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Researchers reveal moral distress impact, actions to support doctors during pandemic

CHAPEL HILL, NC – During the COVID-19 pandemic, healthcare organizations, leaders, researchers, and practitioners have attempted on the fly to deal with…

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CHAPEL HILL, NC – During the COVID-19 pandemic, healthcare organizations, leaders, researchers, and practitioners have attempted on the fly to deal with the inherent stresses, strains, and struggles related to an unprecedented healthcare crisis in modern times. UNC School of Medicine’s Jeffrey Sonis, MD, MPH, who is investigating this issue broadly, published two research articles on two specific aspects: the impact of moral distress on healthcare workers and the actions healthcare organizations made – or did not make – that affected the level of support they received from their workforces.

Credit: UNC School of Medicine

CHAPEL HILL, NC – During the COVID-19 pandemic, healthcare organizations, leaders, researchers, and practitioners have attempted on the fly to deal with the inherent stresses, strains, and struggles related to an unprecedented healthcare crisis in modern times. UNC School of Medicine’s Jeffrey Sonis, MD, MPH, who is investigating this issue broadly, published two research articles on two specific aspects: the impact of moral distress on healthcare workers and the actions healthcare organizations made – or did not make – that affected the level of support they received from their workforces.

Published in PLOS ONE and the Journal of Healthcare Management, respectively, the studies offer insights from an online survey that Sonis and colleagues conducted in late 2020 among internists who are members of the American College of Physicians, the largest medical specialty organization in the United States.

Moral distress is the discomfort that health workers feel when they are prevented, by individuals, institutions or situations, from doing what they believe is morally right. For the PLOS ONE article, Sonis, Associate Professor in the UNC Department of Social Medicine and the UNC Department of Family Medicine, and colleagues evaluated of the overall intensity of moral distress among U.S. internal medicine physicians (internists) during the pandemic.

“Although overall intensity of moral distress was low, approximately one in eight internists had high levels of moral distress, “Sonis said. “Thirteen percent of U.S. internists had moral distress levels that they rated as distressing, intense or worst possible.”

Internists who had low levels of moral distress did not have increased odds of adverse mental health outcomes compared to internists who reported no moral distress. However, those with high levels of moral distress had markedly elevated odds (approximately 5 to 18 times the odds) of screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care.

Two factors were associated with higher levels of moral distress among U.S. internists: perceived risk of dying if infected with COVID-19 and the number of patients seen face-to-face with COVID-19 in the previous two weeks. Perceived organizational support – the belief that their employer cared about their well-being – was associated with lower levels of moral distress.

“Among U.S. internists who have high levels of moral distress, the risk of adverse mental health is high,” Sonis said. “They are also more likely to intend to leave patient care. This may affect the ability of the U.S. to maintain an adequate physician workforce during the pandemic.”

“However”, Sonis added, “healthcare organizations have the ability to reduce moral distress among physicians by taking specific actions to support their healthcare workers during the pandemic.”

 

Supporting the Team

For the Journal of Healthcare Management paper, Sonis and UNC Family Medicine’s Don Pathman, MD, MPH, and colleagues set out to identify specific COVID-19-related policies and actions that health organizations can do to promote (or diminish) perceived organizational support and the effect of that support on mental health of front-line clinicians during the COVID-19 pandemic.  Perceived organizational support is the degree to which employees feel that their organization cares about them and values their contributions.

Using the same national survey of internists who are members of the American College of Physicians, the researchers evaluated ten health organization policies and actions. They reported that three were strongly associated with higher levels of perceived organizational support, after controlling for potential confounding factors.

The three factors are:

  • guaranteeing adequate personal protective equipment for frontline healthcare workers,
  • making sure leaders listen to healthcare workers’ concerns about COVID-19, and
  • offering opportunities for healthcare workers to discuss ethical concerns related to caring for patients with COVID-19.

“The COVID-19 pandemic has unleashed a flood of moral dilemmas for frontline clinicians,” Sonis said. “It is not surprising that offering opportunities to discuss ethical concerns was strongly related to internists’ perceptions that their health organization supported them.”

One health organization action – warning or sanctioning healthcare workers who refused pandemic deployment or spoke up about healthcare worker safety – was associated with lower perceived organizational support.  “Although healthcare organizations have been concerned about maintaining a workforce adequate for the pandemic,” Pathman said, “punitive personnel policies are likely to backfire.”

High levels of perceived organizational support among the internists in the study were associated with lower levels (by about 1/2 to 2/3) in rates of screening positive for anxiety, depression, posttraumatic stress, burnout and intention to leave patient care.

Sonis noted, “We think that by implementing tangible support policies positively associated with perceived organizational support and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and moral distress among their physicians during the COVID-19 pandemic.”

