Hostname: page-component-77f85d65b8-g4pgd Total loading time: 0 Render date: 2026-04-21T01:52:14.741Z Has data issue: false hasContentIssue false
  • English
  • Français

Determining the Impact of Hurricane Dorian and the Covid-19 Pandemic on Moral Distress in Emergency Medical Providers at the Rand Memorial Hospital: Moral distress in emergency medical personnel

Part of: Hurricanes Collection

Published online by Cambridge University Press:  07 March 2024

Latoya E. Storr Open the ORCID record for Latoya E. Storr [Opens in a new window] ,
Attila J. Hertelendy Open the ORCID record for Attila J. Hertelendy [Opens in a new window] ,
Alexander Hart Open the ORCID record for Alexander Hart [Opens in a new window] ,
Lenard Cheng Open the ORCID record for Lenard Cheng [Opens in a new window] ,
Fadi Issa Open the ORCID record for Fadi Issa [Opens in a new window] ,
Todd Benham Open the ORCID record for Todd Benham [Opens in a new window]  and
Gregory Ciottone Open the ORCID record for Gregory Ciottone [Opens in a new window]
Latoya E. Storr*
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Attila J. Hertelendy
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
Alexander Hart
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Department of Emergency Medicine, Hartford Hospital, Hartford, Connecticut, USA University of Connecticut School of Medicine, Farmington, Connecticut, USA
Lenard Cheng
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Department of Emergency Medicine, National University Hospital, National University Health System, Singapore, Singapore
Fadi Issa
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Todd Benham
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Gregory Ciottone
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
*
Corresponding author: Latoya E. Storr; Email: lstorr@bidmc.harvard.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

The aim of this work was to determine the impact of Moral Distress (MD) in emergency physicians, nurses, and emergency medical service staff at the Rand Memorial Hospital (RMH) in the Bahamas, and the impact of Hurricane Dorian and the COVID-19 pandemic on Moral Distress.

Method:

A cross-sectional study utilizing a 3-part survey, which collected sociodemographic information, Hurricane Dorian and COVID-19 experiences, as well as responses to a validated modified Moral Distress Scale (MDS).

Results:

Participants with 2 negatively impactful experiences from COVID-19 had statistically significantly increased MD compared to participants with only 1 negatively impactful experience (40.4 vs. 23.6, P = 0.014). Losing a loved one due to COVID-19 was associated with significantly decreased MD (B = - 0.42, 95% CI -19.70 to -0.88, P = 0.03). Losing a loved one due to Hurricane Dorian had a non-statistically significant trend towards higher MD scores (B = 0.34, 95% CI -1.23 to 28.75, P = 0.07).

Conclusion:

The emergency medical staff at the RMH reported having mild - moderate MD. This is one of the first studies to look at the impact of concurrent disasters on MD in emergency medical providers in the Bahamas.

Keywords

moral distressCOVID-19Hurricane DorianThe BahamasAccident and Emergency

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 18 , 2024 , e42
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

