 1-6, 2022 Sep 27.
Article in English | MEDLINE | ID: covidwho-2050233

ABSTRACT

OBJECTIVES: Moral distress is associated with adverse outcomes contributing to health-care professionals' worsened mental and physical well-being. Medical social workers have been frontline care providers throughout the COVID-19 pandemic, and those specializing in palliative and hospice care have been particularly affected by the overwhelming numbers of those seriously ill and dying. The main objectives of this study were (1) to assess palliative and hospice social workers' experiences of moral distress during COVID-19 and (2) to identify and describe participants' most morally distressing scenarios. METHODS: Using a mixed-methods approach, participants completed an online survey consisting of the Moral Distress Thermometer (MDT) and open-ended text responses. RESULTS: A total of 120 social work participants responded to the study, and the majority of participants (81.4%) had experienced moral distress with an average MDT score of 6.16. COVID-19 restrictions emerged as the main source of moral distress, and an overlap between the clinical and system levels was observed. Primary sources of moral distress were grounded in strict visitation policies and system-level standards that impacted best practices and personal obligations in navigating both work responsibilities and safety. SIGNIFICANCE: In the first year of the COVID-19 pandemic, palliative and hospice social work participants indicated high levels of moral distress. Qualitative findings from this study promote awareness of the kinds of distressing situations palliative and hospice social workers may experience. This knowledge can have education, practice, and policy implications and supports the need for research to explore this aspect of professional social work.

9.
Depression, burnout and suicide in physicians : Insights from oncology and other medical professions ; : 127-135, 2022.
Article in English | APA PsycInfo | ID: covidwho-2047985

ABSTRACT

Moral distress, initially described as the form of distress that occurs "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action," is highly prevalent among physicians. Contemporary descriptions of moral distress involve three domains including negative attitudes one experiences, one's perceived involvement in a situation, and perceived moral undesirability of the situation. Common sources of moral distress stem from clinical situations and internal and external constraints. Interventions can be targeted at the root causes and components of moral injury and distress, on both individual and organizational levels. These include fostering resiliency in individual clinicians, providing support and moral leadership and ethical culture. This chapter will provide an overview of moral distress in physicians including definitions, common sources and constraints, as well as interventions with specific examples from oncology and the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

10.
Médecine de Catastrophe - Urgences Collectives ; 2022.
Article in English | ScienceDirect | ID: covidwho-2042101

ABSTRACT

During the present COVID-19 pandemic healthcare workers are confronted with multiple stressors. At the beginning of the pandemic these stressors mainly related to health and safety issues. In the course of the pandemic societal stressors became more salient. These include lacking credibility of important stakeholders (leadership, organization and policy) as well as lacking appreciation from society and policy. Both, stressors referring to safety related issues, as well as stressors referring to trust or morally related issues have negative impact on psychosocial wellbeing in terms of distress, anxiety, burnout, depression and moral injury. To mitigate the effects of the COVID-19 crisis on healthcare workers and to enhance the resilience and psychosocial well-being of healthcare workers, psychosocial support is important to be delivered on different levels. Résumé Pendant la pandémie actuelle COVID-19, les personnels de santé ont été confrontés à de multiples facteurs de stress. Au début de la pandémie, ces facteurs de stress étaient principalement liés à des questions de santé et de sécurité. Au cours de la pandémie, les facteurs de stress sociétaux sont devenus plus saillants. Il s’agit notamment du manque de crédibilité des parties prenantes importantes (direction, organisation et politiques) ainsi que du manque d’appréciation de la part de la société et des politiques. Que ce soient les facteurs de stress liés à la sécurité, ceux liés à la confiance ou à la morale, tous ont un impact négatif sur le bien-être psychosocial en termes de détresse, d’anxiété, d’épuisement, de dépression et de préjudice moral. Afin d’atténuer les effets de la crise COVID-19 sur les personnels de santé et d’améliorer la résilience et le bien-être psychosocial de ces derniers, il est important d’apporter un soutien psychosocial à différents niveaux.

11.
Nurs Forum ; 2022 Sep 08.
Article in English | MEDLINE | ID: covidwho-2019561

ABSTRACT

Healthcare professionals have battled physically, mentally, and emotionally overwhelming workforce pressures for years. The COVID-19 pandemic exacerbated this burnout substantially since its onset in 2020. Recently implemented federal initiatives aim to assist in the development of moral resiliency against a morally distressing workplace environment. But is this enough? Meeting the immediate need for substantial mental health resources in the healthcare field is essential and will be a long-lasting endeavor.

12.
J Nurs Manag ; 2022 Aug 31.
Article in English | MEDLINE | ID: covidwho-2019492

ABSTRACT

AIM: The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic. BACKGROUND: Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders. METHODS: It is a descriptive phenomenological study that used content analysis. RESULTS: Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress. CONCLUSION: Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Extraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision-making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.

13.
Cancers (Basel) ; 14(17)2022 Sep 02.
Article in English | MEDLINE | ID: covidwho-2009953

ABSTRACT

BACKGROUND: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. STUDY DESIGN: Cross-sectional OnCoVID questionnaire studies. METHODS: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. RESULTS: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. CONCLUSIONS: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.

