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      Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic

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      Nursing Ethics
      SAGE Publications
      COVID-19, nurses, self-care, moral injury, moral distress, pandemic

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          Abstract

          These are strange and unprecedented times in the wake of the COVID-19 pandemic. Most frontline healthcare professionals have never witnessed anything like this before. As a result, staff may experience numerous and continuous traumatic events, which in many instances, will negatively affect their psychological well-being. Particularly, nurses face extraordinary challenges in response to shifting protocols, triage, shortages of resources, and the astonishing numbers of patients who require care in expedited time constraints. As most healthcare workers are passionate nursing professionals, frustration and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. The overwhelming number of deaths, patients isolated and dying alone, and the ever-present fear of being infected and then infecting colleagues, family, friends due to the lack of protective gear or known protocols takes its toll on emotional and psychological well-being. For nurses, the experience of this significant (hopefully once-in-a-lifetime) event can inflict on-going moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Institutions must provide these resources to tend to the well-being of their healthcare staff, during and beyond the pandemic. This article aims to investigate moral distress—considering it as a moral injury—and offer tools and recommendations to support healthcare nurses as they respond to this crisis and its aftermath.

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          Most cited references30

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          Managing mental health challenges faced by healthcare workers during covid-19 pandemic

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            The emotional impact of COVID-19: From medical staff to common people

            Dear Editor, In March 2020, the World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) a pandemic, pointing to over 110 countries and territories around the world where the coronavirus illness is present. Infectious disease outbreaks such as COVID-19, as well as other public health events, can cause emotional distress and anxiety. These feelings of distress and anxiety can occur even in people not at high risk of getting sick, in the face of a virus with which the common people may be unfamiliar. I read publications on “Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control” and on “Traumatization in medical staff helping with COVID-19 control” with a great interest (Li et al., 2020, Joob and Wiwanitkit, 2020). Li et al. reported how much people and medical staff suffer from vicarious traumatization and how this vicarious traumatization of non-front-line medical staff is more serious than that of front-line medical staff (Li et al., 2020). As in South and Southeast Asia countries, also in Italy, there are similar problems in medical staff due to high workload and intermittent lack of protective devices. In addition, some slight form of racism is demonstrated against health care professionals who potentially have a higher risk of being infected and between non-front-line medical staff towards front-line medical staff. We don’t have to forget the many doctors and nurses were infected and many of them died due to COVID-19 infection. Also in Italy, local people also have high levels of stress due to no firm estimate of how long pandemic will last and how long our lives will be disrupted or whether or not we or our loved ones will be infected. Previous research has revealed a profound and wide spectrum of psychological impact that outbreaks can inflict on people (Lima et al., 2020). New psychiatric symptoms in people without mental illness can occur or aggravate the condition of those with pre-existing mental illness and cause distress to the caregivers of affected individuals (Kelvin and Rubino, 2020). Most health professionals working in isolation units and hospitals very often do not receive any training for providing mental health care (Lima et al., 2020). Barbisch et al. (2015) described how the confinement “caused a sense of collective hysteria, leading the staff to desperate measures”. Suicidal cases were reported in India (Goyal et al., 2020) but also in other countries, Italy included, where two infected Italian nurses committed suicide in a period of a few days probably due to fear of spreading COVID-19 to patients. It is possible that fear and anxiety of falling sick or dying, helplessness will drive an increase in the 2020 suicide rates. In the United States (US), the COVID-19 Pandemic’s New Epicenter, a dedicated Lifeline (the National Suicide Prevention Lifeline) was activated for emotional distress related to COVID-19 to prevent suicide. Declaration of Competing Interest The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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              Burnout-depression overlap: a review.

              Whether burnout is a form of depression or a distinct phenomenon is an object of controversy. The aim of the present article was to provide an up-to-date review of the literature dedicated to the question of burnout-depression overlap. A systematic literature search was carried out in PubMed, PsycINFO, and IngentaConnect. A total of 92 studies were identified as informing the issue of burnout-depression overlap. The current state of the art suggests that the distinction between burnout and depression is conceptually fragile. It is notably unclear how the state of burnout (i.e., the end stage of the burnout process) is conceived to differ from clinical depression. Empirically, evidence for the distinctiveness of the burnout phenomenon has been inconsistent, with the most recent studies casting doubt on that distinctiveness. The absence of consensual diagnostic criteria for burnout and burnout research's insufficient consideration of the heterogeneity of depressive disorders constitute major obstacles to the resolution of the raised issue. In conclusion, the epistemic status of the seminal, field-dominating definition of burnout is questioned. It is suggested that systematic clinical observation should be given a central place in future research on burnout-depression overlap.
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                Author and article information

                Contributors
                Journal
                Nurs Ethics
                Nurs Ethics
                NEJ
                spnej
                Nursing Ethics
                SAGE Publications (Sage UK: London, England )
                0969-7330
                1477-0989
                30 October 2020
                : 0969733020961825
                Affiliations
                [1-0969733020961825]Ringgold 6613, universityDuquesne University; , USA
                [2-0969733020961825]Ringgold 6595, universityUniversity of Pittsburgh Medical Center; , USA
                Author notes
                [*]Fahmida Hossain, Center for Healthcare Ethics, Duquesne University, 300 Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA 15282, USA. Email: hossainf@ 123456duq.edu
                Author information
                https://orcid.org/0000-0001-9415-6652
                Article
                10.1177_0969733020961825
                10.1177/0969733020961825
                7604672
                33124492
                13048cdf-3f1b-474b-8c3a-fd8c70170a8f
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                covid-19,nurses,self-care,moral injury,moral distress,pandemic
                covid-19, nurses, self-care, moral injury, moral distress, pandemic

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