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.
The management of proximal humerus fracture is often challenging for orthopedic surgeons. Most of these fractures, in fact, occurs in old women with poor bone quality. Risk of loosening or nonunion and risk of avascular necrosis of humeral head is high, especially in four-parts fractures. We present a case of a 69-year-old woman with proximal humeral nonunion associated with a humeral head osteonecrosis. The peculiarity of this case is that the patient had no follow-up for 7 months because of the Covid-19 pandemic and the restrictions that resulted. We intend to describe how this social situation forced us to change our strategy of treatment and to discuss how to face the possible consequences in orthopedic practice.
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