In critique of moral resilience: UK healthcare professionals' experiences working with asylum applicants housed in contingency accommodation during the COVID-19 pandemic.

This research explores the experiences of UK NHS healthcare professionals working with asylum applicants housed in contingency accommodation during the COVID-19 pandemic. Using a critical understanding of the concept of moral resilience as a theoretical framework, we explore how the difficult circumstances in which they worked were navigated, and the extent to which moral suffering led to moral transformation. Ten staff from a general practice participated in semistructured interviews. Encountering the harms endured by people seeking asylum prior to arrival in the UK and through the UK's 'Hostile Environment' caused healthcare staff moral suffering. They responded to this in several ways, including: (1) feeling grateful for their own fortunes; (2) defining the limitations of their professional obligations; (3) focusing on the rewards of work and (4) going above and beyond usual care. Although moral resilience is reflected in much of the data, some participants described how the work caused ideological transformations and motivated challenges to systems of oppression. We show how current moral resilience theory fails to capture these transformative political and social responses, warning of how, instead, it might encourage healthcare staff to maintain the status quo. We caution against the widespread endorsement of current formulations of moral resilience in contemporary social and political climates, where the hostile and austere systems causing suffering are the result of ideological political decisions. Future work should instead focus on enabling working conditions to support, and developing theory to capture, collective resistance.

Ageism and moral distress in nurses caring for older patients

This study explored the influence of healthcare ageism on nurses' moral distress. Episodic interviews were conducted on 25 Romanian nurses in 2020. Thematic analysis revealed that all moral distress sources reported reflected macro-, meso- and micro-level ageism, benevolent and hostile, self- or other-directed, including stereotyping, prejudice, and discrimination of older patients. The COVID-19 pandemic-related ageist measures increased healthcare ageism and transformed nurses' representations of older patients accordingly. Nurses felt moral conflict both when passively witnessing ageist acts and when perpetrating them to adhere to group norms, highlighting the need to combat ageism for both patients' and nurses' well-being.

Repairing moral injury takes a team: what clinicians can learn from combat veterans.

Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic's advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing moral injury-particularly its social dimensions. Veterans recognise that complex social factors lead to moral injury, and therefore a community approach is necessary for healing. We argue that similar attention must be given in healthcare, where a team-oriented and multidimensional approach is essential both for ameliorating the suffering faced by health professionals and for addressing the underlying causes that give rise to moral injury.

The effect of military morals and values on veterans post-military

The purpose of this study was to better understand the lived experiences of veterans and the transferability of military morals and values. At the time of this study, there was limited research exploring the phenomenon of the military morals and values that become ingrained during Basic Combat Training and how they affect a veteran's life once they reintergrate back into the civilian sector. To further investigate the phenonmenon of the transferability and impact of the military morals and values post-military, the researcher posed this question: How do veterans adapt their military cultural experience, specifically their acquired morals and values, to civilian life? Eight Army veterans were interviewed utilizing a semi-structured format (both in-person and virtual due to COVID-19) and their narratives were analyzed by using Interpretative Phenomenological Analysis (IPA). Thirteen themes were identified, organized into clusters, and classfied as prominent or moderate. Findings from this study suggests that there is nuanced transferability of the Army Values and Warrior Ethos for veterans once they leave the military. These findings also indicate that veterans have embraced the military morals and values in ways that they hold themselves and civilians to higher standards, as well as the morals and values providing a sense of psychological safety through trusting relationships established in the military. Clinical implications of this study point to the usefulness of the thematic findings for professionals providing services to veterans in various settings by having a deeper understanding of veterans' experiences with the military morals and values and how they navigate the systems they encounter. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

ICU Physician Wellness and Coping During the COVID-19 Pandemic

The article discusses a binational, cross-sectional survey assessing wellness of physicians who worked in the intensive care unit (ICU) during the COVID-19 pandemic. It mentions that the study was conducted by Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society (ATS), where it was found that that physicians experienced moderate intrapandemic distress and burnout and they also experienced professional fulfillment.

THE RESTORATIVE POWER OF CIRCLES

The article discusses how indigenous talking circles can help health and social care professionals recover from moral injury due to the pandemic. Topics include reason for moral injury in the health and social care context, a therapeutic intervention that has been developed for moral injury in the U.S. military, and the evidence-based theory of post-traumatic growth.

