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1.
BMC Psychiatry ; 22(1): 19, 2022 01 06.
Article in English | MEDLINE | ID: covidwho-1613228

ABSTRACT

BACKGROUND: Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. METHODS: A total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed. FINDINGS: Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|]. INTERPRETATION: Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.


Subject(s)
COVID-19 , Pandemics , Adult , Aged , Anxiety/epidemiology , Canada , Cross-Sectional Studies , Depression/epidemiology , Female , Health Personnel , Humans , Male , Mental Health , Middle Aged , Morals , SARS-CoV-2
2.
Nurs Educ Perspect ; 43(1): 1-2, 2022.
Article in English | MEDLINE | ID: covidwho-1597032
4.
Euro Surveill ; 26(50)2021 Dec.
Article in English | MEDLINE | ID: covidwho-1592477

ABSTRACT

While many European Union/European Economic Area (EU/EEA) countries recently expanded human papillomavirus (HPV) vaccination to boys, HPV vaccine supply is currently limited for girls in low- and middle-income countries (LMIC) that are severely affected by HPV.Globally, about 50% of countries have introduced HPV vaccination. Some LMIC with high burden of cervical cancer have not yet introduced HPV vaccination, or are reaching suboptimal vaccination coverage. While WHO issued a call for cervical cancer elimination in 2018, a global shortage of HPV vaccines is currently predicted to last at least until 2024.We reviewed national policies of EU/EEA countries and recommendations of the World Health Organization (WHO) Strategic Advisory Group of Experts on immunisation to discuss current challenges and dose-sparing options. Several EU/EEA countries have extended HPV vaccination to boys and the European Cancer Organisation has issued a resolution for elimination of all HPV-associated cancers in both sexes. The European Centre for Disease Prevention and Control concluded in its 2020 guidance that cost-effectiveness of extending routine vaccination to boys depends on several context-specific factors. The extension of HPV vaccination to boys in EU/EEA countries may affect global availability of vaccines. Temporary dose-sparing options could be considered during the COVID-19 post-pandemic period.


Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , European Union , Female , Humans , Immunization , Male , Morals , Papillomavirus Infections/prevention & control , SARS-CoV-2 , Uterine Cervical Neoplasms/prevention & control , Vaccination
5.
Int J Environ Res Public Health ; 18(24)2021 12 19.
Article in English | MEDLINE | ID: covidwho-1580721

ABSTRACT

The COVID-19 pandemic has confronted emergency and critical care physicians with unprecedented ethically challenging situations. The aim of this paper was to explore physicians' experience of moral distress during the pandemic. A qualitative multicenter study was conducted using grounded theory. We recruited 15 emergency and critical care physicians who worked in six hospitals from the Lombardy region of Italy. Semi-structured interviews about their professional experience of moral distress were conducted from November 2020-February 2021 (1 year after the pandemic outbreak). The transcripts were qualitatively analyzed following open, axial, and selective coding. A model of moral distress was generated around the core category of Being a Good Doctor. Several Pandemic Stressors threatened the sense of Being a Good Doctor, causing moral distress. Pandemic Stressors included limited healthcare resources, intensified patient triage, changeable selection criteria, limited therapeutic/clinical knowledge, and patient isolation. Emotions of Moral Distress included powerlessness, frustration/anger, and sadness. Physicians presented different Individual Responses to cope with moral distress, such as avoidance, acquiescence, reinterpretation, and resistance. These Individual Responses generated different Moral Outcomes, such as moral residue, disengagement, or moral integrity. The Working Environment, especially the team and organizational culture, was instrumental in restoring or disrupting moral integrity. In order for physicians to manage moral distress successfully, it was important to use reinterpretation, that is, to find new ways of enacting their own values by reframing morally distressing situations, and to perceive a cooperative and supportive Working Environment.


Subject(s)
COVID-19 , Physicians , Grounded Theory , Humans , Morals , Pandemics , SARS-CoV-2
6.
J Nurs Adm ; 52(1): 57-66, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1575154

ABSTRACT

OBJECTIVE: The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.