14.
Nurs Forum ; 2022 Aug 13.
Article in English | MEDLINE | ID: covidwho-1992879

ABSTRACT

AIM: To provide a critical analysis of the concept of moral distress (MD) in critical care (CC) nursing. BACKGROUND: Despite extensive inquiry pertaining to the legitimacy of MD within nursing discourse, some authors still question its relevancy to the profession. However, amid the global COVID-19 pandemic, MD is generating a significant amount of discussion anew, warranting the further exploration of the concept within CC nursing to provide clarity and expand on the definition. DESIGN: Rodger's Evolutionary Concept Analysis method was used to guide this analysis. METHODS: Related terms, attributes, antecedents, and consequences of MD were identified using current literature. RESULTS: The results of this analysis demonstrate strong congruence between the attributes, antecedents, and negative consequences pertaining to MD. However, a new theme has emerged from this review of the contemporary literature, highlighting the potential unexpected positive outcomes perceived by nurses who experience MD, including the provision of better care, increased levels of empathy, and enhanced opportunities for ethical reflection.

15.
Int J Environ Res Public Health ; 19(15)2022 08 06.
Article in English | MEDLINE | ID: covidwho-1979231

ABSTRACT

Pandemic-management plans shift the care model from patient-centred to public-centred and increase the risk of healthcare workers (HCWs) experiencing moral distress (MD). This study aimed to understand HCWs' MD experiences during the COVID-19 pandemic and to identify HCWs' preferred coping strategies. Based on a qualitative research methodology, three surveys were distributed at different stages of the pandemic response in British Columbia (BC), Canada. The thematic analysis of the data revealed common MD themes: concerns about ability to serve patients and about the risks intrinsic to the pandemic. Additionally, it revealed that COVID-19 fatigue and collateral impact of COVID-19 were important ethical challenges faced by the HCWs who completed the surveys. These experiences caused stress, anxiety, increased/decreased empathy, sleep disturbances, and feelings of helplessness. Respondents identified self-care and support provided by colleagues, family members, or friends as their main MD coping mechanisms. To a lesser extent, they also used formal sources of support provided by their employer and identified additional strategies they would like their employers to implement (e.g., improved access to mental health and wellness resources). These results may help inform pandemic policies for the future.


Subject(s)
COVID-19 , British Columbia/epidemiology , COVID-19/epidemiology , Disease Outbreaks , Health Personnel/psychology , Humans , Morals , Pandemics
16.
Int J Environ Res Public Health ; 19(15)2022 08 05.
Article in English | MEDLINE | ID: covidwho-1979226

ABSTRACT

During the COVID-19 health emergency, healthcare professionals faced several ethical demanding job stressors, becoming at particular risk of moral distress. To date, only a few scales have been developed to evaluate moral distress among frontline professionals working in contact with COVID-19 patients. Moreover, although many healthcare professionals from various disciplines were converted to COVID-19 patient care, no study has yet analyzed whether the resulting change in duties might represent a risk factor for moral distress. Thus, this study aimed to investigate how and when the change in duties during the emergency would be related to healthcare professionals' psycho-physical malaise. To this aim, a first Italian adaptation of the Stress of Conscience Questionnaire (SCQ) was provided. In total, 272 Italian healthcare professionals participated in this cross-sectional study. Healthcare professionals who had to perform tasks outside their usual clinical duties were more likely to experience moral distress and then psycho-physical malaise. This was particularly likely for those who were extremely concerned about becoming infected with the virus. The results also indicated that the Italian adaptation of the SCQ had a one-factor solution composed of six items. This study provides the first Italian adaptation of SCQ and practical suggestions on how supporting professionals' well-being during emergencies.


Subject(s)
COVID-19 , Physicians , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Morals , Pandemics
17.
Int J Environ Res Public Health ; 19(15)2022 08 04.
Article in English | MEDLINE | ID: covidwho-1979212

ABSTRACT

(1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual's moral beliefs and elicits adverse emotional responses. (2) Method: A systematic review was conducted to explore the prevalence, predictors, and psychological experience of MI and MD in the aforementioned population during the COVID-19 pandemic. The databases CINAHL, APA PsychINFO, APA PsychArticles, Web of Science, Medline, and Scopus were systematically searched for original research studies of all designs, published in English, with no geographical restrictions, and dating from when COVID-19 was declared a public health emergency on the 30 January 2020 to the 3 January 2022. Out of 531 studies screened for eligibility, 8 studies were selected for review. A thematic analysis was undertaken to examine the major underpinning themes. (3) Results: MI, MD, and related constructs (notably secondary traumatic stress) were evidenced to be present in staff, although most studies did not explore the prevalence or predictors. The elicited major themes were resource deficits, role challenges, communication and leadership, and emotional and psychosocial consequences. (4) Conclusions: Our findings suggest that moral injury and moral distress were likely to be present prior to COVID-19 but have been exacerbated by the pandemic. Whilst studies were generally of high quality, the dearth of quantitative studies assessing prevalence and predictors suggests a research need, enabling the exploration of causal relationships between variables. However, the implied presence of MI and MD warrants intervention developments and workplace support for nursing and care home staff.