The Impact of Moral Injury on Patients and Colleagues

The article discusses the concept of moral injury that refers to a provider's inability to provide care due to the conflict of a clinician's task and their calling to help people. It cites a case where two physical therapists (PT) faced an ethical issue on whether to accept the organization's lower care standard mindset or make independent decisions in the patient's best interest. Also noted are these developments' consequences on the PTs' mental health and their effective delivery of care.

'Have They Talked About Us At All?' The Moral Distress of Healthcare Social Workers during the COVID-19 Pandemic: A Qualitative Investigation in the State of Texas

Amid the ongoing pandemic, as overburdened and underfunded health systems are requiring health care social workers (HSWs) to assume responsibilities beyond their scope of practice, institutional constraints have undoubtedly heightened encounters of moral distress (MD). MD is the psychological disequilibrium that arises when institutional factors obligate an individual to carry out a task that violates their professional and/or personal ethics. Our qualitative study investigated HSWs' (n  = 43) MD in Texas during the 2019 COVID-19 pandemic. Findings from our study indicate that MD occurs across five levels: (i) patient care decisions;(ii) personal care decisions;(iii) team/unit decisions;(iv) organisational decisions;and (v) social justice decisions. MD is rooted in systems that disproportionately impact historically excluded populations, including social inequities such as financial instability, homelessness and substance use. Organisations need to explicitly consider social justice initiatives that seek to identify growing disparities in care that have been at the forefront of the pandemic;macro-level perspectives that expand MD must address social and health inequities that impede daily tasks of all health care workers. MD encounters that are rooted in social determinants of health can inform supervision, education and practice to ameliorate HSWs' value conflict.

Covid-19 Pandemic and the Moral Values in Christianity and Islam

Religious beliefs have always been the stimulating motives for human behavior. Man's need for religion is not specified to a certain era in time. Rather, it extends over all the times and eras;as a man still invokes religion in the face of ever-rising challenges. One of the most serious of these challenges that humans constantly face is epidemics and diseases. There is no doubt that the two religions, Christianity and Islam, enjoy a high moral heritage. This study aimed to demonstrate the impact of the COVID-19 pandemic on societies, and the importance of Islamic and Christian values in dealing with the pandemic in different societies of the world, by reviewing and analyzing the discourse of religious scholars and priests, and through the sacred texts of the two religions, in addition to reviewing the studies that discussed the pandemic and religious values. The study explained how the Islamic and Christian religious discourses employed morals to confront the pandemic, as they supported and emphasized the precautionary measures, such as home quarantine and social distancing. They also stressed the need for unity, cooperation and solidarity to confront the pandemic in order to preserve the security of societies.

The experts in their labyrinth A reflection on the ethics in pandemic times

Experts or opinion leaders in the biomedical field have become enormously relevant in times of the COVID-19 epidemic. Its influence in the particular circumstances of this pandemic raises in a pressing way the possible conflicts of interest that they may have. A conflict of interest is defined by a situation in which the integrity and judgment of a person can be influenced by a secondary interest, and that can divert him from the primary objectives that dictate his action or activity. The issue about conflicts of interest is almost always considered from a utilitarian perspective, that is, how to detect them and avoid their harmful effects. However, in this article we argue the insufficiency of this approach. We defend the need to recover a moral common ground acceptable to all, in this case the Kantian notion of morality and its concept of autonomy. This would allow to immunize against the drifts that conflicts of interests may produce in a society extremely influenced by the mass media and recovering the concept of authority in contrast with the one of simple expert. Copyright (c) 2022 Xavier Vallès, Gerard Carot-Sans.

The effect of military morals and values on veterans post-military

The purpose of this study was to better understand the lived experiences of veterans and the transferability of military morals and values. At the time of this study, there was limited research exploring the phenomenon of the military morals and values that become ingrained during Basic Combat Training and how they affect a veteran's life once they reintergrate back into the civilian sector. To further investigate the phenonmenon of the transferability and impact of the military morals and values post-military, the researcher posed this question: How do veterans adapt their military cultural experience, specifically their acquired morals and values, to civilian life? Eight Army veterans were interviewed utilizing a semi-structured format (both in-person and virtual due to COVID-19) and their narratives were analyzed by using Interpretative Phenomenological Analysis (IPA). Thirteen themes were identified, organized into clusters, and classfied as prominent or moderate. Findings from this study suggests that there is nuanced transferability of the Army Values and Warrior Ethos for veterans once they leave the military. These findings also indicate that veterans have embraced the military morals and values in ways that they hold themselves and civilians to higher standards, as well as the morals and values providing a sense of psychological safety through trusting relationships established in the military. Clinical implications of this study point to the usefulness of the thematic findings for professionals providing services to veterans in various settings by having a deeper understanding of veterans' experiences with the military morals and values and how they navigate the systems they encounter. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Antecedents of burnout and turnover intentions during the COVID-19 pandemic in critical care nurses: A mediation study

