Work stress and burnout

قَالَتۡ إِحۡدَىٰهُمَا يَٰٓأَبَتِ ٱسۡتَـٔۡجِرۡهُۖ إِنَّ خَيۡرَ مَنِ ٱسۡتَـٔۡجَرۡتَ ٱلۡقَوِيُّ ٱلۡأَمِينُ

One of the women said, ‘Father, hire him: a strong, trustworthy man is the best to hire.’

إِنَّمَا جَزَٰٓؤُاْ ٱلَّذِينَ يُحَارِبُونَ ٱللَّهَ وَرَسُولَهُۥ وَيَسۡعَوۡنَ فِي ٱلۡأَرۡضِ فَسَادًا أَن يُقَتَّلُوٓاْ أَوۡ يُصَلَّبُوٓاْ أَوۡ تُقَطَّعَ أَيۡدِيهِمۡ وَأَرۡجُلُهُم مِّنۡ خِلَٰفٍ أَوۡ يُنفَوۡاْ مِنَ ٱلۡأَرۡضِۚ ذَٰلِكَ لَهُمۡ خِزۡيࣱ فِي ٱلدُّنۡيَاۖ وَلَهُمۡ فِي ٱلۡأٓخِرَةِ عَذَابٌ عَظِيمٌ

Those who wage war against God and His Messenger and strive to spread corruption in the land should be punished by death, crucifixion, the amputation of an alternate hand and foot, or banishment from the land: a disgrace for them in this world, and then a terrible punishment in the Hereafter

أَمۡ كُنتُمۡ شُهَدَآءَ إِذۡ حَضَرَ يَعۡقُوبَ ٱلۡمَوۡتُ إِذۡ قَالَ لِبَنِيهِ مَا تَعۡبُدُونَ مِنۢ بَعۡدِيۖ قَالُواْ نَعۡبُدُ إِلَٰهَكَ وَإِلَٰهَ ءَابَآئِكَ إِبۡرَٰهِـۧمَ وَإِسۡمَٰعِيلَ وَإِسۡحَٰقَ إِلَٰهࣰ ا وَٰحِدࣰ ا وَنَحۡنُ لَهُۥ مُسۡلِمُونَ

Were you [Jews] there to see when death came upon Jacob? When he said to his sons, ‘What will you worship after I am gone?’ they replied, ‘We shall worship your God and the God of your fathers, Abraham, Ishmael, and Isaac, one single God: we devote ourselves to Him.’

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ كُلُواْ مِن طَيِّبَٰتِ مَا رَزَقۡنَٰكُمۡ وَٱشۡكُرُواْ لِلَّهِ إِن كُنتُمۡ إِيَّاهُ تَعۡبُدُونَ

You who believe, eat the good things We have provided for you and be grateful to God, if it is Him that you worship

وَإِذۡ أَخَذۡنَا مِيثَٰقَ بَنِيٓ إِسۡرَٰٓءِيلَ لَا تَعۡبُدُونَ إِلَّا ٱللَّهَ وَبِٱلۡوَٰلِدَيۡنِ إِحۡسَانࣰ ا وَذِي ٱلۡقُرۡبَىٰ وَٱلۡيَتَٰمَىٰ وَٱلۡمَسَٰكِينِ وَقُولُواْ لِلنَّاسِ حُسۡنࣰ ا وَأَقِيمُواْ ٱلصَّلَوٰةَ وَءَاتُواْ ٱلزَّكَوٰةَ ثُمَّ تَوَلَّيۡتُمۡ إِلَّا قَلِيلࣰ ا مِّنكُمۡ وَأَنتُم مُّعۡرِضُونَ

Remember when We took a pledge from the Children of Israel: ‘Worship none but God; be good to your parents and kinsfolk, to orphans and the poor; speak good words to all people; keep up the prayer and pay the prescribed alms.’ Then all but a few of you turned away and paid no heed

قُلۡ أَتَعۡبُدُونَ مِن دُونِ ٱللَّهِ مَا لَا يَمۡلِكُ لَكُمۡ ضَرࣰّ ا وَلَا نَفۡعࣰ اۚ وَٱللَّهُ هُوَ ٱلسَّمِيعُ ٱلۡعَلِيمُ

Say, ‘How can you worship something other than God, that has no power to do you harm or good? God alone is the All Hearing and All Knowing.’

