The stresses endured by health care workers, exacerbated by the still ongoing COVID-19 pandemic, are generally acknowledged. Now two European-based studies are trying to figure out the nature of that COVID-driven stress and what to do about it.
The additional stress that the pandemic is placing on health care workers is the focus of two studies at separate universities in Europe, one at the University of Turin in Italy, the other at the University of Tartu in Estonia. The latter is an international study focusing on what care delivery in COVID-19 patients is doing to nurses in local health care systems.
The studies are still ongoing some observations have already been made. The crisis has emphasized the central role of nurses in health care delivery, Gerli Usberg, assistant of nursing science at the University of Tartu, said.
"Both our own experience and the data collected in other countries indicate that the need for nurses was greater than ever before," Usberg said in a release.
Jobs in health care have always been stressful. Two forms of stress, burnout and moral injury, have long been recognized in health care but there are critical differences between the two.
Moral injury happens when health care providers are “repeatedly expected, in the course of providing care, to make choices that transgress their long-standing, deeply held commitment to healing,” said Wendy Dean, a psychiatrist and president and co-founder of Moral Injury of Healthcare, in an article published by WebMD in February.
Moral Injury of Healthcare is a nonprofit organization devoted to reframing clinician distress as moral injury and battling the source of that injury, according to the article.
Moral injury happens when health care providers are frustrated and unable to prove the care for which they are trained.
By contrast, burnout is described as what happens to stressed health care workers who sustain moral trauma with little respite for too long, so long that it becomes a moral injury, the WebMD article says.
Moral injury is not a new observation. Moral injury first was applied to soldiers in wartime and the phrase described battlefield experiences. Severe cases progress to what today is referred to as post-traumatic stress disorder.
The same observation and severity can be applied in health care settings, a problem recognized before the pandemic but certainly has been exacerbated in the past year.
Health care workers themselves apparently know they are sustaining moral injury. The article referred to a Mental Health America poll of 1,100 health care workers from June-September 2020 about COVID-19. In that poll 93% of participants reported stress, 86% anxiety, 77% frustration, 76% exhaustion and burnout, and 75% reported they are overwhelmed.
“We came onto the pandemic already with distress, and the pandemic hit on top -- an acute layer of distress,” Dean told WebMD.
Much of the stress health care workers have been especially prone to during the pandemic is deciding which patient will receive limited treatment resources and which will not. Another trauma is having to keep patients separated from family members, an unusual scenario that seldom happened prior to the pandemic. That often forces health care workers into becoming surrogate family, another sources of stress, Ariel Clatty, a medical ethicist at the University of Pittsburgh Medical Center, said in the article.
"Scenarios are played out daily where a health care worker holds a cellphone up to the patient to communicate, often for the last time, with their loved ones," Clatty told WebMD. "It used to be a caregiving atmosphere. Now we have taken away the human interacting."