Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic

Abstract

These are strange and unprecedented times in the wake of the COVID-19 pandemic. Most frontline healthcare professionals have never witnessed anything like this before. As a result, staff may experience numerous and continuous traumatic events, which in many instances, will negatively affect their psychological well-being. Particularly, nurses face extraordinary challenges in response to shifting protocols, triage, shortages of resources, and the astonishing numbers of patients who require care in expedited time constraints. As most healthcare workers are passionate nursing professionals, frustration and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. The overwhelming number of deaths, patients isolated and dying alone, and the ever-present fear of being infected and then infecting colleagues, family, friends due to the lack of protective gear or known protocols takes its toll on emotional and psychological well-being. For nurses, the experience of this significant (hopefully once-in-a-lifetime) event can inflict on-going moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Institutions must provide these resources to tend to the well-being of their healthcare staff, during and beyond the pandemic. This article aims to investigate moral distress—considering it as a moral injury—and offer tools and recommendations to support healthcare nurses as they respond to this crisis and its aftermath.

Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study

“…The present study was conducted during the first pandemic surge in Greece, which did not lead to an overwhelming COVID-19 burden; the study was not restricted to hospital employees tasked to treat COVID-19 cases and considered the intensity of pandemic containment measures. In line with previous reports, anxiety severity increased from general population online survey participants to hospital workforces and reached its maximum in COVID-19 frontline workforces, since these employees are more intensively exposed to demanding and unforeseen medical emergencies, (moral) trauma experiences [8,38] and to high risk for becoming infected and transmitting COVID-19 to their social network compared to the other study groups [4,7,16,17,19,21,22,39]. It is noteworthy that the results of the ordered logistic regression model with anxiety symptom severity as dependent variable provided further evidence for the significant differences in anxiety symptoms between COVID-19 frontline-and backstage hospital employees (Table 4).…”

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

“…Managing scarce resources and having to take difficult decisions (e.g., triage, provision of ventilators for certain patients and not for others) create conflict between professional and ethical values on the one hand and HCW’s own safety or the availability of resources on the other [ 83 , 92 , 93 ]. Often, HCWs were aware that the decisions they need to take and the practices they follow because of the pandemic are against what is appropriate for the patient [ 93 ]. HCWs are exposed to continuous and increasing levels of emotional strain and moral injury [ 94 ].…”

“…Dealing with the Covid-19 patients’ feelings of distress, as well as with the loss of big numbers of patients and colleagues are identified as significant psychosocial risk factors affecting HCWs’ mental health [ 88 , 94 , 95 ]. A commentary [ 93 ] on nurses’ moral injury during the pandemic suggests that the shift from patient-centred ethics in healthcare to public health-centred ethics imposed by the current circumstances, represents a major challenge for nurses and triggers moral dilemmas in instances when practices of triage or patient prioritization take place and are in conflict with the duty to care for each particular patient.…”

Nurses’ challenges, concerns and unfair requirements during the COVID-19 outbreak

“…Nurses who reported more ethical stress showed lower job satisfaction and higher intent to leave their current position. 38,39 From this aspect, the literature emphasizes that managing ethical concerns can best be achieved through a positive ethical climate and institutional support, 40,41 yet this does not seem to be the case here. Studies further show that work-home interference and conflict are a source of turnover intentions among new nurses.…”