Healthcare Provider Experiences With Unvaccinated COVID-19 Patients: A Qualitative Study.
Journal
Critical care explorations
ISSN: 2639-8028
Titre abrégé: Crit Care Explor
Pays: United States
ID NLM: 101746347
Informations de publication
Date de publication:
01 Sep 2024
01 Sep 2024
Historique:
medline:
9
9
2024
pubmed:
9
9
2024
entrez:
9
9
2024
Statut:
epublish
Résumé
In the setting of an active pandemic the impact of public vaccine hesitancy on healthcare workers has not yet been explored. There is currently a paucity of literature that examines how patient resistance to disease prevention in general impacts practitioners. The COVID-19 pandemic created unprecedented healthcare challenges with impacts on healthcare workers' wellbeing. Vaccine hesitancy added complexity to providing care for unvaccinated patients. Our study qualitatively explored experiences of healthcare providers caring for unvaccinated patients with severe COVID-19 infection in the intensive care setting. We used interview-based constructivist grounded theory methodology to explore experiences of healthcare providers with critically ill unvaccinated COVID-19 patients. Healthcare providers who cared for unvaccinated patients with severe COVID-19 respiratory failure following availability of severe acute respiratory syndrome coronavirus 2 vaccines were recruited from seven ICUs located within two large academic centers and one community-based hospital. We interviewed 24 participants, consisting of eight attending physicians, seven registered nurses, six critical care fellows, one respiratory therapist, one physiotherapist, and one social worker between March 2022 and September 2022 (approximately 1.5 yr after the availability of COVID-19 vaccines in Canada). Interviews were recorded, transcribed, de-identified, and coded to identify emerging themes. The final data was analyzed to generate the thematic framework. Reflexivity was employed to reflect upon and discuss individual pre-conceptions and opinions that may impact collection and interpretation of the data. Healthcare providers maintained dedication toward professionalism during provision of care, at the cost of suffering emotional turmoil from the pandemic and COVID-19 vaccine hesitancy. Evolving sources of stress associated with vaccine hesitancy included ongoing high volumes of critically ill patients, resource shortages, and visitation restrictions, which contributed to perceived emotional distress, empathy loss, and professional dissatisfaction. As a result, there were profound personal and professional consequences for healthcare professionals, with perceived impacts on patient care. Our study highlights struggles of healthcare providers in fulfilling professional duties while navigating emotional stressors unique to vaccine hesitancy. System-based interventions should be explored to help providers navigate biases and moral distress, and to foster resilience for the next major healthcare system strain.
Identifiants
pubmed: 39250800
doi: 10.1097/CCE.0000000000001157
pii: 02107256-202409000-00004
doi:
Substances chimiques
COVID-19 Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1157Informations de copyright
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
Déclaration de conflit d'intérêts
The authors have disclosed that they do not have any potential conflicts of interest.
Références
Vittone S, Sotomayor CR: Moral distress entangled: Patients and providers in the COVID-19 era. HEC Forum 2021; 33:415–423
Sheather J, Fidler H: Covid-19 has amplified moral distress in medicine. BMJ 2021; 372:n28
Norman SB, Feingold JH, Kaye-Kauderer H, et al.: Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety 2021; 38:1007–1017
Hines SE, Chin KH, Glick DR, et al.: Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. Int J Environ Res Public Health 2021; 18:488
Anderson-Shaw LK, Zar FA: COVID-19, moral conflict, distress, and dying alone. J Bioeth Inq 2020; 17:777–782
Kherbache A, Mertens E, Denier Y: Moral distress in medicine: An ethical analysis. J Health Psychol 2022; 27:1971–1990
Alharbi J, Jackson D, Usher K: The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. J Clin Nurs 2020; 29:2762–2764
Burns KEA, Moss M, Lorens E, et al.; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society: Wellness and coping of physicians who worked in ICUs during the pandemic: A multicenter cross-sectional North American Survey. Crit Care Med 2022; 50:1689–1700
Gualano MR, Sinigaglia T, Lo Moro G, et al.: The burden of burnout among healthcare professionals of intensive care units and emergency departments during the COVID-19 pandemic: A systematic review. Int J Environ Res Public Health 2021; 18:8172
Papazian L, Hraiech S, Loundou A, et al.: High-level burnout in physicians and nurses working in adult ICUs: A systematic review and meta-analysis. Intensive Care Med 2023; 49:387–400
Dzeng E, Wachter RM: Ethics in conflict: Moral distress as a root cause of burnout. J Gen Intern Med 2020; 35:409–411
Boseley S, Oltermann P: Hopes Rise for End of Pandemic As Pfizer Says Vaccine Has 90% Efficacy. The Guardian. 2020. Available at: https://www.theguardian.com/world/2020/nov/09/covid-19-vaccine-candidate-effective-pfizer-biontech. Accessed June 17, 2024
