Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond.

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.

Targeting prevention programs for young and new healthcare workers: what is the association of age and job tenure with occupational injury in healthcare?

BACKGROUND: previous evidence suggests young and new workers experience an increased risk of occupational injury. We sought to confirm this observation for healthcare workers. METHODS: a retrospective cohort of 42,771 healthcare workers (88.2% women) was constructed from an active injury surveillance database. Over 2 years, incidence rates and crude and adjusted relative risks for occupational injury were compared between age groups and job tenures. RESULTS: there were opposite trends in the two main types of injuries which cancelled each other: new workers and young workers had a decreased (not increased) risk of musculoskeletal sprain and strain injuries (adjusted RR [95% CI] for new hires was 0.60 [0.48, 0.73], and 0.85 [0.73, 0.98] for workers <25 years old); but an increased risk of cut and puncture injuries (1.25 [1.07, 1.45] for new hires, 1.28 [0.99, 1.67] for workers <25 years old). CONCLUSIONS: contrary to studies of other sectors, younger age and shorter tenure were not universal risk factors for occupational injuries in the female dominated healthcare sector. Young and new workers had increased risk of cuts and punctures, but a decreased risk of musculoskeletal injuries.

Health care workers' perceptions of respiratory and gastrointestinal algorithms for patient management in emergency care settings.

BACKGROUND: Patients with respiratory or gastrointestinal illness in emergency care settings are often not yet diagnosed but are at risk of transmitting disease. Infection control algorithms delineating a standard approach to patient management decrease risk of secondary exposure, but few articles document health care workers' (HCWs) perceptions as to their effectiveness and ease of implementation. METHODS: A cross-sectional survey approach was used to explore HCWs perceptions in 2 emergency departments of the current algorithms for management of potentially infectious respiratory and gastrointestinal illnesses. RESULTS: Surveys from 96 HCWs revealed that algorithms were perceived as invaluable in protecting staff, patients, and colleagues. Differences in self-reported compliance, clarity, and ease of implementation of the respiratory algorithm were noted between facilities, likely reflecting variation in the physical plant. Physicians scored significantly lower for compliance with the respiratory algorithm. CONCLUSION: Algorithms were perceived to offer a clear and consistent approach to patient management and protect HCWs in spite of environmental and resource limitations.