Pandemic spawns ‘moral stress’
Mental-health experts create guide to support health-care workers
Experts on post-traumatic stress disorder in the military are warning that the COVID-19 pandemic is creating a perfect storm for the development of moral injury and PTSD among front-line healthcare workers.
The Centre for Excellence on
PTSD and Related Mental Health Conditions, funded by Veterans Affairs and located at Ottawa’s The Royal, has released a guide on moral stress among healthcare workers and others during COVID-19 that officials say is aimed at addressing the looming crisis before it worsens.
“We want to get ahead of this developing crisis in our health-care workers,” said Dr. Patrick Smith, the CEO of the Centre of Excellence on PTSD.
He said the guide is a “call to action” for employers and health organizations to protect front-line workers and prevent ongoing mental health issues resulting from the pandemic, said Smith.
“We have all heard these stories about first responders having to make life and death decisions, some living with guilt, many living with fear about becoming infected. While many Canadians are feeling more confident, let me reassure you that those treating patients with COVID -19 are still very much in the eye of the storm.”
Smith said the potentially traumatic events that are being experienced by workers during the COVID-19 pandemic can lead to moral injuries — a type of psychological distress that has debilitating and life-altering effects — and PTSD.
Around the world, health workers have gone public about the stress of having to make difficult moral choices during COVID-19 about who would get ventilators, for example, when they were in short supply.
In Canada, where hospitals have not become overwhelmed with seriously ill COVID-19 patients, health workers have not faced similar choices, but they have had to deal with many difficult issues, said Fardous Hosseiny, vice-president of research and policy at the centre. Among them, anxiety and guilt over not being able to provide the level of care they believe they should be offering and fear of getting COVID-19 or passing it on.
“In Canada, we are fortunate that doctors and nurses are not having to decide who gets access to limited ventilators, but they have struggled to secure adequate supplies of personal protective equipment,” Hosseiny said.
Nurses and PSWs have talked to the Citizen about the stress of not having enough time to help residents in long-term care homes during the pandemic. Front-line workers and military personnel in reports on long-term care have described residents being undernourished and sitting glassy-eyed in front of cold meals because workers did not have time to feed them. They have also described residents ringing call bells that go unanswered and being left in soiled diapers.
Front-line workers have also talked about the fear of contracting COVID -19 or bringing it home to a family member.
Smith said knowledge about moral injury has come, in part, from studying soldiers who were in situations that conflicted with their values. Although the centre’s focus is on the military, Smith said it has a moral obligation to use some of its knowledge to help protect front-line workers affected by the pandemic.
The centre worked with Phoenix Australia, a national centre of excellence that does similar work to the Canadian organization, to come up with guidelines aimed at understanding and countering the impact of moral stress on workers during the pandemic.
“In the health-care context, the deeply held moral belief that can lead to moral injury if transgressed is the oath that health-care providers take to put the needs of the patient first.”
That includes situations that do not allow health-care workers to deliver care in the way they have been trained, according to the document created by the two centres of excellence on PTSD.
Even those not working with COVID -19 patients can be affected when they see patients, for example, suffering because their procedure has been delayed or they can’t
They have also described residents ringing call bells that go unanswered and being left in soiled diapers.
see family members.
Sarah Beanlands, a public health nurse from Ottawa who works in harm reduction, said the need to wear full personal protective equipment during the pandemic has caused some clients to lose trust and stop visiting the clinic because they have lost their connection with the nurses.
The pamphlet suggests recognition of the potential impact, providing sufficient resources and support, and rotating workers in and out of high-stress situations can make a difference in how workers cope. Individuals can also take steps to reduce their stress, but Smith said much of the onus is on employers to understand and mitigate potential damage.
“We might not be able to prevent everyone’s moral dilemmas, but what we put in place can have a huge impact on making sure that people don’t progress into PTSD and moral injury. This is a call to action for all employers to take this on.”