Subject(s)
Burnout, Professional , COVID-19 , Health Personnel/organization & administration , Health Personnel/psychology , Mental Health , Morals , Workplace , Adult , Humans , Workplace/organization & administration , Workplace/psychology
7.
Int J Environ Res Public Health ; 18(24)2021 12 11.
Article in English | MEDLINE | ID: covidwho-1572463

ABSTRACT

A so-called COVID-19 passport or Immunity passport (IP) has been proposed to facilitate the mobility of individuals while the SARS-CoV-2 pandemic persists. A COVID-19 passport can play a key role in the control of the pandemic, specifically in areas with a high density of population, and the help of smart city technology could be very useful to successfully implement IPs. This research studies the impact of ethical judgments on user attitudes toward using vaccine passports based on a Multidimensional Ethics Scale (MES) that contains five ethical constructs: moral equity, relativism, egoism, utilitarianism, and contractualism. Regression analysis shows that MES satisfactorily explains attitude (R2 = 87.82%, p < 0.001) and that a positive evaluation in moral equity, egoism and utilitarianism is significant (p < 0.001). The objective of the passport (variable leisure) shows a significant negative moderating effect on moral equity (coefficient = -0.147, p = 0.0302) and a positive one on relativism (coefficient = 0.158, p = 0.0287). Adjustment by means of fsQCA shows that five ethical constructs satisfactorily explain both favorable and unfavorable attitudes toward IPs. Solutions explaining acceptance attain an overall consistency (cons) = 0.871 and coverage (cov) = 0.980. In the case of resistance, we found that cons = 0.979 and cov = 0.775. However, that influence is asymmetrical. To have a positive attitude toward the passport, it is a sufficient condition to attain a positive evaluation on a single ethical factor. On the other hand, when explaining resistance, and with the exception of the recipe ~utilitarianism (cons = 0.911 and cov = 0.859), explanatory prime implications require the interaction of at least two variables. Likewise, the context in which the passport is required is significant to explain rejection.


Subject(s)
COVID-19 , Attitude , Humans , Morals , SARS-CoV-2 , Spain
8.
Nursing ; 51(12): 39-43, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1528184

ABSTRACT

ABSTRACT: ED nurses are at high risk for developing moral distress during the COVID-19 pandemic. Predisposing factors include limited resources, inadequate staffing, PPE shortages, and caring for vulnerable populations. This article explores personal and organizational strategies to help nurses cope with moral distress.


Subject(s)
COVID-19 , Adaptation, Psychological , Humans , Morals , Pandemics , SARS-CoV-2
10.
Ann Intern Med ; 174(9): 1325-1326, 2021 09.
Article in English | MEDLINE | ID: covidwho-1526997
11.
Front Public Health ; 9: 756281, 2021.
Article in English | MEDLINE | ID: covidwho-1526800

ABSTRACT

Despite the possible social implications of the coronavirus disease 2019 (COVID-19), previous studies of the extended parallel processing model (EPPM) in the context of COVID-19 overlooked the emotional aspects when processing fear-inducing COVID-19-related messages. Drawing upon the moral foundation theory (MFT), this study aimed to (a) apply EPPM in the Korean COVID-19 context, (b) introduce MFT and explain why moral intuitions can be related to the processing of COVID-19 messages, and (c) examine the moderating role of moral intuitions in the EPPM model. Based on the theoretical backgrounds, this study tested EPPM hypotheses and also tested whether moral intuition can moderate the relationship between perceived self-efficacy, perceived threat, fear of COVID-19, and health compliance behavioral intention. This study conducted an online survey using measurements of perceived self-efficacy, perceived threat, MFQ-20, fear of COVID, and health compliance. Our study showed three main findings. First, our study found the main effects of (a) self-efficacy on health compliance behavioral intention and (b) perceived threat on health compliance behavioral intention. Second, our study found that morality moderated the main effects of self-efficacy or perceived threat and also moderated EPPM interaction on fear of COVID. Third, the moderation of morality in the relationship between self-efficacy and health compliance behavioral intention showed that health compliance intention decreased as morality increased. Our findings suggest that people can consider COVID-19 as a social and moral issue that involves protecting others.


