from the editor
Lack of PPE Contributed to Nurses ’ Distress During COVID-19 Crisis Care
During the entirety of the pandemic , nurses delivered a crisis standard of care , which required allocating and using scarce medical resources . This care in the context of COVID-19 , experts say , requires nurses to balance their duty to care for patients while protecting themselves and their families . Common sense tells us that crisis standards of care can cause high levels of distress for clinicians , and the lack of preparedness of U . S . hospitals amplifies this distress .
Researchers at the University of Pennsylvania School of Nursing explored factors associated with nurses ’ moral distress during the pandemic and attempted to close the knowledge gaps about the types of and degree of moral distress experienced by nurses , the factors associated with moral distress during the COVID-19 pandemic , and its relation to longer-term mental health . COVID-19-specific situations were the most distressing , including worrying about transmission risk to nurses ’ family members , caring for patients without family members present , and caring for patients dying without family or clergy present . But it was a lack of PPE that caused considerable angst .
“ We found that COVID-19 patient-care volume and personal protective equipment workarounds increased moral distress , while effective leadership communication decreased it and improved post-surge mental health ,” says lead-author Eileen T . Lake , PhD , MSN , MA , BSN , FAAN . “ Given the lingering negative effects on nurses suffering moral distress during a crisis , our findings should motivate and provide guidance for leaders in the ongoing COVID-19 pandemic and future crises .”
According to the study , more than half of respondents had difficulty accessing cleaning supplies or PPE , principally masks and eye protection ( such as face shields or goggles ). Nearly all nurses reporting having difficulty accessing PPE reported reuse / extended use
( one workaround ) of N95 masks or surgical masks . Ninety percent reported reuse / extended use of face shields . Of the three access workarounds ( reuse / extended use , improvised use , providing your own ), the greatest utilization was 1.3 workarounds per nurse for N95 and face shields / goggles . Gloves were the most accessible , evident from very few workarounds : 0.17 per nurse . More than half of the nurses with access difficulty had to improvise disinfectant wipes and cleaning solution . About one-quarter of nurses reported re-use / extended use of cleaning supplies . Overall , nurses reported trying , on average , 6 of 21 workarounds to access various types of PPE and cleaning supplies . They tried four of nine workarounds , on average , to access facial PPE .
As the researchers observe , “ The association of PPE workarounds to moral distress is not surprising given the transmission risks that nurses faced . Uncivil behavior among staff might have contributed to moral distress if limited PPE led to problematic interactions among co-workers or those deciding how to ration PPE . Circumstances of severe workarounds to obtain PPE is likely to correlate with concurring broader chaos in the healthcare setting , which fuels morally distressing situations even if they are not about transmission risk .” They add , “ Transparent and timely leadership communication correlated to decreased moral distress , which in turn improved post-surge mental health . Given the lingering negative effects on nurses of suffering moral distress during a crisis , our findings should motivate and provide guidance for leaders in future crises .”
Until next month , bust those bugs ! Kelly M . Pyrek Editor & Publisher kelly @ healthcarehygienemagazine . com
Reference : Lake ET , et al . Hospital nurses ’ moral distress and mental health during COVID-19 . J Advanced Nurs . Aug . 17 , 2021 . https :// doi . org / 10.1111 / jan . 15013 healthcarehygienemagazine
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