(The only reward of those who make war upon Allah and His messenger�) [5:33]. Abu Nasr Ahmad ibn �Ubayd Allah al-Makhladi informed us> Abu �Amr ibn Nujayd> Muslim> �Abd al-Rahman ibn Hammad> Sa�id ibn Abi �Arubah> Qatadah> Anas who related that a group of people from �Ukal and �Uraynah went to see the Messenger of Allah, Allah, bless him and give him peace. They said: �O Messenger of Allah, we were never people of agriculture, and before we settled around Medina we used to be people who looked after cattle�. The Messenger of Allah, Allah bless him and give him peace, ordered that they be given a flock of camels, a shepherd and commanded them to set off with them, with a dispensation to drink their milk and urine. When they reached the region of al-Harrah, they killed the shepherd of the Messenger of Allah, Allah bless him and give him peace, and took off with the camels. The Messenger of

(Or were ye present when death came to Jacob�) [2:133]. This was revealed about the Jews when they said: �Do you not know that when Jacob was about to die he advised his sons to follow Judaism?�

One of the two women the one that had been sent by her father either the elder or the younger said ‘O my father hire him employ him in return for a wage that he may tend our flock instead of us. Surely the best man you can hire is the strong the trustworthy man’ in other words hire him on account of his strength and trustworthiness. He Shu‘ayb asked her about him and she told him as mentioned above how he had lifted the rock off the well and that he had said to her ‘Walk behind me’ in addition to his lowering his head when he realised that she was coming towards him refusing to lift it until she left. He Shu‘ayb therefore was keen to have him marry one of his daughters.

The following was revealed when the ‘Arniyyūn came to Medina suffering from some illness and the Prophet s gave them permission to go and drink from the camels’ urine and milk. Once they felt well they slew the Prophet’s shepherd and stole the herd of camels Truly the only requital of those who fight against God and His Messenger by fighting against Muslims and hasten about the earth to do corruption there by waylaying is that they shall be slaughtered or crucified or have their hands and feet cut off on opposite sides that is their right hands and left feet or be banished from the land the aw ‘or’ is used to indicate the separate application of each of the cases listed; thus death is for those that have only killed; crucifixion is for those that have killed and stolen property; the cutting off of limbs on opposite sides is for those that have stolen property but have not killed; while b

Then there came to him one of them, walking shyly. She said: "Verily, my father calls you that he may reward you for having watered (our flocks) for us." So when he came to him and narrated the story, he said: "Fear you not. You have escaped from the people who are wrongdoers. (25)And said one of them (the two women): "O my father! Hire him! Verily, the best of men for you to hire is the strong, the trustworthy. (26)He said: "I intend to wed one of these two daughters of mine to you, on condition that you serve me for eight years; but if you complete ten years, it will be (a favor) from you. But I intend not to place you under a difficulty. If Allah wills, you will find me one of the righteous. (27)He (Musa) said: "That (is settled) between me and you: whichever of the two terms I fulfill, there will be no injustice to me, and Allah is Surety over what we say. (28) Musa, the Father of t

And mention when We made a covenant with the Children of Israel in the Torah where We said ‘You shall not worship a variant reading for lā ta‘budūna has third person plural lā ya‘budūn ‘they shall not worship’ any other than God lā ta‘budūna illā Llāha is a predicate denoting a prohibition; one may also read lā ta‘budū Worship you not; and to be good and righteous to parents and the near of kin here kinship is adjoined to parents; and to orphans and to the needy; and speak well good words to men commanding good and forbidding evil being truthful with regard to the status of Muhammad (s) and being kind to them sc. orphans and the needy a variant reading for hasanan has husnan the verbal noun used as a hyperbolic description; and observe prayer and pay the alms’ which you actually accepted but then you turned away refusing to fulfil these obligations here the second person address is used

