Building Resilience to Combat Symptoms of Moral Distress and Burnout in Nurses: Is it Effective? An Integrative Review

Background: Moral Distress (MD) is an experience of painful feelings and/or psychological imbalance that occurs when a person’s moral integrity is seriously compromised, either because one feels unable to act in accordance with core values and obligations, or attempted actions fail to achieve the desired outcome (Hamric, 2014). The consequences of repeated episodes of moral distress have been linked to nurses reporting symptoms of low job satisfaction, caregiver burnout, compassion fatigue, emotional exhaustion, poor work engagement, and nurses leaving their positions. Problem: There is evidence that makes the connection between an existing high level of resilience and a low level of MD and symptoms of burnout. There are fewer studies that evaluate what effect, if any, efforts may have on building resilience or reducing existing symptoms of moral distress and its correlate of burnout within nurses. Aim: To evaluate the available literature and explore the question of whether the use of resilience-building strategies influences moral distress, burnout, and levels of resilience in nurses. Results: Twenty studies with pre-post intervention measures were critically reviewed. Despite variation between study components and small sizes of individual studies, the general results suggest that traits of resilience may be increased, and traits of moral distress and burnout may be decreased through resilience interventions. This review also provides direction for further efforts to address this issue within healthcare professionals

Mapping the human genetic architecture of COVID-19

The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-191,2, host genetics may also be important. Identifying host-specific genetic factors may reveal biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. Here we describe the results of three genome-wide association meta-analyses that consist of up to 49,562 patients with COVID-19 from 46 studies across 19 countries. We report 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases3,4,5,6,7. They also represent potentially actionable mechanisms in response to infection. Mendelian randomization analyses support a causal role for smoking and body-mass index for severe COVID-19 although not for type II diabetes. The identification of novel host genetic factors associated with COVID-19 was made possible by the community of human genetics researchers coming together to prioritize the sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease