- •Wellbeing in the intensive care unit (ICU) is affected by a combination of personal factors, organizational factors, quality of interpersonal relationships, and exposure to end-of-life issues.
- •Moral injury occurs when an act is perpetrated, one bears witness to or fails to prevent an act that is against deeply held moral beliefs.
- •Second victim syndrome is the guilt and other psychological onslaught faced by health care providers who hold themselves responsible following unexpected patient morbidity or mortality.
- •Leadership held check-ins, active listening to feedback, and availability of wellness resources help mitigate health care worker (HCW) burnout.
- •Training in communication, conflict resolution, and simulation of team-based care aid in creating collaborative scenarios and clarifying roles among multi-disciplinary teams.
Wellbeing Versus Burnout Syndrome
Concepts and Definitions Associated with Well-being Literature
Implications of the Coronavirus Pandemic
Risk Factors for Burnout among Intensive Care Unit Personnel
- 1.Personal characteristics: self-criticism, idealism, perfectionism, inadequate coping strategies, sleep deprivation, and overcommitment. These characteristics are often seen among highly productive workers.21
- 2.Organizational factors: unmanageable workload, lack of control over the work environment, insufficient rewards, and general breakdown in the work community. Specifically, for critical care physicians, night shifts and lack of time off between ICU weeks increased burnout, whereas for nurses, lack of ability in choosing days off and rapid patient turnover increased BOS.23
- 3.Quality of working relationships is an important modifiable risk factor for BOS. The conflicts between members of multidisciplinary teams caring for a complex patient as well as difficult HCW–patient relationships exact a toll on clinician well-being.
- 4.Exposure to end-of-life issues: Critical Care nurses cite increased burnout related to care of a dying patient—witnessing, and participating in transitions to comfort care Critical care physicians cite increased burnout due to: the constant exposure to inappropriate care (this can be related to delays in care and/or the wrong amount of care) (an example would include delivery of inaccurate information to a patient or family, disrespecting a patient’s wishes, and advocating that another patient might benefit from an ICU bed as issues that compound).24,29
- 5.The pandemic has unearthed unprecedented anxiety and conflict among HCWs due to resource shortages and politicization of standard preventative measures such as wearing a mask, social distancing, avoiding super-spreader events, and vaccination to protect against severe disease. This is magnified among ICU personnel as they care for the most critically ill patients that often require resource-intensive advanced therapies including mechanical ventilation and extracorporeal membrane oxygenation.25
Moral Injury and Intensive Care Unit Practice
Second Victim Syndrome
Solutions to Mitigate Burnout and Improve Intensivist Fulfillment
COVID-19-specific measures to improve critical care clinician well-being
- Giordano F.
- Cipolla A.
- Ungar M.
Long-term Measures to Mitigate Burnout
Post-intensive Care Unit Clinics and Longevity Programs
CLINICS CARE POINTS
- •Moral injury occurs when an act is perpetrated, one bears witness to or fails to prevent an act that is against deeply held moral beliefs, especially in the care of a patient at the end of their lives. Having multidisciplinary debriefings to discuss different viewpoints among the various caregivers may help the team to understand the varying opinions and basis of care being provided.
- •Lack of control over one’s control schedule can be addressed by incorporating flexible scheduling paradigms.
- •Difficult relationships among members of different specialties caring for the same critically ill patient can be modified by providing communication and conflict resolution training, and simulation programs for team-based care
- •Understanding a patient’s progress after leaving the ICU by investing in post-ICU clinics helps HCWs realize the value of their efforts as well as gain perspective on the consequences of ICU therapies.
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