Subject(s)
COVID-19 , Intuition , Humans , Morals , Republic of Korea , SARS-CoV-2
12.
Depress Anxiety ; 38(10): 1007-1017, 2021 10.
Article in English | MEDLINE | ID: covidwho-1525429

ABSTRACT

INTRODUCTION: Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties. METHOD: Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample. RESULTS: The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes. CONCLUSION: Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.


Subject(s)
Burnout, Professional , COVID-19 , Stress Disorders, Post-Traumatic , Burnout, Professional/epidemiology , Health Personnel , Humans , Morals , Pandemics , Psychosocial Functioning , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , United States/epidemiology
13.
Eur J Psychotraumatol ; 12(1): 1984667, 2021.
Article in English | MEDLINE | ID: covidwho-1510837

ABSTRACT

Background: Research is urgently needed to understand health care workers' (HCWs') experiences of moral-ethical dilemmas encountered throughout the COVID-19 pandemic, and their associations with organizational perceptions and personal well-being. This research is important to prevent long-term moral and psychological distress and to ensure that workers can optimally provide health services. Objective: Evaluate associations between workplace experiences during COVID-19, moral distress, and the psychological well-being of Canadian HCWs. Method: A total of 1362 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in an online survey. Participants completed measures reflecting moral distress, perceptions of organizational response to the pandemic, burnout, and symptoms of psychological disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Results: Structural equation modelling showed that when organizational predictors were considered together, resource adequacy, positive work life impact, and ethical work environment negatively predicted severity of moral distress, whereas COVID-19 risk perception positively predicted severity of moral distress. Moral distress also significantly and positively predicted symptoms of depression, anxiety, PTSD, and burnout. Conclusions: Our findings highlight an urgent need for HCW organizations to implement strategies designed to prevent long-term moral and psychological distress within the workplace. Ensuring availability of adequate resources, reducing HCW risk of contracting COVID-19, providing organizational support regarding individual priorities, and upholding ethical considerations are crucial to reducing severity of moral distress in HCWs.


Antecedentes: Se necesita con urgencia investigaciones para comprender las experiencias de los dilemas éticos y morales que los trabajadores de la salud encontraron durante la pandemia de la COVID-19 y su asociación con las percepciones de la organización y el bienestar personal. Esta investigación es importante para prevenir la angustia moral y psicológica a largo plazo y para asegurar que los trabajadores de la salud puedan proveer de manera óptima los servicios de salud.Objetivo: Evaluar la asociación entre las experiencias en el lugar de trabajo durante la COVID-19, la angustia moral y el bienestar psicológico de los trabajadores de salud canadienses.Métodos: Se reclutó a un total de 1362 trabajadores de salud canadienses, que hablaban francés e inglés y que fueron contratados durante la pandemia de la COVID-19, para participar en un cuestionario en línea. Los participantes completaron mediciones que reflejaban la angustia moral, la percepción de la respuesta de la organización a la pandemia, el burnout y los síntomas de trastornos psicológicos, que incluían a la depresión, a la ansiedad y al trastorno de estrés postraumático (TEPT).Resultados: El modelo de ecuaciones estructurales mostró que cuando los predictores de la organización se consideraban en conjunto ­ los recursos adecuados, el impacto positivo en la vida laboral y un ambiente de trabajo ético ­, predijeron negativamente la gravedad de la angustia moral, mientras que la percepción del riesgo de contraer la COVID-19 predijo positivamente la gravedad de la angustia moral. La angustia moral también predijo de manera significativa y positiva los síntomas de la depresión, la ansiedad, el TEPT y el burnout.Conclusiones: Nuestros hallazgos resaltan la urgente necesidad de que las organizaciones de trabajadores de salud implementen estrategias diseñadas para prevenir la angustia moral y psicológica a largo plazo en el lugar de trabajo. El asegurar la disponibilidad de los recursos adecuados, el reducir el riesgo de que los trabajadores de salud contraigan la COVID-19, el proveer un soporte organizacional adecuado según las prioridades individuales y el respetar las consideraciones éticas son fundamentales para reducir la gravedad de la angustia moral en los trabajadores de salud.背景:亟需研究以了解卫生保健工作者 (HCW) 在整个 COVID-19 疫情期间遇到的道德伦理困境的经历, 及其与组织观念和个人幸福感的关联。本研究对于预防长期道德和心理困扰并确保工作人员能够最好地提供健康服务非常重要。目的:评估加拿大医护人员的 COVID-19 期间工作场所经历, 道德困扰和心理健康之间的关联。方法:共招募了 1362 名在 COVID-19 疫情期间受雇的讲法语和英语的加拿大 HCW 参与在线调查。参与者完成了反映道德困扰, 组织对疫情, 倦怠和心理障碍症状 (包括抑郁, 焦虑和创伤后应激障碍 (PTSD)) 的看法的测量。结果:结构方程模型表明, 当同时考虑组织预测因素时, 资源充足性, 积极的工作生活影响和道德工作环境负向预测道德困扰的严重程度, 而 COVID-19 风险感知正向预测道德困扰的严重程度。道德困扰也显著且正向预测了抑郁, 焦虑, PTSD和倦怠的症状。结论:我们的结果强调了 HCW 组织迫切需要实施旨在预防工作场所内长期道德和心理困扰的策略。确保可获取足够资源, 降低HCW接触 COVID-19 的风险, 提供个体优先性相关的组织支持以及坚持伦理考虑对于降低医护人员道德困境的严重程度至关重要.