National Hurricane Center; Avila, LA, Stewart, SR, Berg, R, et al. Hurricane Center Tropical Cyclone Report: Hurricane Dorian. Published April 20, 2020. https://efaidnbmnnnibpcajpcglclefindmkaj/https://www.nhc.noaa.gov/data/tcr/AL052019_Dorian.pdf. Accessed August 7, 2022.Google Scholar
The International Federation of Red Cross and Red Crescent Societies (IFRC). Operation Update No.7: The Bahamas: Hurricane Dorian. Published 2021. https://www.pwc.com/bs/en/assets/bahamas-budget-2020.pdf. Accessed August 7, 2022.Google Scholar
Pan American Health Organization (PAHO). Covid -19 Situation Update. Published June 3, 2022. https://www.paho.org/en/documents/COVID-19-situation-report-bahamas-and-turks-and-caicos-islands-june-3rd-2022. Accessed August 1, 2022.Google Scholar
Lowe, SR, McGrath, JA, Young, MN, et al. Cumulative disaster exposure and mental and physical health symptoms among a large sample of Gulf Coast residents. J Trauma Stress. 2019;32(2):196-205. doi: 10.1002/jts.22392 Google Scholar
Harville, EW, Shankar, A, Schetter, CD, et al. Cumulative effects of the Gulf oil spill and other disasters on mental health among reproductive-aged women: the Gulf resilience on women’s health study. Psychol Trauma. 2018;10(5):533-541. doi: 10.1037/tra0000345 Google Scholar
Hugelius, K, Adolfsson, A, Örtenwall, P, et al. Being both helpers and victims: health professionals’ experiences of working during a natural disaster. Prehosp Disaster Med. 2017;32(2):117-123. doi: 10.1017/S1049023X16001412 Google Scholar
Naushad, VA, Bierens, JJ, Nishan, KP, et al. A systematic review of the impact of disaster on the mental health of medical responders. Prehosp Disaster Med. 2019;34(6):632-643. doi: 10.1017/S1049023X19004874 Google Scholar
Gustavsson, ME, Arnberg, FK, Juth, N, et al. Moral Distress among disaster responders: What is it? Prehosp Disaster Med. 2020;35(2):212-219. doi: 10.1017/S1049023X20000096 Google Scholar
Rabow, MW, Huang, CHS, White-Hammond, GE, et al. Witnesses and victims both: healthcare workers and grief in the time of COVID-19. J Pain Symptom Manage. 2021;62(3):647-656. doi: 10.1016/j.jpainsymman.2021.01.139 Google Scholar
Epstein, EG, Haizlip, J, Liaschenko, J, et al. Moral distress, mattering, and secondary traumatic stress in provider burnout: a call for moral community. AACN Adv Crit Care. 2020;31(2):146-157. doi: 10.4037/aacnacc2020285 Google Scholar
Jafari, M, Ebadi, A, Khankeh, HR, et al. Development and validation of moral distress scale in pre-hospital emergency service providers. Int J Emerg Serv. 2022;doi: 10.1108/IJES-05-2021-0028.CrossRefGoogle Scholar
Zhizhong, W, Koenig, HG, Yan, T, et al. Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry. 2020;20(1):556. doi: 10.1186/s12888-020-02954-w Google Scholar
Epstein, EG, Whitehead, PB, Prompahakul, C, et al. Enhancing understanding of Moral Distress: the measure of Moral Distress for health care professionals. AJOB Empir Bioeth. 2019;10(2):113-124. doi: 10.1080/23294515.2019.1586008 Google Scholar
Smallwood, N, Pascoe, A, Karimi, L, et al. Moral distress and perceived community views are associated with mental health symptoms in frontline health workers during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(16):8723. doi: 10.3390/ijerph18168723 Google Scholar
Gustavsson, ME, Juth, N, Arnberg, FK, et al. Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders. Confl Health. 2022;16(1):24. doi: 10.1186/s13031-022-00456-y Google Scholar
Gustavsson, ME, Juth, N, Schreeb, JV, et al. Moral stress among Swedish health care workers during the COVID-19 pandemic: a cross-sectional study. Scandinavian J Work Organ Psychol. 2023;8(1). doi: 10.16993/sjwop.170 Google Scholar
Jameton, A. Nursing Practice, the Ethical Issues. Prentice-Hall; 1984.Google Scholar
Spilg, EG, Rushton, CH, Phillips, JL, et al. The new frontline: exploring the links between moral distress, moral resilience, and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatry. 2022;22(1):19. doi: 10.1186/s12888-021-03637-w CrossRefGoogle ScholarPubMed
Fagerdahl, AM, Torbjörnsson, E, Gustavsson, M, et al. Moral Distress among operating room personnel during the COVID-19 pandemic: a qualitative study. J Surg Res. 2022;273:110-118. doi: 10.1016/j.jss.2021.12.011 Google Scholar
Hertelendy, AJ, Gutberg, J, Mitchell, C, et al. Mitigating Moral Distress in leaders of healthcare organizations: a scoping review. J Healthc Manag. 2022;67(5):380-402. doi: 10.1097/JHM-D-21-00263 Google ScholarPubMed
Fumis, RRL, Junqueira Amarante, GA, de Fátima Nascimento, A, Vieira Junior, JM. Moral distress and its contribution to the development of burnout syndrome among critical care providers. Ann Intensive Care. 2017;7(1). doi:10.1186/s13613-017-0293-2 Google Scholar
Whitehead, PB, Herbertson, RK, Hamric, AB, et al. Moral Distress among healthcare professionals: report of an institution-wide survey. J Nurs Scholar. 2015;47(2):117-125. doi: 10.1111/jnu.12115 CrossRefGoogle ScholarPubMed
Hamric, AB, Blackhall, LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007;35(2):422-429. doi: 10.1097/01.CCM.0000254722.50608.2D CrossRefGoogle ScholarPubMed
Kreh, A, Brancaleoni, R, Magalini, SC, et al. Ethical and psychosocial considerations for hospital personnel in the COVID-19 crisis: moral injury and resilience. PLoS One. 2021;16(4). doi: 10.1371/journal.pone.0249609 CrossRefGoogle ScholarPubMed
Rushton, CH. Moral resilience: a capacity for navigating moral distress in critical care. AACN Advance Critical Care. 2016;27(1):111-119.Google Scholar
Rushton, CH. Cultivating Moral Resilience Shifting the narrative from powerlessness to possibility. Am J Nurs. 2017;117(2):S11-S15. http://journals.lww.com/ajnonline Google Scholar
Thompson-Evariste, J. Nursing shortage in Grand Bahama. Published online December 30, 2022. Accessed June 3, 2023. https://znsbahamas.com/nurse-shortage-in-grand-bahama/ Google Scholar
Gibson, N. Preface 2022 census of population and housing preliminary results. Published April 14, 2023. https://www.bahamas.gov.bs/wps/portal/public/agency%20news/population. Accessed June 6, 2023.Google Scholar
Dai, Y, Hu, G, Xiong, H, et al. Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. MedRxiv. 2020. doi: 10.1101/2020.03.03.20030874 Google Scholar
Ansari, D. An accumulation of distress: grief, loss, and isolation among healthcare providers during the COVID-19 pandemic. SSM - Mental Health. 2022;2:100146. doi: 10.1016/j.ssmmh.2022.100146 Google Scholar
Eftekhar, AM, Naserbakht, M, Bernstein, C, et al. Healthcare providers’ experience of working during the COVID-19 pandemic: a qualitative study. Am J Infect Control. 2021;49(5):547-554. doi: 10.1016/j.ajic.2020.10.001 Google Scholar
Atwoli, L, Stein, DJ, King, A, et al. Posttraumatic stress disorder associated with unexpected death of a loved one: cross-national findings from the world mental health surveys. Depress Anxiety. 2017;34(4):315-326. doi: 10.1002/da.22579 Google Scholar
Gesi, C, Carmassi, C, Cerveri, G, et al. Complicated Grief: what to expect after the Coronavirus pandemic. Front Psychiatry. 2020;11:489. doi: 10.3389/fpsyt.2020.00489 Google Scholar
Kristensen, P, Weisaeth, L, Bereavement, Heir T., and mental health after sudden and violent losses: a review. Psych. 2012;75(1):76-97. doi: 10.1521/psyc.2012.75.1.76 Google Scholar
Boss, P, Yeats, JR. Ambiguous loss: a complicated type of grief when loved ones disappear. Bereavement Care. 2014;33(2):63-69. doi: 10.1080/02682621.2014.933573 Google Scholar
Rushton, CH, Christine Westphal, FG, Campbell, RN, et al. The 4A’s to Rise Above Moral Distress; 2012:1-14.Google Scholar