Moral Distress, Building Resiliency, and Supporting Health Center Staff During COVID-19’s Winter Surge |
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Nine months into the COVID-19 pandemic and a time when positive cases and deaths are steadily increasing, community health center staff at all levels are grappling with a range of emotional, physical, and mental stress. Regardless of whether health center staff are working remotely or onsite, many are feeling overwhelmed, frustrated, fatigued, and burned out. Staff are also sensing sadness and grief for patients whom they have lost or who have lost family members and are experiencing a sense of helplessness that they are not doing enough for their patients or staff.
Additionally, not being able to deliver the care one believes is good and right can create a moral dilemma that is experienced as moral distress. Moral distress and moral injury are emotions and bodily changes (i.e., insomnia or loss of appetite) that accompany a disconnect between what you believe is right and good and what you are able to do or what you see happening around you.
As Grace Wang, MD, MPH, a family physician at International Community Health Services in Seattle, Washington, explains, “Our work in the health center is part of the overall health system. We sometimes find ourself in situations where we know what to do and we want to do the right thing but we can’t. This is very difficult and takes its toll. “
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FIVE THINGS YOU AND YOUR HEALTH CENTER CARE TEAM CAN DO TO PREVENT AND LESSEN MORAL DISTRESS |
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1. Name it.
2. Find time to talk about it.
• Carve out time during team meetings to discuss the situation causing you moral stress
• Task specific team members to facilitate conversations about challenging and frustrating situations that are at the root of moral distress
3. Recognize early clues such as:
• Use of words ‘should’ or ‘ought’ are important clues that values are at stake
• Emotions that range from anger to guilt and shame
• Knowing the right thing to do but experiencing constraints to doing it
4. Educate clinical teams about preventative strategies including:
• Buddy up to watch out for each other
• Create a safe place to talk
• Develop team cues for asking about and acknowledging moral distress
Adapted from the presentation “Taking Care of the Compassionate Care Team: Conversations About Moral Distress and Moral Injury” by Gerri Lamb, PhD, RN, FANN, Arizona State University for Advancing Interprofessional Practice, Education and Research, March 26, 2020.
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COMMUNITY HEALTH CENTERS IN ACTION |
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We are excited to launch our new digital series, COVID-19 Conversations, where we talk with health center leaders, administrators, providers, and quality improvement directors on how their health centers are responding to their many COVID-19-related challenges. Each month we will be sharing their insights, tips, and experiences.
We are kicking off the series with a conversation with Jean D. Pierre, LCSW, MBA/HA, Vice President and Chief Behavioral Officer at Community Health of South Florida (CHSF).
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Jean shares with us how CHSF is addressing current challenges facing staff and leadership during this second wave of the pandemic and winter holiday season, including emotional wellbeing.
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MULTI-STATE QUALITY IMPROVEMENT EFFORT |
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CRISIS BUSINESS CONTINUITY PLANNING |
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Coming January 2021:
NACHC 4-Part Business Continuity Planning Webinar Series
Business continuity planning (BCP) is a process that outlines the potential impacts of an unplanned event that causes a disruption in operations. It identifies the steps an organization takes to prepare for, respond to, recover from, and mitigate potential impacts caused by unplanned disruption.
Unplanned disasters take many forms from shutdowns and service reductions resulting from the COVID-19 pandemic, to a cyberattack, power outage or natural disaster like a hurricane or a wildfire. Having business continuity plans in place help health centers protect their supply chains and mitigate financial and cybersecurity risks.
In early January, look out for details and registration information to attend NACHC's webinar series on business continuity planning.
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7 COMPONENTS OF ALL BUSINESS CONTINUITY PLANS |
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1. List Essential Business Functions (EBF) and their respective recovery times
This should be brief, easily understood, and laid out in a matrix format.
2. Decision making hierarchy
Clearly identify who in the health center activates the BCP and when.
3. Staff evacuations guidance
Provide guidance to health center staff on when they can evacuate the health center without management approval. If possible, provide guidance on a back-up location.
4. Communications Plan
Fully document how communication to and among staff will be handled during a disruption.
5. Emergency and vendor contact information
6. Employee contact information
7. Notification matrix
Guidance on who staff call during specific types of disruptions or emergencies.
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NEW CDC’s Morbidity and Mortality Weekly Report (MMWR) features a study on health centers’ capacity to reach medically underserved populations with COVID-19 testing and follow-up and a study on telehealth services
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The CDC and HRSA study, Health Center Testing for SARS-CoV-2 During the COVID-19 Pandemic — United States, June 5–October 2, 2020 analyzed weekly health center survey data collected by HRSA that describe
all patients tested and those who received positive SARS-CoV-2 test results by race, ethnicity, and state of residence. Hispanic, non-Hispanic White and non-Hispanic Black persons accounted for most persons tested and those who received positive test results. The report noted that increasing health centers’ ability to reach populations at higher risk for COVID-19 is an important mitigation strategy and might reduce COVID-19 transmission by identifying cases and supporting contact tracing and isolation among populations they serve and addressing social factors linked to increased risk for exposure to COVID-19.
The Telehealth Practice Among Health Centers During the COVID-19 Pandemic — United States, July 11–17, 2020 report highlighted results from a weekly survey on providing telehealth services. 963 (95.4%) of 1,009 Health Resources and Services Administration–funded health centers that responded to a voluntary weekly survey reported providing telehealth services. Health centers in urban areas reported they were more likely to provide (>30%) of visits virtually than were those in rural areas.
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CDC has published a new set of communication materials for medical centers, clinics, and clinicians to promote vaccine confidence and uptake of the COVID-19 vaccine among providers and eventually patients. The downloadable toolkit contents include slides, social media posts, fact sheets, FAQs, posters, stickers, and a video on how the Advisory Committee on Immunization Practices develops recommendations and advises CDC on the use of vaccines in our country and the process for making recommendations on COVID-19 vaccines based on their safety and efficacy. |
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GHC3 Talks is a podcast series produced by the Global Health Crisis Coordination Center (GHC3). In this episode, Kathy McNamara, NACHC’s Associate Vice President of Clinical Affairs, discusses how community health centers have responded to the challenges posed by COVID-19 and the burnout faced by dedicated staff who have been on the frontline since March. She also highlights the importance of moving from macro to micro planning for the distribution of the new vaccine at the community level and the critical need for tailored messaging to be delivered by trusted members of the community.
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UPCOMING NACHC LEARNING EVENT |
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This publication is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,000,000, with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
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