Moral Injury in Health Care: Identification and Repair in the COVID-19 Era

Rosen, Amanda; Cahill, Jonathan M.; Dugdale, Lydia S.

doi:10.1007/s11606-022-07761-5

Cited by 28 publications

(30 citation statements)

References 34 publications

(43 reference statements)

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“…32 Frailty's ability to allow hospitals to anticipate which patients may need extra postoperative attention and care allows hospitals to maximize their limited resources. 33,34 The preoperative diagnosis of frailty can facilitate conversations about prognosis; as a result, an improved decision-making conversation may be enabled between the clinician and the patient/family. 11,24 The limitations of this study include its retrospective nature.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Moya

Owodunni

Harrison

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Cranioplasty is a common surgical procedure used to repair cranial defects, and it is associated with significant morbidity and mortality. Although frailty is a strong predictor of poor postoperative outcomes across surgical specialties, little is known about frailty's impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing the effect of the Risk Analysis Index-Administrative (RAI-A) and the Modified Frailty Index-5 (mFI-5) on cranioplasty outcomes. Methods: The National Surgical Quality Improvement Program was queried for patients undergoing cranioplasty between 2012 and 2020. Receiver operating characteristics and multivariable analyses were used to assess the relationship of postoperative outcomes and the RAI-A, mFI-5, and increasing patient age. Results: There were 2864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were women (57.0%) and White (68.5%). The RAI-A had a more robust predictive ability for 30-day mortality (C-Statistic, 0.741; 95% confidence interval (CI), 0.678-0.804) compared with mFI-5 (C-Statistic, 0.574; 95% CI, 0.489-0.659) and increasing patient age (C-Statistic, 0.671; 95% CI, 0.610-0.732). On multivariable analyses, frailty was independently associated with mortality and other poor postoperative outcomes (P < 0.05). Conclusions:The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting mortality. Additionally, the RAI-A showed independent associations with nonhome discharge and postoperative complications (CDII, CDIIIb, and CDIV). The high rates of operative morbidity (5.0%-36.5%) and mortality (0.4%-3.2%) after cranioplasty highlight the importance of identifying independent risk factors for poor cranioplasty outcomes.

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Section: Discussionmentioning

confidence: 99%

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Moya

Owodunni

Harrison

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Acknowledgement of moral distress and regret amongst nurses, related to the constraints of delivering care in a pandemic is vitally important to mitigate potential negative consequences. Unresolved or repeated incidents of moral distress can lead to moral injury, which is psychological trauma resulting from a profound compromise of moral values (Rosen et al, 2022 ). Whilst moral distress can prompt emotions of frustration, unease and anger, moral injury can trigger a crisis in identity (Rosen et al, 2022 ; Rushton et al, 2022 ) The consequences of moral injury are long‐term and often irreversible, including poor mental health, burnout and workforce attrition, as well as damage to morale in the workplace (Morley et al, 2020 ; Rosen et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Unresolved or repeated incidents of moral distress can lead to moral injury, which is psychological trauma resulting from a profound compromise of moral values (Rosen et al, 2022 ). Whilst moral distress can prompt emotions of frustration, unease and anger, moral injury can trigger a crisis in identity (Rosen et al, 2022 ; Rushton et al, 2022 ) The consequences of moral injury are long‐term and often irreversible, including poor mental health, burnout and workforce attrition, as well as damage to morale in the workplace (Morley et al, 2020 ; Rosen et al, 2022 ). Building moral resilience through interventions such as facilitated ethical reflection is vital to combating moral distress and mitigating the effect of moral injury (Rosen et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Whilst moral distress can prompt emotions of frustration, unease and anger, moral injury can trigger a crisis in identity (Rosen et al, 2022 ; Rushton et al, 2022 ) The consequences of moral injury are long‐term and often irreversible, including poor mental health, burnout and workforce attrition, as well as damage to morale in the workplace (Morley et al, 2020 ; Rosen et al, 2022 ). Building moral resilience through interventions such as facilitated ethical reflection is vital to combating moral distress and mitigating the effect of moral injury (Rosen et al, 2022 ). Such interventions should be built into the COVID‐19 recovery process of the nursing workforce and supported by the organizational culture (Delany et al, 2021 ; Rushton et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

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Exploring the impact of the COVID‐19 environment on nursing delivery of family‐centred care in a paediatric hospital

O’Neill

Devsam

Kinney

et al. 2022

Journal of Advanced Nursing

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Aims and objectives:To understand how the pandemic environment impacted the delivery of FCC of children and families from a nursing perspective in a major tertiary paediatric hospital.Background: Family-centred care (FCC) is a well-established framework to promote parental involvement in every aspect of a child's hospitalization, however, rules and restrictions in place during the COVID-19 pandemic affected the ways in which Family-centred Care could be delivered in practice.Design: This is a qualitative exploratory descriptive study to elicit the perspective of paediatric nurses delivering care to children in a hospital during the COVID-19 pandemic in Victoria, Australia. Methods:Nurses from all subspecialties in a tertiary paediatric hospital were invited to participate in virtual focus groups to discuss their experience of delivering FCC during the COVID-19 pandemic. Focus groups were recorded and transcribed, then analysed using Framework Analysis. Results: Nineteen nurses participated across seven focus groups during June and July 2020. The four themes-Advocating with empathy, Enabling communication, Responding with flexibility, and Balancing competing considerations-and the eight subthemes that were generated, outline how nurses deliver FCC, and how these FCC actions were impacted by the COVID-19 environment and the related hospital restrictions. Conclusion: This study documents the experiences, resilience and resourcefulness of paediatric nurses in Australia during the COVID-19 pandemic as well as moving Family-centred Care from a theoretical framework into a practical reality. Impact: The findings from this study should inform consideration of the impacts of public health policies during infectious disease outbreaks moving forward. In addition by describing the core actions of Family-centred Care, this study has implications for educational interventions on how to translate FCC theory into practice.No public or patient contribution as this study explored nursing perceptions only.

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“…Indeed, current reflections on the underlying causes of burnout suggest it is a symptom of a broken health care system. The term "moral injury" has been suggested to be more apt than "burnout" to describe the plight of health care workers, since we, the caregivers, are increasingly faced with a multitude of external factors in the care environment that compete with what we have long sought as our professional goals: to heal, to comfort, and to act in our patients' best interests (5)(6)(7).…”

mentioning

confidence: 99%

“Burnout” Coupled with Workforce Shortages Spells Trouble: Innovative Solutions Are Essential for More Satisfying Rheumatology Practice

Calabrese

Battafarano²,

Stamatos

2023

Arthritis & Rheumatology

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Moral Injury in Health Care: Identification and Repair in the COVID-19 Era

Cited by 28 publications

References 34 publications

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

Exploring the impact of the COVID‐19 environment on nursing delivery of family‐centred care in a paediatric hospital

“Burnout” Coupled with Workforce Shortages Spells Trouble: Innovative Solutions Are Essential for More Satisfying Rheumatology Practice

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