Covid-19 has amplified moral distress in medicine

Sheather, Julian; Fidler, Helen

doi:10.1136/bmj.n28

Cited by 57 publications

(69 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 Experiences from previous pandemics confirm front-line healthcare professionals may develop poor mental health as a consequence, including formal mental health disorders such as post-traumatic stress disorder (PTSD) 17 and moral injury. 20 Moral injury refers to the moral distress caused by the powerlessness of healthcare professionals to meet patients' needs in a situation of high demand and constrained resources, and it has been linked with the development of suicidal thoughts, depression, anxiety, flashbacks or PTSD. 21 It is paramount that the importance of the impact on mental health and psychological well-being on all parts of the healthcare workforce is identified, characterised and addressed.…”

Section: Key Messagesmentioning

confidence: 99%

Experiences of nurses caring for respiratory patients during the first wave of the COVID-19 pandemic: an online survey study

et al. 2021

View full text Add to dashboard Cite

BackgroundNurses have been at the forefront of the pandemic response, involved in extensive coordination of services, screening, vaccination and front-line work in respiratory, emergency and intensive care environments. The nature of this work is often intense and stress-provoking with an inevitable psychological impact on nurses and all healthcare workers. This study focused on nurses working in respiratory areas with the aim of identifying and characterising the self-reported issues that exacerbated or alleviated their concerns during the first wave of the COVID-19 pandemic.MethodsAn online survey was developed consisting of 90 questions using a mixture of open-ended and closed questions. Participant demographic data were also collected (age, gender, ethnicity, number of years qualified, details of long-term health conditions, geographical location, nursing background/role and home life). The online survey was disseminated via social media and professional respiratory societies (British Thoracic Society, Primary Care Respiratory Society, Association of Respiratory Nurse Specialists) over a 3-week period in May 2020 and the survey closed on 1 June 2020.ResultsThe study highlights the experiences of nurses caring for respiratory patients during the first wave of the pandemic in early 2020. Concerns were expressed over the working environment, the supply and availability of adequate protective personal equipment, the quality of care individuals were able to deliver, and the impact on mental health to nurses and their families. A high number provided free-text comments around their worries and concerns about the impact on their household; these included bringing the virus home, the effect on family members worrying about them, mental health and the impact of changing working patterns, and managing with children. Although both formal and informal support were available, there were inconsistencies in provision, highlighting the importance of nursing leadership and management in ensuring equity of access to services.ConclusionsSupport for staff is essential both throughout the pandemic and afterwards, and it is important that preparation of individuals regarding building resilience is recognised. It is also clear that psychological support and services for nurses and the wider healthcare team need to be available and quickly convened in the event of similar major incidents, either global or local.

show abstract

Section: Key Messagesmentioning

confidence: 99%

Experiences of nurses caring for respiratory patients during the first wave of the COVID-19 pandemic: an online survey study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Doctors and nurses are exhausted or absent because of sickness or the need to self-isolate. Many will experience moral distress or its damaging sequel, moral injury, caused by the gap between what you think should be done for a patient and what can be done under constraints beyond your control 3. In the UK it may not yet, or ever, be about whether a patient can be ventilated.…”

mentioning

confidence: 99%

Covid 19: Hope is being eclipsed by deep frustration

Godlee¹

2021

BMJ

View full text Add to dashboard Cite

show abstract

“…In terms of maternity care, this requires a sophisticated understanding of what 'companionship' means, over the whole life course, and for mother, baby, and family. It also requires attention to the potential moral distress of maternity care staff (and health care staff in general, including ultrasonographers) who are faced with the stress of having to balance these two imperatives with real people, in intensely emotional real time, repeatedly day in and day out, and at times with insufficient PPE equipment available; at a time when they, too could be pregnant women at risk of exposure to infection, or parents/carers fearful of infecting family members (25)(26)(27)(28). The study by Nguyen and colleagues identified that that infection risks for acquiring infection were high for staff compared to women, and particularly among front-line health-care workers (29).…”

Section: Discussionmentioning

confidence: 99%

Companionship for women using English maternity services during COVID-19: National and organisational perspectives

Thomson

Balaam

Nowland

et al. 2021

Preprint

View full text Add to dashboard Cite

Objectives: To explore the impact of COVID-19 on companionship for women using maternity services in England, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE COVID-19 UK) study. Setting: Maternity care provision in England. Participants: Interviews were held with 26 national governmental, professional, and service-user organisation leads including representatives from the Royal College of Midwives, NHS England, Birthrights and AIMS (July-Dec). Other data included public-facing outputs logged from 25 maternity Trusts (Sept/Oct) and data extracted from 78 documents from 8 key governmental, professional and service-user organisations that informed national maternity care guidance and policy (Feb-Dec). Results: Six themes emerged: Postcode lottery of care highlights variations in companionship practices, Confusion and stress around rules relates to a lack of and variable information concerning companionship, Unintended consequences concerns the negative impacts of restricted companionship on service-users and staff, Need for flexibility highlights concerns about applying companionship policies irrespective of need, Acceptable time for support highlights variations in when and if companionship was allowed antenatally and intrapartum; and Loss of human rights for gain in infection control emphasizes how a predominant focus on infection control was at a cost to psychological safety and womens human rights. Conclusions: Policies concerning companionship have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. This was associated with psychological harms for some women and staff. There is an urgent need to determine how to balance risks and benefits sensitively and flexibly and to optimise outcomes during the current and future crisis situations.

show abstract

Covid-19 has amplified moral distress in medicine

Abstract: Simply working harder cannot resolve the conflicts caused by responsibility without autonomy

Cited by 57 publications

References 3 publications

Experiences of nurses caring for respiratory patients during the first wave of the COVID-19 pandemic: an online survey study

Experiences of nurses caring for respiratory patients during the first wave of the COVID-19 pandemic: an online survey study

Covid 19: Hope is being eclipsed by deep frustration

Companionship for women using English maternity services during COVID-19: National and organisational perspectives

Contact Info

Product

Resources

About