WORK FORCE I S SUE S
Addressing moral injury: caring for the carers
Clinicians and caregivers are facing unprecedented levels of extreme emotional stressors during the pandemic with moral injuries triggering acute levels of staff burnout. Phil Taylor and Dr. Timothy McDonald discuss what we can learn from past traumatic events and how they can be applied to healthcare to help safeguard the mental wellbeing of clinical staff during COVID-19 and beyond.
Staff burnout has long been an issue in healthcare and is now being exacerbated by the pandemic. Clinicians are seeing patients die, having to make heart-breaking decisions about who to treat, coping with lack of resources, shortages of ICU units and oxygen supplies, fearful of contracting the virus and infecting family, working long hours and treating extremely poorly patients. This is leading to increased depression, post- traumatic stress disorder and even suicides. Staff are suffering from significant ‘moral injuries’ which, if left untreated, may threaten the long-term capacity of the healthcare service. Research indicates that while, for many people, symptoms of PTSD resolve within several weeks, between 10% and 20% of individuals exposed to trauma experience PTSD symptoms that persist and are associated with impairment. In military populations the rate for lifetime symptoms is estimated at about 8%,1
a significant figure.
Recent data from the BMA reveals that 45.69% of the 7,000 doctors surveyed are suffering far worse from depression, anxiety, stress, burnout or emotional distress than before the start of the pandemic, while 62.20% say they are overcome by far higher levels of fatigue and exhaustion.2 In Preventing a Parallel Pandemic – A National Strategy to Protect Clinicians’ Well- Being,3
the authors make the point that we could be facing a parallel pandemic where, although those working on the frontline are remembered as heroes, the trauma they have lived through could mean a surge of emotional harm that equates to another pandemic.
Just as patient safety has been a top priority for healthcare organisations for many years, the authors (all doctors of medicine) make the case for immediate action to
MARCH 2021
Recent data reveals that doctors are suffering far worse from depression, anxiety, stress, burnout or emotional distress than before the start of the pandemic.
address caregiver safety and wellbeing, bringing it equally to the top of the agenda. PTSD can be difficult to treat; it is extremely difficult to live with, and while it may not be possible to avoid the traumatic aspects of being a frontline clinician, we can at least ensure that every effort is made to provide the support and care for those affected.
Appropriate emotional support Research4
has found that an organisational approach to improving clinician well-being is more effective than strategies focusing on personal resilience. However, the design of initiatives to improve emotional well-being, which are often based on mental health models, can
see low uptake due to deeply entrenched views about what is expected of clinicians. Many caregivers feel under pressure to live up to an unrealistic image of doctors and nurses where there is an expectation of personal sacrifice due to the general culture where self-care is seen as selfish and that physical and emotional exhaustion are part of the job.
A recently published article that appeared
in the New England Journal of Medicine by Jo Shapiro, M.D., and Timothy B. McDonald, M.D., J.D.5
suggests some
proactive steps healthcare organisations can take, that have been proven to support staff that are suffering stress, emotional exhaustion and burnout.
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