Subject(s)
COVID-19 , Health Personnel , Mental Health/trends , Morals , Psychological Distress , Workplace/psychology , Adult , Anxiety/psychology , Burnout, Professional/psychology , Canada , Depression/psychology , Female , Health Personnel/ethics , Health Personnel/psychology , Humans , Internet , Male , Middle Aged , Organizational Culture , Surveys and Questionnaires
14.
Eur J Public Health ; 31(Supplement_4): iv50-iv53, 2021 Nov 09.
Article in English | MEDLINE | ID: covidwho-1506359

ABSTRACT

The COVID-19 pandemic has highlighted a number of ethical issues that typically have not been addressed openly in public debate. The argument 'protect the vulnerable' has been a mantra to motivate all sorts of measures, many of them not scientifically motivated. In this article, the concept of 'vulnerability' is analyzed, and a model is suggested to distinguish layers of vulnerability that may or may not result in poor outcomes, depending on how many layers are present and how they interact. Ethical aspects also need to be considered at the global level, where the issue of vaccine distribution illustrates that stronger obligations and responsibilities need to be taken to fulfil wishes and declarations on the fair distribution of resources.


Subject(s)
COVID-19 , Pandemics , Humans , Morals , SARS-CoV-2
15.
Int J Environ Res Public Health ; 18(20)2021 10 15.
Article in English | MEDLINE | ID: covidwho-1480729

ABSTRACT

Employees' emotional exhaustion caused by their leaders has significant consequences for both individuals and organizations. Identifying the roles of intra-organizational emotional labor is important to prevent employees' emotional exhaustion. This study examined the relationships between ethical leadership, followers' emotional labor toward leaders, and emotional exhaustion using Hobfoll's conservation of resources theory. Data collected from 259 employees working in South Korea were analyzed using regression and SEM. The results indicate that ethical leadership was negatively related to followers' emotional exhaustion. It is demonstrated that ethical leadership has a significant indirect relationship with followers' emotional exhaustion through three types of emotional labor strategies; genuine display, faked display, and suppressed display. Through genuine display and suppressed display, ethical leadership had an indirect and negative relationship with followers' emotional exhaustion, whereas ethical leadership and followers' emotional exhaustion showed a positive indirect relationship through faked display. We discuss the implications and limitations of this research and future research directions.


Subject(s)
Emotions , Leadership , Humans , Morals , Republic of Korea
16.
PLoS One ; 16(10): e0259110, 2021.
Article in English | MEDLINE | ID: covidwho-1480467

ABSTRACT

The COVID-19 pandemic poses many real-world moral dilemmas, which can pit the needs and rights of the many against the needs and rights of the few. We investigated moral judgments in the context of the contemporary global crisis among older adults, who are at greatest personal risk from the pandemic. We hypothesized that during this pandemic, individuals would give fewer utilitarian responses to hypothetical dilemmas, accompanied by higher levels of confidence and emotion elicitation. Our pre-registered analysis (https://osf.io/g2wtp) involved two waves of data collection, before (2014) and during (2020) the COVID-19 pandemic, regarding three categories of moral dilemmas (personal rights, agent-centered permissions, and special obligations). While utilitarian responses considered across all categories of dilemma did not differ, participants during the 2020 wave gave fewer utilitarian responses to dilemmas involving personal rights; that is, they were less willing to violate the personal rights of others to produce the best overall outcomes.


Subject(s)
COVID-19 , Ethical Theory , Judgment , Morals , Pandemics , SARS-CoV-2 , Aged , Humans , Male
17.
J Sch Nurs ; 37(6): 419-420, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1480376
18.
Acta Biomed ; 92(S6): e2021461, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-1478884

ABSTRACT

Background and aim of the work .The fluctuation from day to day within a working week of moral distress, coping, and general health of frontline healthcare workers (HCWs) in facing the challenges of the COVID-19 pandemic has been poorly studied. This study described the weekly fluctuation from day to day of moral distress, coping, and general health in frontline HCWs who worked during the first epidemic wave (May-June 2020) of the COVID-19 pandemic in Italy. METHODS: This study has an intensive longitudinal design, and a convenience sampling procedure was employed to enroll physicians, nurses, allied health professions, and healthcare assistants. Data collection was performed using diary encompassed four sections: a socio-demographic form (required only at the baseline data collection) and three scales to assess moral distress, coping, and general health. RESULTS: Results confirmed poor perceived health and mild moral distress in frontline HCWs, especially in HCWs with offspring, during the initial phases of the COVID-19 pandemic and the stability of their daily perception over a working week regarding moral distress, general health, and avoidant coping strategy, while approach coping strategy reported a slight fluctuation over time. CONCLUSIONS: Accordingly, on the one hand, these results confirm that outcomes regarding mental health and moral distress are pretty stable and provide insights, on the other hand, regarding the possible organizational interventions to support approach coping strategy as it seems more susceptible to variation over time.


Subject(s)
COVID-19 , Pandemics , Adaptation, Psychological , Disease Outbreaks , Health Personnel , Humans , Morals , SARS-CoV-2
19.
Kennedy Inst Ethics J ; 31(3): 327-341, 2021.
Article in English | MEDLINE | ID: covidwho-1440974

ABSTRACT

Crises illustrate the value of digital connectedness. When our physical routines are disrupted, having alternative options to connect with others is important. Yet there are clear divisions in access to the internet, and in the distribution of the skills required to take advantage of the internet. I argue that the COVID-19 pandemic is but one example of a more general idea; that everyone has a moral claim to internet access. We ought to use this opportunity to address the continued inequities in internet access and use amongst our population.


Subject(s)
COVID-19 , Internet Access/ethics , Interpersonal Relations , Pandemics , Social Isolation , Social Justice , COVID-19/psychology , Digital Technology , Humans , Internet , Morals , Resilience, Psychological
20.
Nurs Sci Q ; 34(4): 356-358, 2021 10.
Article in English | MEDLINE | ID: covidwho-1440874

ABSTRACT

The discipline of nursing is at a crossroads following the pandemic as scores of both budding and seasoned scholars and practitioners have left the discipline of nursing. Lower numbers of experienced nurses are entering into doctoral programs of nursing, especially PhD programs. A mentoring model is needed to guide and retain budding scholars of the discipline. The author of this article presents the humanbecoming mentorship model. It will be used to illustrate ethical straight-thinking implications for the future of the discipline of nursing.


Subject(s)
Education, Nursing, Graduate , Ethics, Nursing , Mentoring , Humanism , Humans , Mentors , Morals
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