حَدَّثَنَا يَحْيَى بْنُ بُكَيْرٍ، حَدَّثَنَا اللَّيْثُ، عَنْ عُقَيْلٍ، قَالَ ابْنُ شِهَابٍ فَأَخْبَرَنِي عُرْوَةُ بْنُ الزُّبَيْرِ، أَنَّ عَائِشَةَ ـ رضى الله عنها ـ زَوْجَ النَّبِيِّ صلى الله عليه وسلم قَالَتْ وَاسْتَأْجَرَ رَسُولُ اللَّهِ صلى الله عليه وسلم وَأَبُو بَكْرٍ رَجُلاً مِنْ بَنِي الدِّيلِ، هَادِيًا خِرِّيتًا وَهْوَ عَلَى دِينِ كُفَّارِ قُرَيْشٍ، فَدَفَعَا إِلَيْهِ رَاحِلَتَيْهِمَا، وَوَاعَدَاهُ غَارَ ثَوْرٍ بَعْدَ ثَلاَثِ لَيَالٍ بِرَاحِلَتَيْهِمَا صُبْحَ ثَلاَثٍ‏.‏

Narrated Aisha:(the wife of the Prophet) Allah's Messenger (ﷺ) and Abu Bakr hired a man from the tribe of Bani-Ad-Dil as an expert guide who was a pagan (follower of the religion of the pagans of Quraish). The Prophet (ﷺ) and Abu Bakr gave him their two riding camels and took a promise from him to bring their riding camels in the morning of the third day to the Cave of Thaur

حَدَّثَنَا يَعْقُوبُ بْنُ إِبْرَاهِيمَ، حَدَّثَنَا إِسْمَاعِيلُ ابْنُ عُلَيَّةَ، أَخْبَرَنَا ابْنُ جُرَيْجٍ، قَالَ أَخْبَرَنِي عَطَاءٌ، عَنْ صَفْوَانَ بْنِ يَعْلَى، عَنْ يَعْلَى بْنِ أُمَيَّةَ ـ رضى الله عنه ـ قَالَ غَزَوْتُ مَعَ النَّبِيِّ صلى الله عليه وسلم جَيْشَ الْعُسْرَةِ فَكَانَ مِنْ أَوْثَقِ أَعْمَالِي فِي نَفْسِي، فَكَانَ لِي أَجِيرٌ، فَقَاتَلَ إِنْسَانًا، فَعَضَّ أَحَدُهُمَا إِصْبَعَ صَاحِبِهِ، فَانْتَزَعَ إِصْبَعَهُ، فَأَنْدَرَ ثَنِيَّتَهُ فَسَقَطَتْ، فَانْطَلَقَ إِلَى النَّبِيِّ صلى الله عليه وسلم فَأَهْدَرَ ثَنِيَّتَهُ وَقَالَ ‏ "‏ أَفَيَدَعُ إِصْبَعَهُ فِي فِيكَ تَقْضَمُهَا ـ قَالَ أَحْسِبُهُ قَالَ ـ كَمَا يَقْضَمُ الْفَحْلُ ‏"‏‏.‏ قَالَ ابْنُ جُرَيْجٍ وَحَدَّثَنِي عَبْدُ اللَّهِ بْنُ أَبِي مُلَيْكَةَ، عَنْ جَدِّهِ، بِمِثْلِ هَذِهِ الصِّفَةِ أَنَّ رَجُلاً، عَضَّ يَدَ رَجُلٍ، فَأَنْدَرَ ثَنِيَّتَهُ، فَأَهْدَرَهَا أَبُو بَكْرٍ رضى الله عنه‏.‏

