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

Fahmida Hossain, Ariel Clatty, Fahmida Hossain, Ariel Clatty

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.

Keywords: COVID-19; moral distress; moral injury; nurses; pandemic; self-care.

Conflict of interest statement

Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Montemurro N. The emotional impact of COVID-19: from medical staff to common people. Brain Behav Immun 2020; 87: 23–24.
    1. Mannelli C. Whose life to save? Scarce resources allocation in the COVID-19 outbreak. J Med Ethics 2020; 46(6): 364–366.
    1. Berlinger N, Wynia M, Powell T, et al. Ethical framework for health care institutions responding to novel coronavirus SARS-CoV-2 (COVID-19) guidelines for institutional ethics services responding to COVID-19: managing uncertainty, safeguarding communities, guiding practice. Garrison, NY: The Hastings Center, 2020.
    1. Angelos P. Surgeons, ethics, and COVID-19: early lessons learned. J Am Coll Surg 2020; 230(6): 1119–1120.
    1. Alharbi J, Jackson D, Usher K. The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing 2020; 29(15-16): 2762–2764.
    1. Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Fed Pract 2019; 36: 400–402.
    1. Henrich NJ, Dodek PM, Alden L, et al. Causes of moral distress in the intensive care unit: a qualitative study. J Crit Care 2016; 35: 57–62.
    1. Frakt A. Who should be saved first? Experts offer ethical guidance. The New York Times, 24 March 2020,
    1. Gustavsson ME, Arnberg FK, Juth N, et al. Moral distress among disaster responders: what is it. Prehosp Disaster Med 2020; 35(2): 212–219.
    1. Williams RD, Brundage JA, Williams EB. Moral injury in times of COVID-19. J Health Serv Psychol. Epub ahead of print 2 May 2020 DOI: 10.1007/s42843-020-00011-4.
    1. Asken MJ. Now it is moral injury: the COVID-19 pandemic and moral distress. Medical Economics, 29 April 2020,
    1. James A. ‘Unfriend me’: nurse shares frustrations, life experience months into pandemic. abc15news, 25 July 2020,
    1. Aacharya RP, Gastmans C, Denier Y. Emergency department triage: an ethical analysis. BMC Emergency Medicine 2011; 11: 16.
    1. Binkley CE, Kemp DS. Ethical rationing of personal protective equipment to minimize moral residue during the COVID-19 pandemic. J Am Coll Surg 2020; 230(6): 1111–1113.
    1. Meet 10 nurses pioneering innovation Covid-19 solutions. Johnson & Johnson Nursing, 2020,
    1. Purba AK. How should the role of the nurse change in response to Covid-19? Nurs Time 2020; 116: 25–28,
    1. Morley G, Grady C, McCarthy J, et al. Covid-19: ethical challenges for nurses. Hastings Cent Rep 2020; 50: 35–39.
    1. Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020; 368: m1211.
    1. Ripp J, Peccoralo L, Charney D. Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic. Acad Med 2020; 95(8): 1136–1139.
    1. He H. RN-BSN students desire more healthcare ethics education. Int J Nurs Clin Pract 2018; 5: 300.
    1. Jarrad RA, Hammad S. Oncology nurses’ compassion fatigue, burn out and compassion satisfaction. Ann Gen Psychiatry 2020; 19: 22–22.
    1. Moon JY, Kim J-O. Ethics in the intensive care unit. Tuberc Respir Dis 2015; 78: 175–179.
    1. Monteverde S. Caring for tomorrow’s workforce: moral resilience and healthcare ethics education. Nursing Ethics 2014; 23: 104–116.
    1. Rushton CH. Moral resilience: a capacity for navigating moral distress in critical care. AACN Adv Crit Care 2016; 27(1): 111–119.
    1. Abraham M, Smith RE. Beyond resilience: addressing moral distress during the COVID-19 pandemic, 2020,
    1. Phillips C, Bassell K, Fillmore L, et al. Transforming leaders into stewards of teaching excellence: building and sustaining an academic culture through leadership immersion. Contemp Issues Educ Res 2018; 11: 1–8.
    1. Goodman A, Cranmer H, Murray S, et al. ETHICS in disaster response: the development of an ethics disaster response program. Prehosp Disast Med 2017; 32: S50–S51.
    1. Bianchi R, Schonfeld IS, Laurent E. Burnout-depression overlap: a review. Clin Psychol Rev 2015; 36: 28–41.
    1. Church D, Stern S, Boath E, et al. Emotional freedom techniques to treat posttraumatic stress disorder in veterans: review of the evidence, survey of practitioners, and proposed clinical guidelines. Perm J 2017; 21: 16–100.
    1. Rancour P. The emotional freedom technique: finally, a unifying theory for the practice of holistic nursing, or too good to be true? J Holist Nurs 2017; 35: 382–388.
    1. Greenberg N, Megnin-Viggars O, Leach J. Occupational health professionals and 2018 NICE post-traumatic stress disorder guidelines. Occupational Medicine 2019; 69: 397–399.
    1. Rushton CH. Cultivating moral resilience. Am J Nurs 2017; 117(2 Suppl. 1): S11–S15.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera