Moral distress and injury in the public health professional workforce during the COVID-19 pandemic

BACKGROUND: There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature, frequency, severity and duration of the problem in the public health professional workforce. METHODS: Between 14 December 2021 and 23 February 2022, Faculty of Public Health (FPH) members were surveyed about their experiences of moral distress before and during the pandemic. RESULTS: In total, 629 FPH members responded, of which, 405 (64%; 95% confidence interval [95%CI] = 61-68%) reported one or more experience of moral distress associated with their own action (or inaction), and 163 (26%; 95%CI = 23-29%) reported experiencing moral distress associated with a colleague's or organization's action (or inaction) since the start of the pandemic. The majority reported moral distress being more frequent during the pandemic and that the effects endured for over a week. In total, 56 respondents (9% of total sample, 14% of those with moral distress), reported moral injury severe enough to require time off work and/or therapeutic help. CONCLUSIONS: Moral distress and injury are significant problems in the UK public health professional workforce, exacerbated by the COVID-19 pandemic. There is urgent need to understand the causes and potential options for its prevention, amelioration and care

‘Telling them “that’s what it says in the guidance” didn’t feel good enough’: moral distress during the pandemic in UK public health professionals

Background: The study aimed to identify the causes of moral distress in public health professionals associated with the COVID-19 pandemic, and the potential ways of avoiding or mitigating the distress. // Methods: The survey was distributed to all members of the UK Faculty of Public Health between 14 December 2021 and 23 February 2022. Conventional qualitative content analysis was conducted to explore the situations in which moral distress arises, the moral judgments that led to distress and the proposed ways to address moral distress. // Results: A total of 629 responses were received from respondents broadly representative of the public health professional workforce. The main situations causing moral distress were national policy, guidance and law; public health advice; and workplace environments. Moral distress was precipitated by judgments about having caused injury, being unable to do good, dishonest communications and unjust prioritization. The need to improve guidance, communication and preparedness was recognized, though there was disagreement over how to achieve this. There were consistent calls for more subsidiarity, moral development and support and freedom to voice concerns. // Conclusions: The causes of moral distress in public health are distinct from other healthcare professions. Important proposals for addressing moral distress associated with the COVID-19 pandemic have been voiced by public health professionals themselves

Education, training, and experience in public health ethics and law within the UK public health workforce.

BACKGROUND: Public health ethics and law (PHEL) is a core professional competency for the public health workforce. However, few data are available describing the extent to which UK public health workforce members experience ethical and legal issues or have sufficient educational and/or training background to adequately deal with such issues. METHODS: An anonymous online survey was developed for dissemination via member mailing lists of the: Faculty of Public Health, Royal Society of Public Health, and UK Public Health Register. Public Health England also included a link to the survey in their newsletter. The survey included questions about education, training, and experience in relation to PHEL. The survey was deployed from October 2017 to January 2018. RESULTS: The survey was completed by a diverse sample of five hundred and sixty-two individuals. The majority of respondents reported: (i) regularly encountering ethical issues, (ii) resolving ethical issues through personal reflection, (iii) having little or no education and training in PHEL, and (iv) questioning whether they have dealt with ethical issues encountered in practice in the best way. CONCLUSIONS: The results suggest that there is a need to develop and support wider PHEL capacity within the UK public health workforce through the provision of PHEL education, training, guidance, and mentoring

Norms in and between the philosophical ivory tower and public health practice: A heuristic model of translational ethics

This paper draws attention to the translation of ethical norms between the theoretical discourses of philosophers and practical discourses in public health. It is suggested that five levels can be identified describing categories of a transferral process of ethical norms – a process we will refer hereto as “translational ethics”. The aim of the described process is to generate understanding regarding how ethical norms come into public health policy documents and are eventually referred to in practice. Categorizing several levels can show how ethical-philosophical concepts such as norms are transforming in meaning and scope. By subdividing the model to five levels, it is suggested that ethical concepts reduce their “content thickness” and complexity and trade this in for practicability and potential consensus in public health discourses from level to level. The model presented here is illustrated by showing how the philosophical-ethical terms “autonomy”, “dignity”, and “justice” are used at different levels of the translation process, from Kant’s and Rawls’ theories (level 1) to, in this example, WHO reports and communications (levels 4 and 5). A central role is seen for what is called “applied ethics” (level 3). &nbsp