4 research outputs found
Staff Care in the Midst of Traumatic Events
Traumatic events bring upheaval and uncertainty. Yet not all difficult or jarring events are experienced as distressing, “traumatic,” or morally injurious by those present, the latter of which in military contexts involves an experience that violates one’s moral code or betrayal by once-trusted sources. Trauma has a certain subjective quality to it, as we learn from military personnel who may witness the same event and interpret or internalize it differently. Exposure to a potentially injurious event does not necessarily lead to post-traumatic stress or moral injury for all who witness the event.
So, how do we define a traumatic event for the purposes of this eBook? Trauma overwhelms a person’s capacity to make meaning. Healthcare staff may experience traumatic events that tax their ability to respond, such as when a situation overwhelms their capabilities or when the details of an event intersect with current or past experiences, amplifying a common event to a traumatic level.
The chaplain writers of this eBook chose a compilation of vignettes that incorporate multiple types of traumatic events. Some of these encounters are with individual staff members, while others occurred in staff groups. Some of these events are personal and individual, like a particularly jarring patient encounter, or intersection of personal story with professional experience; other events represent societal trauma such as experiences of racism, COVID-19, or attempts to disrupt activities of the federal government. Each traumatic event includes a particular chaplain’s approach to staff care, recognizing the contextual features of the encounter. Some vignettes are compilations, and details have been changed to protect privacy.
A certified educator once described staff as the primary congregation the healthcare chaplain serves; in this metaphor, patients and families are visitors to the congregation. Though the specific words used for “staff” vary by setting (healthcare workers, team members, care partners, care receivers, professional caregivers, front line workers, employees, and so on), those who work and serve alongside chaplains are the metaphorical “regulars.” These co-laborers clean rooms, prep supplies, sterilize equipment, prepare food, compound medications, administer breathing treatments, process labs, perform surgeries, and manage conditions; each does their part to contribute to patients’ healing.
With staff being integral to the flow and function of the setting, chaplains have a meaningful role in providing care to professional caregivers. Each vignette includes structural similarities: background about the encounter, the chaplain’s assessment (or, at times, the recipient’s self-assessment), chaplain-provided support or intervention, outcome or staff response, and the chaplain’s reflection or concluding thought. Recognizing a single setting has limitations and that no resource is exhaustive, the chaplain writers anticipate readers will adapt and modify these approaches to the benefit of other settings.Henry Luce Foundatio
A descriptive study of the multidisciplinary healthcare experiences of inpatient resuscitation events
Background: In-hospital resuscitation events have complex and enduring effects on clinicians, with implications for job satisfaction, performance, and burnout. Ethically ambiguous cases are associated with increased moral distress. We aim to quantitatively describe the multidisciplinary resuscitation experience.
Methods: Multidisciplinary in-hospital healthcare professionals at an adult academic health center in the Midwestern United States completed surveys one and six weeks after a resuscitation event. Surveys included demographic data, task load (NASA-TLX), overall and moral distress, anxiety, depression, and spiritual peace. Spearman's rank correlation was computed to assess task load and distress.
Results: During the 5-month study period, the study included 12 resuscitation events across six inpatient units. Of 82 in-hospital healthcare professionals eligible for recruitment, 44 (53.7%) completed the one-week post-resuscitation event survey. Of those, 37 (84.1%) completed the six-week survey. Highest median task load burden at one week was seen for temporal demand, effort, and mental demand. Median moral distress scores were low, while "at peace" median scores tended to be high. There were no significant non-zero changes in task load or distress scores from weeks 1-6. Mental demand (r = 0.545, p < 0.001), physical demand (r = 0.464, p = 0.005), performance (r = -0.539, p < 0.001), and frustration (r = 0.545, p < 0.001) significantly correlated with overall distress. Performance (r = -0.371, p = 0.028) and frustration (r = 0.480, p = 0.004) also significantly correlated with moral distress.
Conclusions: In-hospital healthcare professionals' experiences of resuscitation events are varied and complex. Aspects of task load burden including mental and physical demand, performance, and frustration contribute to overall and moral distress, deserving greater attention in clinical contexts
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Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract
Importance Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited. Objective To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location. Design, Setting, and Participants This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023. Exposures Lensectomy with primary IOL implantation. Main Outcome and Measures Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models. Results The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality. Conclusions and Relevance In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring