Moral dis­tress: Let’s take this time to help the helpers dur­ing Nurses Week

Leav­ing some­one to die alone is the po­lar op­po­site of what health-care work­ers are trained to do

The Hamilton Spectator - - OPINION - SHARON KAASALAINE­N Sharon Kaasalaine­n is a pro­fes­sor in the School of Nurs­ing at Mc­Mas­ter Univer­sity

The COVID-19 pan­demic is re­veal­ing some truly dis­turb­ing facts about life in long-term care — not just for the res­i­dents, but for the un­der­staffed, poorly paid front-line work­ers who care for them. Lessons learned from COVID-19 should be much broader than fund­ing, stan­dards of care and in­fec­tion con­trol; it’s time for us to think about those who are and will suf­fer much longer-term con­se­quences of this pan­demic, both phys­i­cally and psy­cho­log­i­cally.

Based on cur­rent data from three Cana­dian health re­gions, it’s a sad fact that in18 months when we have a vac­cine, the ma­jor­ity of longterm-care res­i­dents would have died nat­u­rally with­out COVID as they are in frag­ile health.

The real tragedy is not so much the num­ber of deaths, but rather the qual­ity of their deaths and its im­pact on fam­i­lies and staff. Sep­a­rated from their loved ones and un­able to be com­forted at the end, their fi­nal mo­ments are spent alone, of­ten con­fused by their iso­la­tion.

These are ter­ri­ble si­t­u­a­tions for fam­ily mem­bers who feel enor­mous grief and guilt. How­ever, it’s equally dis­tress­ing for the staff who care for res­i­dents, and who, be­cause of un­der­staffing and re­stric­tions, can­not sup­port fam­i­lies through a good death. In some ways, their suf­fer­ing is greater — fam­ily mem­bers must en­dure the tragic loss of one per­son; longterm-care work­ers are in some cases re­liv­ing this hor­ri­ble ex­pe­ri­ence mul­ti­ple times a day. This com­pounded loss and grief can be un­bear­able know­ing that res­i­dents de­served a bet­ter death.

Moral dis­tress is an emo­tional state that oc­curs when some­one feels that an ac­tion they are tasked with do­ing is eth­i­cally op­po­site to what they feel is the right thing to do. In the case of long-term-care work­ers — nurses, physi­cians, per­sonal sup­port work­ers or care aides and oth­ers — leav­ing some­one to die alone and con­fused is com­pletely an­ti­thet­i­cal to their be­liefs and train­ing.

In a long-term-care set­ting, the psy­choso­cial and spir­i­tual sides of health care are of­ten more im­por­tant that med­i­ca­tion or other treat­ments. Nurses and per­sonal sup­port work­ers, for ex­am­ple, work in­ti­mately with res­i­dents, and of­ten form deep and car­ing re­la­tion­ships with them.

Res­i­dents of­ten rely on them for emo­tional sup­port, some­times more than they ex­pect from their own fam­i­lies. And for some res­i­dents, nurses and per­sonal sup­ports work­ers are the only ‘fam­ily’ they have, and with fam­ily vis­it­ing re­stric­tions due to COVID-19, this is even more preva­lent. That’s why it’s so dis­tress­ing for them to see so many res­i­dents dy­ing alone or in dis­tress dur­ing COVID-19.

In our re­search, it is clear that nurses and per­sonal sup­port work­ers need more train­ing and sup­port to help them care for dy­ing res­i­dents and this is even more crit­i­cal dur­ing COVID-19. But it is just as im­por­tant that they learn how to nav­i­gate their way through the moral dis­tress as a re­sult of the many dif­fi­cult res­i­dent deaths they’ve ex­pe­ri­enced.

How can we help the helpers? Fund­ing is def­i­nitely one an­swer. Long-term-care work­ers are the low­est paid ac­cord­ing to their dis­ci­pline, which ex­plains why we have a short­age of geri­a­tri­cians and long-term-care nurses and per­sonal sup­port work­ers in Canada.

Restruc­tur­ing of LTC homes has been on the agenda for the govern­ment for over a decade now with plans to re­move any four-bed rooms to a more ‘in­fec­tion-con­trol friendly’ en­vi­ron­ment. But other is­sues al­ways seem to take pri­or­ity, and long-term-care im­prove­ments end up at the bot­tom of the list.

These are im­por­tant ac­tion items. But we need to look beyond num­bers and in­fec­tion con­trol stan­dards. It’s time for us to un­der­stand and re­spect the psy­cho­log­i­cal and phys­i­cal toll that our front-line work­ers ex­pe­ri­ence on the job, and rec­og­nize that we need a strat­egy to help them help our most vul­ner­a­ble pop­u­la­tion.

By 2030, se­niors will num­ber over 9.5 mil­lion and make up 23 per cent of Cana­di­ans. A re­cent Con­fer­ence Board of Canada study es­ti­mated that Canada must nearly dou­ble the num­ber of long-term-care beds by 2035. Given these num­bers, it’s clear that we will need ap­pro­pri­ately trained and sup­ported staff for our el­derly. But who will want to work in an un­der­funded, un­re­spected sys­tem?

Let’s take this mo­ment of cri­sis dur­ing Nurses Week to get at the root of the prob­lem. It’s time to help our helpers, and give them the sup­port and re­spect they de­serve.

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