Narrated Ya`la bin Umaiya:I fought in Jaish-al-Usra (Ghazwa of Tabuk) along with the Prophet (ﷺ) and in my opinion that was the best of my deeds. Then I had an employee, who quarrel led with someone and one of the them bit and cut the other's finger and caused his own tooth to fall out. He then went to the Prophet (with a complaint) but the Prophet (ﷺ) canceled the suit and said to the complainant, "Did you expect him to let his finger in your mouth so that you might snap and cut it (as does a stallion camel)?" Narrated Ibn Juraij from `Abdullah bin Abu Mulaika from his grandfather a similar story: A man bit the hand of another man and caused his own tooth to fall out, but Abu Bakr judged that he had no right for compensation (for the broken tooth)

أَخْبَرَنَا أَحْمَدُ بْنُ سُلَيْمَانَ الرُّهَاوِيُّ، وَمُوسَى بْنُ عَبْدِ الرَّحْمَنِ، قَالاَ حَدَّثَنَا مُحَمَّدُ بْنُ بِشْرٍ، قَالَ حَدَّثَنَا سُفْيَانُ، عَنْ مُوسَى بْنِ عُقْبَةَ، عَنْ سَالِمِ بْنِ عَبْدِ اللَّهِ بْنِ عُمَرَ، عَنِ ابْنِ عُمَرَ، قَالَ كَانَتْ يَمِينٌ يَحْلِفُ عَلَيْهَا رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ لاَ وَمُقَلِّبِ الْقُلُوبِ ‏"‏ ‏.‏

It was narrated that Ibn 'Umar said:"The oath by which the Messenger of Allah used to swear was: 'No, by the Controller of the hearts

أَخْبَرَنِي مُحَمَّدُ بْنُ يَحْيَى بْنِ عَبْدِ اللَّهِ، قَالَ حَدَّثَنَا مُحَمَّدُ بْنُ الصَّلْتِ أَبُو يَعْلَى، قَالَ حَدَّثَنَا عَبْدُ اللَّهِ بْنُ رَجَاءٍ، عَنْ عَبَّادِ بْنِ إِسْحَاقَ، عَنِ الزُّهْرِيِّ، عَنْ سَالِمٍ، عَنْ أَبِيهِ، قَالَ كَانَتْ يَمِينُ رَسُولِ اللَّهِ صلى الله عليه وسلم الَّتِي يَحْلِفُ بِهَا ‏ "‏ لاَ وَمُصَرِّفِ الْقُلُوبِ ‏"‏ ‏.‏

It was narrated from Salim that his father said:"The oath by which the Messenger of Allah used to swear was: 'No, by the Controller of the hearts

حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي شَيْبَةَ، حَدَّثَنَا وَكِيعٌ، وَحُمَيْدُ بْنُ عَبْدِ الرَّحْمَنِ الرُّؤَاسِيُّ، عَنْ مُغِيرَةَ بْنِ زِيَادٍ، عَنْ عُبَادَةَ بْنِ نُسَىٍّ، عَنِ الأَسْوَدِ بْنِ ثَعْلَبَةَ، عَنْ عُبَادَةَ بْنِ الصَّامِتِ، قَالَ عَلَّمْتُ نَاسًا مِنْ أَهْلِ الصُّفَّةِ الْكِتَابَ وَالْقُرْآنَ فَأَهْدَى إِلَىَّ رَجُلٌ مِنْهُمْ قَوْسًا فَقُلْتُ لَيْسَتْ بِمَالٍ وَأَرْمِي عَنْهَا فِي سَبِيلِ اللَّهِ عَزَّ وَجَلَّ لآتِيَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم فَلأَسْأَلَنَّهُ فَأَتَيْتُهُ فَقُلْتُ يَا رَسُولَ اللَّهِ رَجُلٌ أَهْدَى إِلَىَّ قَوْسًا مِمَّنْ كُنْتُ أُعَلِّمُهُ الْكِتَابَ وَالْقُرْآنَ وَلَيْسَتْ بِمَالٍ وَأَرْمِي عَنْهَا فِي سَبِيلِ اللَّهِ ‏.‏ قَالَ ‏ "‏ إِنْ كُنْتَ تُحِبُّ أَنْ تُطَوَّقَ طَوْقًا مِنْ نَارٍ فَاقْبَلْهَا ‏"‏ ‏.‏

