Moral Injury

From the Document: "These are unprecedented times. We need to work extra hard to manage our emotions well. Expect to have a lot of mixed feelings. Naturally we feel anxiety, and maybe waves of panic, particularly when seeing new headlines. A recent article by stress scientist and Vice Chair of Adult Psychology Elissa Epel, PhD, outlines the psychology behind the COVID-19 [coronavirus disease 2019] panic response and how we can try to make the best of this situation. Our anxiety is helping us cope, bond together from a physical distance, and slow the spread of the virus. So our anxiety - while uncomfortable - is a good thing right now, especially if we manage it well. At the same time, we must effortfully prevent panic contagion and create periods when we can be screen-free and calm, engaging our attention in normal daily activities. Seize opportunities to share lightness and humor. Laughter right now is a relief for all of us!"

From the Key Points: "[1] Question: What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? [2] Findings: In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. [3] Meaning: These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions."

From the Abstract: "The coronavirus pandemic (COVID-19) will undoubtedly have psychological impacts for healthcare workers, which could be sustained; frontline workers will be particularly at risk. Actions are needed to mitigate the impacts of COVID-19 on mental health by protecting and promoting the psychological wellbeing of healthcare workers during and after the outbreak. We developed and evaluated a digital learning package using Agile methodology within the first three weeks of UK outbreak. This e-package includes evidence-based guidance, support and signposting relating to psychological wellbeing for all UK healthcare employees. A three-step rapid development process included public involvement activities (PPIs) (STEP 1), content and technical development with iterative peer review (STEP 2), and delivery and evaluation (STEP 3). The package outlines the actions that team leaders can take to provide psychologically safe spaces for staff, together with guidance on communication and reducing social stigma, peer and family support, signposting others through psychological first aid (PFA), self-care strategies (e.g., rest, work breaks, sleep, shift work, fatigue, healthy lifestyle behaviours), and managing emotions (e.g., moral injury, coping, guilt, grief, fear, anxiety, depression, preventing burnout and psychological trauma). The e-package includes advice from experts in mental wellbeing as well as those with direct pandemic experiences from the frontline, as well as signposting to public mental health guidance."

From the Document: "Moral injury (sometimes referred to as 'moral distress') can occur when someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs. Most healthcare workers typically do not experience significant distress from difficult situations at work because of their training and preparation, healthcare cultural norms, messages and behavior of peers and leaders, and acceptance by families and the culture at large. However, in unprecedented contexts, such as a pandemic, some people may have difficulty with unfamiliar and potentially distressing work experiences."

From the Abstract: "Health care providers are facing increased risk of moral distress during the COVID-19 [coronavirus disease 2019] pandemic because of changes in clinical practice and resource allocation procedures. Health care systems that employ a proactive approach in mitigating the lasting effects of moral distress will fare better in the long run. Psychologists are well poised to apply timely psychological first aid to the crisis needs of patients, colleagues, and even themselves. Key interventions are detailed, including creating and promoting safety, calmness, connectedness, self-efficacy, and hope."

From the Document: "The current COVID-19 [coronavirus disease 2019] pandemic is unprecedented in reach around the world and the extended nature of this invisible threat. No one is left without impact whether it is direct such as exposure to infection or infection risks or changes in or loss of employment or indirect through impact on loved ones and communities. [...] Key to any mental health response to the current pandemic or other extended potentially highly distressing and/or traumatic events is a response that simultaneously considers both timing (referred to as phase) and associated distress and/or functional impairment (referred to as level). As defined below, the framework includes three phases (initial, post, and longer-term) and three levels (system level, self-directed level, and mental health supported brief intervention)."

From the Executive Summary: "Although the COVID-19 [coronavirus disease 2019] crisis is, in the first instance, a physical health crisis, it has the seeds of a major mental health crisis as well, if action is not taken. Good mental health is critical to the functioning of society at the best of times. It must be front and centre of every country's response to and recovery from the COVID-19 pandemic. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. Psychological distress in populations is widespread. Many people are distressed due to the immediate health impacts of the virus and the consequences of physical isolation. Many are afraid of infection, dying, and losing family members. Individuals have been physically distanced from loved ones and peers. Millions of people are facing economic turmoil having lost or being at risk of losing their income and livelihoods. Frequent misinformation and rumours about the virus and deep uncertainty about the future are common sources of distress. A long-term upsurge in the number and severity of mental health problems is likely."