Background: Nurses working in critical care environments have experienced a great deal of psychological stress during the successive waves of the COVID-19 pandemic. Identifying factors that contribute to burnout and turnover intentions are important to retain intensive care unit (ICU) nurses. Purpose: The purpose of this study is to identify factors that are directly and indirectly associated with burnout and turnover intentions in ICU nurses. Methods: A cross-sectional design was used with survey data during the peak of the second wave of the COVID-19 pandemic. Data were collected through an online survey and analyzed using mediation analysis. A total of 236 ICU nurses across Canada participated in the study. Results: The results indicate that burnout mediates the relationship between moral distress, organizational support, resilience, and turnover intentions. Moreover, 49% of the participants were considering leaving. The reasons were related to lack of administrative support, poor work environment and safety concerns. Discussion: Organizational support and individual resilience can both play a role in turnover intentions through the prevention of burnout symptoms. Managers at all levels play an important role in mitigating the harmful effects of the pandemic. Conclusion: The pandemic has had a serious psychological impact on ICU nurses. Targeted interventions are needed to support this group.

Managing Moral Distress

The article informs about applying strategies to help prevent moral destress or resolving moral distress in a positive way can benefit both nurses and organizations by promoting optimal patient care and reducing staff turnover and the risk of litigation from clinical errors. It mentions that nurse manages moral distress which is unnecessary treatment for a patient or witnessing inadequate pain relief because a provider fails to order adequate medication.

[Factors Influencing Nurses' Performance of Care in COVID-19 Wards].

PURPOSE: The purpose of this study was to identify factors influencing nurses' performance of care in COVID-19 wards. METHODS: The participants were 132 nurses who worked in COVID-19 wards at three hospitals, and were recruited from April 1 to May 31, 2021. Data were analyzed using descriptive statistics, t-test, ANOVA, and multiple regression analysis with SPSS/WIN 24.0 program. RESULTS: Nursing performance was significantly and positively correlated with ethical sensitivity (r = .75, p < .001), nursing professionalism (r = .67, p < .001), and social support (r = .67, p < .001). Nursing professionalism was positively correlated with ethical sensitivity (r = .64, p < .001) and social support (r = .55, p < .001). Multiple regression analysis for nursing performance revealed that the most significant factor was ethical sensitivity (ß = .47, p < .001). Ethical sensitivity, nursing professionalism, and social support explained 66.0% of total variance in nursing performance. CONCLUSION: Ethical sensitiviy, nursing professionalism, and social support significantly influence nurses' performace of care in COVID-19 wards. It suggests that intervention programs should be directed at improving nurses' ethical sensitivity, bolstering social support, and enhancing nursing professionalism.

[Bioethics in times of pandemic]. / Bioética en tiempos de pandemia.

It has been demonstrated by statistics that COVID-19 pandemic has not been as aggressive among pediatric population as in adults. Yet, pediatricians and the rest of the health care team face the dilemma of keeping the commitment and responsibilities towards the patients or withstanding the uncertainties arising versus the possibilities of getting infected and spreading it to their beloved ones. There are two main issues: during the professional everyday practice, is there a moral limit when it comes to taking risks? And what is the importance of having difficulty in getting the proper safety equipment in order to decrease the potential risks? Bioethics, as we think, may work as a tool, helping us all to ponder this and the many other bearings we are facing with the current pandemic.

Las estadísticas arrojadas por la pandemia de COVID-19 evidencian que el impacto sobre la población pediátrica no ha tenido la magnitud mostrada en los adultos. Aun así, tanto para los pediatras como para el resto de los integrantes de los equipos de salud, se plantea un dilema entre el mantenimiento de la responsabilidad, el compromiso en la atención de los pacientes afectados y las dudas e incertidumbres surgidas frente a la posibilidad de contraer la enfermedad y de trasmitirla a los seres más cercanos. Desde allí, se estructuran dos cuestiones centrales: ¿existe un límite moral frente a la posibilidad de correr riesgos durante el ejercicio profesional?, ¿qué influencia tiene la dificultad de acceso a mecanismos de protección imprescindibles para disminuir los riesgos que aquel implica? Consideramos que la bioética puede actuar como una herramienta que permita reflexionar sobre estos y otros aspectos a los que la actual pandemia nos enfrenta.