Narrated Ubaydah ibn as-Samit: I taught some persons of the people of Suffah writing and the Qur'an. A man of them presented to me a bow. I said: It cannot be reckoned property; may I shoot with it in Allah's path? I must come to the Apostle of of Allah (ﷺ) and ask him (about it). So I came to him and said : Messenger of Allah (ﷺ), one of those whom I have been teaching writing and the Qur'an has presented me a bow, and as it cannot be reckoned property, may I shoot with it in Allah's path? He said: If you want to have a necklace of fire on you, accept it

حَدَّثَنَا عَمْرُو بْنُ عُثْمَانَ، وَكَثِيرُ بْنُ عُبَيْدٍ، قَالاَ حَدَّثَنَا بَقِيَّةُ، حَدَّثَنِي بِشْرُ بْنُ عَبْدِ اللَّهِ بْنِ يَسَارٍ، قَالَ عَمْرٌو حَدَّثَنِي عُبَادَةُ بْنُ نُسَىٍّ، عَنْ جُنَادَةَ بْنِ أَبِي أُمَيَّةَ، عَنْ عُبَادَةَ بْنِ الصَّامِتِ، نَحْوَ هَذَا الْخَبَرِ - وَالأَوَّلُ أَتَمُّ - فَقُلْتُ مَا تَرَى فِيهَا يَا رَسُولَ اللَّهِ فَقَالَ ‏"‏ جَمْرَةٌ بَيْنَ كَتِفَيْكَ تَقَلَّدْتَهَا ‏"‏ ‏.‏ أَوْ ‏"‏ تَعَلَّقْتَهَا ‏"‏ ‏.‏

A similar tradition has also been transmitted by 'Ubadah b. al-Samit through a different chain of narrators, but the former tradition is more perfect. This version has:I said: What do you think about it, Messenger of Allah? He said: A live coal between your shoulders which you have put around your neck or hanged it

الخامس: المحترف: وهو محتاج إلى الكسب له أو لعياله، فليس له أن يستغرق الزمان في التعبد، بل يجتهد في الكسب مع دوام الذكر، فإذا حصل له ما يكفيه عاود الأوراد.

الثالثة الخوف من كثرة الحرج بسبب كثرة الأولاد والاحتراز من الحاجة إلى التعب في الكسب ودخول مداخل السوء وهذا أيضا غير منهي عنه فإن قلة الحرج معين على الدين نعم الكمال والفضل في التوكل والثقة بضمان الله حيث قال @QB@ وما من دابة في الأرض إلا على الله رزقها @QE@ ولا جرم فيه سقوط عن ذروة الكمال وترك الأفضل ولكن النظر إلى العواقب وحفظ المال وادخاره مع كونه مناقضا للتوكل لا نقول إنه منهي عنه

وخاصية التعبد الحب مع الخضوع والذل للمحبوب فمن أحب شيئا وخضع له فقد تعبد قلبه له بل التعبد آخر مراتب الحب ويقال له التتيم أيضا فان أول مراتبه العلاقة وسميت علاقة لتعلق الحب بالمحبوب قال الشاعر

قالوا لأنه أبعد الأشياء عن هواها وهو حقيقة التعبد

والأفضل في أيام عشر ذي الحجة الإكثار من التعبد لا سيما التكبير والتهليل والتحميد فهو أفضل من الجهاد غير المتعين

فعندهم أن العبادات شرعت أثمانا لما يناله العباد من الثواب والنعيم وأنها بمنزلة استيفاء أجرة الأجير

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Moral distress among acute mental health nurses: A systematic review.: Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing

Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews.: Objectives: (i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features; (ii) to scope evidence for interventions with similar aims, and compare effectiveness and key features to Rounds. Design: Systematic review of Rounds literature; scoping reviews of comparator interventions (action learning sets; after action reviews; Balint groups; caregiver support programme; clinical supervision; critical incident stress debrie

Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis.: Introduction: The severe conditions often experienced in an intensive care unit, combined with poor working conditions, increase stress and therefore decrease job satisfaction. Sustained stress in the workplace leads to the development of burnout, a syndrome characterised by three dimensions: emotional exhaustion, depersonalisation and perceived lack of personal fulfilment. Objective: To analyse the relationship between burnout syndrome and job satisfaction among ICU personnel. Data sources: The

The influence of the hidden curriculum on the risk of burnout in junior doctors in a palliative medicine rotation - a qualitative exploratory study.

