Balancing health worker well-being and duty to care: an ethical approach to staff safety in COVID-19 and beyond

Abstract

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment (PPE) in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff.

A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic

“…The prolonged use of PPE in different settings in healthcare is associated with practice disruptions, barriers in communication among HCWs and between HCWs and patients, conflicts among colleagues regarding PPE distribution and proper use, as well as difficulties in movement, and a constant need to adjust to changing protocols and safety guidelines [ 79 , 81 ]. Moreover, the use of PPE has been associated with moral dilemmas, for example, having to care of a suspected Covid-19 patient while not having appropriate PPE; or being unable to offer emotional support through facial expressions and touch [ 82 , 83 ]. For example, in speech therapy practice, one of the greatest challenges is the difficulty in communicating with patients through expressions and gestures to demonstrate movements, which is impaired due to the use of PPE.…”

“…Similarly, HCWs and especially women and nurses have been also the victims of attacks and violence in their communities in Latin America [ 69 ]. Stigmatization as a psychosocial risk factor is also highlighted in commentaries and opinion papers focusing on the UK and the USA [ 82 , 85 ]. Moreover, studies show that HCWs are often the targets of intersectional processes of stigmatization across their professional roles, ethnicity, gender, and race.…”

Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic

“…These risks are clearly present from the chance of infection and death, but also of psychological burden, overwork and time away from loved ones. HCWs have long experienced a duty to care [ 46 ]. Sacrifice of personal wants for the benefit of patients is not new.…”

“…HCWs take on long work shifts, care of dying patients and difficult conversations with grieving or angry family members as a regular part of work. Ethically, however, there must be balance between duty to care and worker well-being [ 46 ]. Protection from the consequences of occupational exposure to moral injury may require a similar framework as HCW protection from blood-borne pathogen or tuberculosis exposure.…”

Changing Research Paradigm in the Face of a Global Pandemic: Foreseeable Impact and Adaptive Measures in Academic Research in the Future

“…Additionally, it must also include the purpose of distance participation and confi rm that the patient is willing to self-examine and accurately report their fi ndings in a timely and appropriate manner [27]. Safety of staff conducting research is another major concern [28].…”