Ethical and psychosocial considerations for hospital personnel in the Covid-19 crisis: Moral injury and resilience

Abstract

This study aims at investigating the nature of resilience and stress experience of health care workers during the COVID-19 pandemic. Thirteen healthcare workers from Italian and Austrian hospitals specifically dealing with COVID-19 patients during the first phase of the pandemic were interviewed. Data was analysed using grounded theory methodology. Psychosocial effects on stress experience, stressors and resilience factors were identified. We generated three hypotheses. Hypothesis one is that moral distress and moral injury are main stressors experienced by healthcare workers. Hypothesis two states that organisational resilience plays an important part in how healthcare workers experience the crisis. Organisational justice and decentralized decision making are essential elements of staff wellbeing. Hypothesis three refers to effective psychosocial support: Basic on scene psychosocial support based on the Hobfoll principles given by trusted and well-known mental health professionals and peers in an integrated approach works best during the pandemic.

Occupational challenges of health care workers during the COVID-19 pandemic. A qualitative study

“…28 Once the crisis is over, a major task should therefore be after care, addressing moral injury in HCWs and rebuilding trust in the system. 29,30 We also found that some nurses who have no professional infectious disease background or training were recruited from other wards to remedy staff shortages. Redeployment of staff without specific training may lead to absenteeism, especially once the crisis is over.…”

“…21 Other studies found that HCWs experience moral injury as a consequence of their commitment. 28,29 Insufficient protection, as well as other factors such as (lack of) actions that violate one's ethical principles (e.g. not being able to provide good quality care to patients due to being overworked), lead to negative selfperception and distrust in the system.…”

Psychosocial Problems among Nurses in Patient’s Care of COVID-19: A Literature Review

“…Social pressures: negative societal stigma, discomfort with the environment, the presence of strangers, changes in relationships with patients and relatives, decreased closeness to other relatives, fear of being stigmatized by others, and injustice. Alizadeh et al, 2020;Kackin et al, 2020;Sun et al, 2020;Kreh et al, 2021. Uncertainty: Changes in work patterns, heavy work and difficulties in communicating with patients, new roles or tasks and broken routines, and uncertainty about future conditions. Cui et al, 2020;Kackin et al, 2020;Kreh et al, 2021. Study Zhang et al (2020) stated that nurses who work to treat COVID-19 patients undergo a process of change at work into three stages, namely the initial stage (ambivalence), the middle stage (emotional exhaustion), and the next stage (energy renewal).…”

“…Alizadeh et al, 2020;Kackin et al, 2020;Sun et al, 2020;Kreh et al, 2021. Uncertainty: Changes in work patterns, heavy work and difficulties in communicating with patients, new roles or tasks and broken routines, and uncertainty about future conditions. Cui et al, 2020;Kackin et al, 2020;Kreh et al, 2021. Study Zhang et al (2020) stated that nurses who work to treat COVID-19 patients undergo a process of change at work into three stages, namely the initial stage (ambivalence), the middle stage (emotional exhaustion), and the next stage (energy renewal). At each stage, nurses have different psychological characteristics.…”

“…Study Kreh et al (2021) stated that emotionally, the fear of being infected and subsequently infecting family and friends is a common feeling. However, many health workers do not return to their homes because they do not want to infect their own families.…”