Background: Palliative Care (PC) provides person-centred care for patients with life-limiting diseases and their families. Studies have shown that healthcare professionals delivering PC are predisposed to moral distress and burnout due to constant exposure to death and dying and aspects of the hidden curriculum (HC) through which culture and values are transmitted implicitly. However, there are limited studies focusing on the latter through the lens of junior doctors. Using the Ring Theory of Personhood (RToP) and the Krishna-Pisupati Model (KPM), which categorize and map conflicts between personal and professional values, beliefs, and principles within the four domains of personhood, this study investigates the impact of palliative care experiences on the risk of burnout in junior doctors. Methods: This qualitative exploratory study was conducted at the Division of Supportive and Pallia…

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A Bibliometric Analysis of Nurses' Job Satisfaction From 2004 to 2023.

Aim: To conduct a bibliometric analysis of the nurses' job satisfaction from 2004 to 2023. Design: The bibliometric and visual analysis was performed in January 2024. Methods: Bibliometric approaches were applied to analyse 11,993 articles, utilising R and VOSviewer software. Results: Articles published by 24,155 authors from 1735 distinct sources between 2004 and 2023 were retrieved from the Web of Science and incorporated into the research's purview. The most productive nation and institution correspondingly were the United States and the University of Toronto. The leading scholars in this sphere were Spence Laschinger, Heather K, Labrague, Leodoro J, and Rodwell, John according to Price's Law, author co-citation and bibliographic-coupling network analysis. 14,152 keywords about nurses' job satisfaction study were discovered in this research. The most common keywords encompassed "job s…

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Facilitators and barriers to engaging in expressive writing among health and social care professionals.

Healthcare workers in the UK report high levels of burnout and poor wellbeing, and interventions are urgently needed to address this issue. Expressive writing, whereby individuals write about emotionally laden thoughts or experiences, is an effective intervention for reducing stress and enhancing wellbeing, and is a potential candidate for use with healthcare workers. However, it is crucial that the preferences of healthcare workers are taken into account in the design of future trials in this area, and that perceived barriers and facilitators to engaging with expressive writing activities are considered. Therefore, the present study aimed to seek healthcare workers' views on expressive writing activities for enhancing wellbeing. We informed 11 UK-based health and social care professionals about current research into the potential wellbeing benefits of expressive writing activities and c…

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The collective experience of moral distress: a qualitative analysis of perspectives of frontline health workers during COVID-19.

Background: Moral distress is reported to be a critical force contributing to intensifying rates of anxiety, depression and burnout experienced by healthcare workers. In this paper, we examine the moral dilemmas and ensuing distress personally and collectively experienced by healthcare workers while caring for patients during the pandemic. Methods: Data are drawn from free-text responses from a cross-sectional national online survey of Australian healthcare workers about the patient care challenges they faced. Results: Three themes were derived from qualitative content analysis that illuminated the ways in which moral dilemmas and distress were relationally experienced by healthcare workers: (1) the moral ambiguity of how to care well for patients amid a rapidly changing work environment; (2) the distress of witnessing suffering shared between healthcare workers and patients; and (3) the…

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Lessons learned from the Health Resources and Services Administration health workforce well-being grantees.