Subject(s)
COVID-19 , COVID-19/epidemiology , Humans , Morals , Pandemics , Prevalence , Workplace/psychology
18.
Transcult Psychiatry ; 59(4): 551-567, 2022 08.
Article in English | MEDLINE | ID: covidwho-1978712

ABSTRACT

In this invited commentary on the thematic issue of Transcultural Psychiatry on idioms of distress, concern, and care, I provide a brief overview of how my research agenda evolved over the years while conducting community and clinic-based research in South and Southeast Asia as well as North America. I then suggest areas where future research on idioms of distress, concern, care, and resilience will be needed among different demographics given social change and shifts in how we communicate face to face and in virtual reality, the impact of medicalization, pharmaceuticalization and bracket creep, changes in indigenous healing systems, and hybridization. I further call attention to the importance of conducting idioms guided research in occupational settings. Toward this end I highlight the moral distress health care workers in the U.S. have experienced during the Covid-19 pandemic and point out the importance of differentiating individual burnout from moral injury related to structural distress. I conclude by discussing the general utility of an idioms of distress perspective in the practice of cultural psychiatry and suggest that this perspective needs to be included in the training of all practitioners regardless of the system of medicine they practice. Doing so may enable the formation of mental health communities of practice in contexts where there are pluralistic health care arenas.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Ethnopsychology , Humans , Morals , Pandemics
19.
Intensive Crit Care Nurs ; 72: 103279, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1945121

ABSTRACT

OBJECTIVES: To describe critical care nurses' perception of moral distress during the second year of the COVID-19 pandemic. DESIGN/METHODS: A cross-sectional study involving a questionnaire was conducted. Participants responded to the Italian version of the Moral Distress Scale-Revised, which consists of 14 items divided in dimensions Futile care (three items), Ethical misconduct (five items), Deceptive communication (three items) and Poor teamwork (three items). For each item, participants were also invited to write about their experiences and participants' intention to leave a position now was measured by a dichotomous question. The data were analysed with descriptive statistics and qualitative content analysis. The study followed the checklist (CHERRIES) for reporting results of internet surveys. SETTING: Critical care nurses (n = 71) working in Swedish adult intensive care units. RESULTS: Critical care nurses experienced the intensity of moral distress as the highest when no one decided to withdraw ventilator support to a hopelessly ill person (Futile care), and when they had to assist another physician or nurse who provided incompetent care (Poor teamwork). Thirty-nine percent of critical care nurses were considering leaving their current position because of moral distress. CONCLUSIONS: During the COVID-19 pandemic, critical care nurses, due to their education and experience of intensive care nursing, assume tremendous responsibility for critically ill patients. Throughout, communication within the intensive care team seems to have a bearing on the degree of moral distress. Improvements in communication and teamwork are needed to reduce moral distress among critical care nurses.


Subject(s)
COVID-19 , Nurses , Adult , Attitude of Health Personnel , Critical Care , Cross-Sectional Studies , Humans , Morals , Pandemics , Perception , Pilot Projects , Stress, Psychological/etiology , Surveys and Questionnaires
20.
Crit Care ; 26(1): 221, 2022 07 19.
Article in English | MEDLINE | ID: covidwho-1938336

ABSTRACT

BACKGROUND: Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seems to be modified during the COVID-19 pandemic with potential burden of moral distress to health care providers (HCPs). We seek to assess the practice of EOL care during the COVID-19 pandemic in ICUs in the Czech Republic focusing on the level of moral distress and its possible modifiable factors. METHODS: Between 16 June 2021 and 16 September 2021, a national, cross-sectional study in intensive care units (ICUs) in Czech Republic was performed. All physicians and nurses working in ICUs during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyse possible modifiable factors of moral distress. RESULTS: In total, 313 HCPs (14.5% out of all HCPs who opened the questionnaire) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to moral distress during the COVID-19 pandemic. 63.1% (n = 113) of nurses and 71.6% of (n = 96) physicians had experience with the perception of inappropriate care. If inappropriate care was perceived, a higher chance for the occurrence of moral distress for HCPs (OR, 1.854; CI, 1.057-3.252; p = 0.0312) was found. When patients died with dignity, the chance for moral distress was lower (OR, 0.235; CI, 0.128-0.430; p < 0.001). The three most often reported differences in palliative care practice during pandemic were health system congestion, personnel factors, and characteristics of COVID-19 infection. CONCLUSIONS: HCPs working at ICUs experienced significant moral distress during the COVID-19 pandemic in the Czech Republic. The major sources were perceiving inappropriate care and dying of patients without dignity. Improvement of the decision-making process and communication at the end of life could lead to a better ethical and safety climate. TRIAL REGISTRATION: NCT04910243 .


Subject(s)
COVID-19 , Palliative Care , Attitude of Health Personnel , COVID-19/epidemiology , Cross-Sectional Studies , Czech Republic/epidemiology , Death , Humans , Intensive Care Units , Morals , Pandemics , Stress, Psychological , Surveys and Questionnaires
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