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Improving Entropic Flow in Healthcare Organisations
Published in Lesley Kuhn, Kieran Le Plastrier, Managing Complexity in Healthcare, 2022
Lesley Kuhn, Kieran Le Plastrier
These ‘confrontations’ to emotional and professional demands within the patient–clinician relationship harbour an ethical dimension to the stress-ors experienced by healthcare workers and augur the risk of moral injury (Griffin et al., 2019). Researchers have found that practitioners experience moral stress in every day practice stemming from inter-professional trust and opportunities to listen to patients and their carers (Bartholdson et al., 2016) that can affect perception about the quality of care and the effectiveness of decision-making in professional teams (Atabay, Cangarli and Penbek, 2015). Ulrich, Taylor and Penbek (2013) argue that there is a lack of emphasis on the moral hazards of clinical practice and that, for nurses, this increases levels of stress and may affect nursing staff retention. Importantly, in Griffin et al.’s review of literature on moral stressors and moral injury, organisational and institutional factors were reported by people experiencing adverse effects of moral injury, including out-of-touch leadership, difficulty identifying threats in the environment, dehumanisation of others, and loss of trust in external relationships including partners, communities, and governments.
Skin: Resilience
Published in Philip Berry, Necessary Scars, 2021
The capacity of the NHS is always behind the demand for its services. It serves best those who have potentially mortal problems who are taken on an express route straight to its technologically impressive and highly focused heart. Those who may have cancer are similarly mainlined through its bureaucracy into clinics, scanners and operating theatres. Others, with benign disease, less visible psychological issues or social needs, may find themselves struggling to get a look in. Doctors and health care workers trying to apply guidelines and protocols that are written to a high standard may find themselves unable to provide ‘excellent’ care in a timely manner. A sense of perpetual ‘sub-optimalism’ may set in. The gap between the ideal and achievable becomes established. They stop fighting for the best. They sigh and take paths of least resistance. This is burnout. Or if not full-blown burnout, then a kind of smoulder. It is not failure. It is adaptation to a service that can only spend so much. I’m not sure ‘moral injury’ describes this situation.
What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
I have never felt completely without resources, I’m grateful to say. There have definitely been times, and I wish I could say they were rare, when I have felt I needed to make a change. Or when I’ve needed to make different choices. There is personal ownership I feel to some of this. There has been a lot of talk about healthcare professionals experiencing “moral injury,” rather than burnout. I am not a big fan of that narrative because it feels disempowering to me. Yes, life happens to us. Yes, the system of healthcare is happening to us to some extent. It is not all in our sphere of control to change. However, I still feel accountable to make it better. Only about 2% of the workforce is simultaneously burned out and checked out. Another 40–50% of us are navigating the pressures of burning out and are still showing up engaged. There is a lot of talent and goodwill available to improve our system. If we feel like victims, it is going to be more challenging to participate in the change that is needed.
Let’s Get “REAL”: A Collaborative Group Therapy for Moral Injury
Published in Journal of Health Care Chaplaincy, 2022
Melissa A. Smigelsky, Jesse Malott, Ryan Parker, Carter Check, Brad Rappaport, Steffanie Ward
The relatively newer construct of “moral injury” presents another response to profoundly distressing life events that retains the central positioning of basic capacities of trust, autonomy, competence, and identity. Moral injury is theorized to manifest in the aftermath of exposure to certain events or experiences that involve a violation of one’s deeply held moral beliefs or values, including betrayal and moral paradox (Fleming, 2021; Litz et al., 2009; Shay, 2014). The experience of moral injury in the aftermath of these events/experiences can be characterized by difficulty trusting oneself or others, a compromised sense of self or others as capable and good, and fractures to one’s internal meaning-making frameworks. Research among veterans suggests that exposure to potentially morally injurious experiences is associated with changes in spirituality, including feeling abandoned by God or questioning one’s beliefs or purpose (Evans et al., 2018), and struggles with meaning in the context of potentially morally injurious events are associated with adverse clinical outcomes including posttraumatic stress and suicide ideation (Corona, Van Orden, Wisco, & Pietrzak, 2019; Currier, Holland, Chisty, & Allen, 2011).
Cultivating psychological flexibility to address religious and spiritual suffering in moral injury
Published in Journal of Health Care Chaplaincy, 2022
Lauren M. Borges, Sean M. Barnes, Jacob K. Farnsworth, Wyatt R. Evans, Zachary Moon, Kent D. Drescher, Robyn D. Walser
Moral injury, a concept linked to the fallout of moral violations during wartime, has seen a recent surge in attention through research and theoretical writings across Veterans, Service Members, and healthcare workers (Borges, Barnes, Farnsworth, Drescher, & Walser, 2020; Griffin et al., 2019). As research supporting moral injury grows, attention to its amelioration continues to be emphasized. It will be critical that conceptual models of moral injury, and interventional approaches based on these models, are inclusive of providers across disciplines and settings to reach the broadest range of individuals suffering. The consequences of moral injury can be multidimensional and often include difficulties in interpersonal relationships, self-care, and spiritual practice. In the current paper, we expand the dialogue about addressing spiritual suffering associated with moral injury using Acceptance and Commitment Therapy. The application of psychological flexibility processes to moral injury-related spiritual suffering is explored and a framework for spiritual care providers and Chaplains is provided.
COVID-19 and psychosocial cancer care
Published in Journal of Psychosocial Oncology, 2021
Healthcare workers, too, have been deeply affected. While they have been rightly lauded by the general public for continuing to provide essential healthcare services even when doing so puts themselves and their families at great risk, the governmental response to their basic occupational safety needs was tragically inadequate. The International Council of Nurses (ICN) estimates that healthcare workers represent 10% of all COVID-19 cases globally. ICN also reports that through the end of 2020, 1.6 million healthcare workers from 34 countries had been infected. According to Lost on the Frontline,6 a project documenting the number of COVID-19 deaths among healthcare workers in the U.S., as of April 4, 2021, that number was 3,605. Not surprisingly, healthcare workers around the world report feeling overwhelmed and exhausted. They also report considerable increases in mental health symptoms such as anxiety and depression since the pandemic began. Moral injury, which occurs when one commits, witnesses or fails to prevent actions or situations that violate their values, ethics, moral beliefs and expectations about care provision, has become a significant problem.