Introduction: Burnout and moral injury are among the most pressing issues facing healthcare and public safety today. In 2021, Congress provided $120 million through the American Rescue Plan Act for 44 Health Resources and Services Administration grants to implement evidence-informed strategies to address burnout and improve mental health among the health workforce. This article examines facilitators and barriers to implementation and reported impact of grantees' interventions. Method: Key informant interviews (n = 39) and surveys (n = 36) with grantees were conducted between May and August 2023 and qualitatively analyzed using inductive and deductive approaches. Results: This study found grantees were adapting their program modality, timing, and content to meet the needs of their workforce. Many grantees were increasingly focused on training/engaging leadership, establishing structures f…

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Health Care Professional Distress and Mental Health: A Call to the Continuing Professional Development Community.

COVID-19 unleashed a maelstrom of distress on health care professionals. The pandemic contributed to a host of stressors for workers because of the need for rapid acquisition of new knowledge and skills to provide best treatment while simultaneously dealing with personal safety, limited resources, staffing shortages, and access to care issues. Concurrently, problems with systemic racial inequality and discrimination became more apparent secondary to difficulties with accessing health care for minorities and other marginalized groups. These problems contributed to many health care professionals experiencing severe moral injury and burnout as they struggled to uphold core values and do their jobs professionally. Some left or disengaged. Others died. As continuing professional development leaders focused on all health professionals, we must act deliberately to address health care profession…

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"The new normal has become a nonstop crisis": a qualitative study of burnout among Philadelphia's harm reduction and substance use disorder treatment workers during the COVID-19 pandemic.

Background: The COVID-19 pandemic worsened the ongoing overdose crisis in the United States (US) and caused significant mental health strain and burnout among health care workers (HCW). Harm reduction, overdose prevention, and substance use disorder (SUD) workers may be especially impacted due to underfunding, resources shortages, and chaotic working environments. Existing research on HCW burnout primarily focuses on licensed HCWs in traditional environments and fails to account for the unique experiences of harm reduction workers, community organizers, and SUD treatment clinicians. Methods: We conducted a qualitative secondary analysis descriptive study of 30 Philadelphia-based harm reduction workers, community organizers, and SUD treatment clinicians about their experiences working in their roles during the COVID-19 pandemic in July-August 2020. Our analysis was guided by Shanafelt and…

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2022 Central Surgical Association presidential address: Grit and resilience in surgery.

Grit is a personality trait that is defined as passion and perseverance for a long-term goal. Resilience is defined as the ability to recover or adjust to misfortune or change. The 2 concepts are inexorably intertwined. Surgery residents demonstrate higher average grit scores than the general population. Increased levels of grit predict success in many areas of life and are positively correlated with satisfaction in surgery residency. Decreased levels of grit correlate with burnout, attrition, and suicidality in resident surgeons. Personal grittiness can be increased by a focused interest in an area, deliberate goal-directed practice, finding a calling in life, and cultivating hope and resilience. Resilience, like grit, can be nurtured over time with deliberate steps. Grit and resilience are important in residency training, and training programs can be tailored to promote a wise environm…

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"I Don't Want to Go to Work": A Mixed-Methods Analysis of Healthcare Worker Experiences from the Front- and Side-Lines of COVID-19.

During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 …

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Burnout following moral injury and dehumanization: A study of distress among Italian medical staff during the first COVID-19 pandemic period.

Background: Italy was the first country outside Asia to deal with the early phase of the COVID-19 pandemic, and health care facilities and medical staff were not fully prepared. Research worldwide has documented the enormous effect of the COVID-19 pandemic on health care providers' mental health, including experiences of dehumanization, but less work has focused on factors which may influence the development of these outcomes in response to COVID-19-related stress. Objective: This study examined the association of dehumanization, self-efficacy, and alienation to burnout, depression, and PTSD among medical staff. Potential moderators included moral injury, professional role, COVID workload, and work in a critical care unit (CCU). Method: Participants were recruited through the Internet. The sample consisted of 270 medical staff members who completed a self-report survey online. Instrument…

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Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting.

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting. Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity. Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect. Results: Using an exploratory structural equation modelling (ESEM) we assessed th…

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An unheard voice: infection prevention professionals reflect on their experiences during the covid-19 pandemic.