Journal

PLoS ONE

DOI

10.1371/journal.pone.0268375

Method of Research

Survey

Subject of Research

People

Article Title

A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

Article Publication Date

16-May-2022

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Low Iron Levels In Blood Could Trigger Long COVID: Study

Low Iron Levels In Blood Could Trigger Long COVID: Study

Authored by Amie Dahnke via The Epoch Times (emphasis ours),

People with inadequate…

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March 9, 2024

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Low Iron Levels In Blood Could Trigger Long COVID: Study

Authored by Amie Dahnke via The Epoch Times (emphasis ours),

People with inadequate iron levels in their blood due to a COVID-19 infection could be at greater risk of long COVID.

(Shutterstock)

A new study indicates that problems with iron levels in the bloodstream likely trigger chronic inflammation and other conditions associated with the post-COVID phenomenon. The findings, published on March 1 in Nature Immunology, could offer new ways to treat or prevent the condition.

Long COVID Patients Have Low Iron Levels

Researchers at the University of Cambridge pinpointed low iron as a potential link to long-COVID symptoms thanks to a study they initiated shortly after the start of the pandemic. They recruited people who tested positive for the virus to provide blood samples for analysis over a year, which allowed the researchers to look for post-infection changes in the blood. The researchers looked at 214 samples and found that 45 percent of patients reported symptoms of long COVID that lasted between three and 10 months.

In analyzing the blood samples, the research team noticed that people experiencing long COVID had low iron levels, contributing to anemia and low red blood cell production, just two weeks after they were diagnosed with COVID-19. This was true for patients regardless of age, sex, or the initial severity of their infection.

According to one of the study co-authors, the removal of iron from the bloodstream is a natural process and defense mechanism of the body.

But it can jeopardize a person’s recovery.

“When the body has an infection, it responds by removing iron from the bloodstream. This protects us from potentially lethal bacteria that capture the iron in the bloodstream and grow rapidly. It’s an evolutionary response that redistributes iron in the body, and the blood plasma becomes an iron desert,” University of Oxford professor Hal Drakesmith said in a press release. “However, if this goes on for a long time, there is less iron for red blood cells, so oxygen is transported less efficiently affecting metabolism and energy production, and for white blood cells, which need iron to work properly. The protective mechanism ends up becoming a problem.”

The research team believes that consistently low iron levels could explain why individuals with long COVID continue to experience fatigue and difficulty exercising. As such, the researchers suggested iron supplementation to help regulate and prevent the often debilitating symptoms associated with long COVID.

“It isn’t necessarily the case that individuals don’t have enough iron in their body, it’s just that it’s trapped in the wrong place,” Aimee Hanson, a postdoctoral researcher at the University of Cambridge who worked on the study, said in the press release. “What we need is a way to remobilize the iron and pull it back into the bloodstream, where it becomes more useful to the red blood cells.”

The research team pointed out that iron supplementation isn’t always straightforward. Achieving the right level of iron varies from person to person. Too much iron can cause stomach issues, ranging from constipation, nausea, and abdominal pain to gastritis and gastric lesions.

1 in 5 Still Affected by Long COVID

COVID-19 has affected nearly 40 percent of Americans, with one in five of those still suffering from symptoms of long COVID, according to the U.S. Centers for Disease Control and Prevention (CDC). Long COVID is marked by health issues that continue at least four weeks after an individual was initially diagnosed with COVID-19. Symptoms can last for days, weeks, months, or years and may include fatigue, cough or chest pain, headache, brain fog, depression or anxiety, digestive issues, and joint or muscle pain.

Tyler Durden Sat, 03/09/2024 - 12:50

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February Employment Situation

By Paul Gomme and Peter Rupert The establishment data from the BLS showed a 275,000 increase in payroll employment for February, outpacing the 230,000…

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March 9, 2024

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By Paul Gomme and Peter Rupert

The establishment data from the BLS showed a 275,000 increase in payroll employment for February, outpacing the 230,000 average over the previous 12 months. The payroll data for January and December were revised down by a total of 167,000. The private sector added 223,000 new jobs, the largest gain since May of last year.

Temporary help services employment continues a steep decline after a sharp post-pandemic rise.

Average hours of work increased from 34.2 to 34.3. The increase, along with the 223,000 private employment increase led to a hefty increase in total hours of 5.6% at an annualized rate, also the largest increase since May of last year.

The establishment report, once again, beat “expectations;” the WSJ survey of economists was 198,000. Other than the downward revisions, mentioned above, another bit of negative news was a smallish increase in wage growth, from $34.52 to $34.57.

The household survey shows that the labor force increased 150,000, a drop in employment of 184,000 and an increase in the number of unemployed persons of 334,000. The labor force participation rate held steady at 62.5, the employment to population ratio decreased from 60.2 to 60.1 and the unemployment rate increased from 3.66 to 3.86. Remember that the unemployment rate is the number of unemployed relative to the labor force (the number employed plus the number unemployed). Consequently, the unemployment rate can go up if the number of unemployed rises holding fixed the labor force, or if the labor force shrinks holding the number unemployed unchanged. An increase in the unemployment rate is not necessarily a bad thing: it may reflect a strong labor market drawing “marginally attached” individuals from outside the labor force. Indeed, there was a 96,000 decline in those workers.