Zhang S: The End of the Pandemic Is Now in Sight. The Atlantic. 2020. Available at: https://www.theatlantic.com/health/archive/2020/11/vaccines-end-covid-19-pandemic-sight/617141/. Accessed June 17, 2024
Lockyer B, Islam S, Rahman A, et al.; Bradford Institute for Health Research Covid-19 Scientific Advisory Group: Understanding COVID-19 misinformation and vaccine hesitancy in context: Findings from a qualitative study involving citizens in Bradford, UK. Health Expect 2021; 24:1158–1167
Khan YH, Mallhi TH, Alotaibi NH, et al.: Threat of COVID-19 vaccine hesitancy in Pakistan: The need for measures to neutralize misleading narratives. Am J Trop Med Hyg 2020; 103:603–604
Pavey L, Rotella A, Vallée-Tourangeau G: Moral obligation, autonomous motivation and vaccine hesitancy: Highlighting moral obligation increases reactance in hesitant individuals. Appl Psychol Health Well Being 2024; Online:1-19. https://doi.org/10.1111/aphw.12540 Apr 1. [online first]
doi: 10.1111/aphw.12540
Bibler TM, Nelson RH, Schuman O, et al.: Caring for unvaccinated patients in the ICU: Beyond frustration, toward beneficial relationships. Crit Care Explor 2021; 3:e0581
Vergara RJD, Sarmiento PJD, Lagman JDN: Building public trust: A response to COVID-19 vaccine hesitancy predicament. J Public Health (Oxf) 2021; 43:e291–e292
Mills J, Bonner A, Francis K: The development of constructivist grounded theory. Int J Qual Methods 2006; 5:25–35
Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19:349–357
Piquette D, Burns KEA, Carnevale F, et al.: Moral orientation, moral decision-making, and moral distress among critical care physicians: A qualitative study. Crit Care Explor 2023; 5:e0879
Piquette D, Burns KEA, Carnevale F, et al.: Moral distress in Canadian intensivists: A complex interplay of contextual and relational factors. Chest 2023; 163:1101–1108
Oppenheim D, Dauchy S, Hartmann O: [Refusing treatment: Patient responsibility and autonomy. About a French National Consultative Ethics Committee statement(no 87, April 2005)]. Bull Cancer 2006; 93:133–137
Upshur REG: Principles for the justification of public health intervention. Can J Public Health 2002; 93:101–103
Jing S, Milne R, Wang H, et al.: Vaccine hesitancy promotes emergence of new SARS-CoV-2 variants. J Theor Biol 2023; 570:111522
Tenforde MW, Self WH, Adams K, et al.; Influenza and Other Viruses in the Acutely Ill (IVY) Network: Association between mRNA vaccination and COVID-19 hospitalization and disease severity. JAMA 2021; 326:2043–2054
Butler J, Sorell T: Does libertarianism provide a justification for vaccine hesitancy? Polit Q 2022; 93:342–346
Moyo N, Bhappu AD, Bhebhe M, et al.: Perceived risk of COVID-19 and employee decision-making: How psychological distress during the pandemic increases negative performance outcomes among healthcare workers. Int J Environ Res Public Health 2022; 19:6762
Labrague LJ, de Los Santos JAA: Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses. J Nurs Manag 2021; 29:395–403
Qasem Surrati AM, Asad Mansuri FM, Ayadh Alihabi AA: Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15:536–543
Morgan KM, Maglalang DD, Monnig MA, et al.: Medical mistrust, perceived discrimination, and race: A longitudinal analysis of predictors of COVID-19 vaccine hesitancy in US adults. J Racial Ethn Health Disparities 2023; 10:1846–1855
Guttormson JL, Calkins K, McAndrew N, et al.: Critical care nurse burnout, moral distress, and mental health during the COVID-19 pandemic: A United States Survey. Heart Lung 2022; 55:127–133
Silverman HJ, Kheirbek RE, Moscou-Jackson G, et al.: Moral distress in nurses caring for patients with Covid-19. Nurs Ethics 2021; 28:1137–1164
Moss SJ, Krewulak KD, Stelfox HT, et al.: Restricted visitation policies in acute care settings during the COVID-19 pandemic: A scoping review. Crit Care 2021; 25:347
Royan R, Pendergrast TR, Woitowich NC, et al.: Physician and biomedical scientist harassment on social media during the COVID-19 pandemic. JAMA Netw Open 2023; 6:e2318315
Bertges Yost W, Eshelman A, Raoufi M, et al.: A national study of burnout among American transplant surgeons. Transplant Proc 2005; 37:1399–1401
Renger D, Miché M, Casini A: Professional recognition at work: The protective role of esteem, respect, and care for burnout among employees. J Occup Environ Med 2020; 62:202–209
Agarwal SD, Pabo E, Rozenblum R, et al.: Professional dissonance and burnout in primary care: A qualitative study. JAMA Intern Med 2020; 180:395–401
Nadkarni A, Harry E, Rozenblum R, et al.: Understanding perceived appreciation to create a culture of wellness. Acad Psychiatry 2022; 46:228–232
ten Hoeve Y, Jansen G, Roodbol P: The nursing profession: Public image, self-concept and professional identity. A discussion paper. J Adv Nurs 2014; 70:295–309
Di Giuseppe M, Nepa G, Prout TA, et al.: Stress, burnout, and resilience among healthcare workers during the COVID-19 emergency: The role of defense mechanisms. Int J Environ Res Public Health 2021; 18:5258
Leo CG, Sabina S, Tumolo MR, et al.: Burnout among healthcare workers in the COVID 19 era: A review of the existing literature. Front Public Health 2021; 9:750529
Galanis P, Vraka I, Fragkou D, et al.: Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. J Adv Nurs 2021; 77:3286–3302
Trumello C, Bramanti SM, Ballarotto G, et al.: Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: Differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17:8358