Earlier in the week, the BLS announced JOLTS (Job Openings and Labor Turnover Survey) data for January. There isn’t much to report here as the job openings changed little at 8.9 million, the number of hires and total separations were little changed at 5.7 million and 5.3 million, respectively.

As has been the case for the last couple of years, the number of job openings remains higher than the number of unemployed persons.

Also earlier in the week the BLS announced that productivity increased 3.2% in the 4th quarter with output rising 3.5% and hours of work rising 0.3%.

The bottom line is that the labor market continues its surprisingly (to some) strong performance, once again proving stronger than many had expected. This strength makes it difficult to justify any interest rate cuts soon, particularly given the recent inflation spike.

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Spread & Containment

Another beloved brewery files Chapter 11 bankruptcy

The beer industry has been devastated by covid, changing tastes, and maybe fallout from the Bud Light scandal.

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March 9, 2024

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Before the covid pandemic, craft beer was having a moment. Most cities had multiple breweries and taprooms with some having so many that people put together the brewery version of a pub crawl.

It was a period where beer snobbery ruled the day and it was not uncommon to hear bar patrons discuss the makeup of the beer the beer they were drinking. This boom period always seemed destined for failure, or at least a retraction as many markets seemed to have more craft breweries than they could support.

Related: Fast-food chain closes more stores after Chapter 11 bankruptcy

The pandemic, however, hastened that downfall. Many of these local and regional craft breweries counted on in-person sales to drive their business. 

And while many had local and regional distribution, selling through a third party comes with much lower margins. Direct sales drove their business and the pandemic forced many breweries to shut down their taprooms during the period where social distancing rules were in effect.

During those months the breweries still had rent and employees to pay while little money was coming in. That led to a number of popular beermakers including San Francisco's nationally-known Anchor Brewing as well as many regional favorites including Chicago’s Metropolitan Brewing, New Jersey’s Flying Fish, Denver’s Joyride Brewing, Tampa’s Zydeco Brew Werks, and Cleveland’s Terrestrial Brewing filing bankruptcy.

Some of these brands hope to survive, but others, including Anchor Brewing, fell into Chapter 7 liquidation. Now, another domino has fallen as a popular regional brewery has filed for Chapter 11 bankruptcy protection.

Overall beer sales have fallen.

Image source: Shutterstock

Covid is not the only reason for brewery bankruptcies

While covid deserves some of the blame for brewery failures, it's not the only reason why so many have filed for bankruptcy protection. Overall beer sales have fallen driven by younger people embracing non-alcoholic cocktails, and the rise in popularity of non-beer alcoholic offerings,

Beer sales have fallen to their lowest levels since 1999 and some industry analysts

"Sales declined by more than 5% in the first nine months of the year, dragged down not only by the backlash and boycotts against Anheuser-Busch-owned Bud Light but the changing habits of younger drinkers," according to data from Beer Marketer’s Insights published by the New York Post.

Bud Light parent Anheuser Busch InBev (BUD) faced massive boycotts after it partnered with transgender social media influencer Dylan Mulvaney. It was a very small partnership but it led to a right-wing backlash spurred on by Kid Rock, who posted a video on social media where he chastised the company before shooting up cases of Bud Light with an automatic weapon.

Another brewery files Chapter 11 bankruptcy

Gizmo Brew Works, which does business under the name Roth Brewing Company LLC, filed for Chapter 11 bankruptcy protection on March 8. In its filing, the company checked the box that indicates that its debts are less than $7.5 million and it chooses to proceed under Subchapter V of Chapter 11. 

"Both small business and subchapter V cases are treated differently than a traditional chapter 11 case primarily due to accelerated deadlines and the speed with which the plan is confirmed," USCourts.gov explained. 

Roth Brewing/Gizmo Brew Works shared that it has 50-99 creditors and assets $100,000 and $500,000. The filing noted that the company does expect to have funds available for unsecured creditors. 

The popular brewery operates three taprooms and sells its beer to go at those locations.

"Join us at Gizmo Brew Works Craft Brewery and Taprooms located in Raleigh, Durham, and Chapel Hill, North Carolina. Find us for entertainment, live music, food trucks, beer specials, and most importantly, great-tasting craft beer by Gizmo Brew Works," the company shared on its website.

The company estimates that it has between $1 and $10 million in liabilities (a broad range as the bankruptcy form does not provide a space to be more specific).

Gizmo Brew Works/Roth Brewing did not share a reorganization or funding plan in its bankruptcy filing. An email request for comment sent through the company's contact page was not immediately returned.

 

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