Background: The COVID-19 pandemic required a shift away from the evidence-based practices known to infection prevention professionals' (IPP). Relaying these guidelines to beleaguered front line staff contributed to the experience of moral distress and burnout among IPPs. Methods: A mixed methods design was used to explore the experiences of IPPs during the COVID-19 pandemic. An electronic survey was sent to a convenience sample from the Wisconsin APIC membership. A subset of this sample completed additional semi-structured interviews. Results: A total of 61 IPPs responded to the survey, 18 agreed to interviews with 11 completions. Most respondents identified as female (n=58, 95.0%) and White (n=55, 90.1%). More than half of the respondents (n=39, 63.9 %) reported they experienced moral distress (MD). Themes from one-on-one interviews included: Feeling depleted, challenges to IPP role, va…

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The Association of Grit With Burnout Components (Professional Efficacy, Exhaustion, and Cynicism) Among Academic Rheumatologists: The TRUMP 2 -SLE Study.

Objectives: There is a high prevalence of burnout among rheumatologists. Grit, which is defined as possessing perseverance and a passion to achieve long-term goals, is predictive of success in many professions; however, whether grit is associated with burnout remains unclear, especially among academic rheumatologists, who have multiple simultaneous responsibilities. Thus, the purpose of this study was to examine the associations between grit and self-reported burnout components-professional efficacy, exhaustion, and cynicism-in academic rheumatologists. Methods: This cross-sectional study involved 51 rheumatologists from 5 university hospitals. The exposure was grit, measured using mean scores for the 8-item Short Grit Scale (range, 1-5 [5 = extremely high grit]). The outcome measures were mean scores for 3 burnout domains (exhaustion, professional efficacy, and cynicism; range, 1-6; mea…

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Self-Care and Storytelling for Radiologists: A Feasibility Study.

Rationale and objectives: Physician wellness and burnout mitigation strategies have become priority practices in recent years. Despite these efforts, however, physicians living with the psychological effects of the current COVID-19 global pandemic, political stressors, and social injustices, face ever increasing threats to their personal and professional well-being. This manuscript investigates the process of storytelling as a self-care practice for radiologists. Materials and methods: The AUR Well Being Ad-Hoc Committee introduced and approved Storytelling Geek Week, a virtual workshop held by The Moth, a Peabody award-winning storytelling nonprofit group. Nineteen AUR members applied and were selected for participation in the workshop which occurred over 5 days in November 2020. Anonymous electronic surveys were sent to participants before and after the workshop to gather feedback on t…

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Social belonging, compassion, and kindness: Key ingredients for fostering resilience, recovery, and growth from the COVID-19 pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to increases in anxiety, depression, posttraumatic stress disorder, burnout, grief, and suicide, particularly for healthcare workers and vulnerable individuals. In some places, due to low vaccination rates and new variants of SARS-CoV-2 emerging, psychosocial strategies for remaining resilient during an ongoing multi-faceted stressor are still needed. Elsewhere, thanks to successful vaccination campaigns, some countries have begun reopening but questions remain regarding how to best recover, adjust, and grow following the collective stress and loss caused by the pandemic. Method: Here, we briefly describe three evidence-based strategies that can help foster individual and collective recovery, growth, and resilience: cultivating social belonging, practicing compassion, and engaging in kindness. Results: Social belonging …

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Grit Levels of Graduate Nursing Students: Why Grit Is Needed in Nursing.

Background: The coronavirus disease 2019 (COVID-19) pandemic has created a need for nurses who are perseverant and passionate, the definition of grit. This study examined grit levels in Master in Nursing (MSN) and Doctor of Nursing Practice (DNP) students. Method: MSN and DNP students were surveyed using the Grit-S scale, which is composed of two parts: Grit-CI (consistency of interest) and Grit-PE (perseverance of effort). Results: Overall, graduate nursing students had high levels of grit as measured by the Grit-S (M = 3.9, SD = 0.5). Perseverance was higher for both MSN and DNP students than passion (M = 4.2, SD = 0.5 vs. M = 3.6, SD = 0.7). There was no difference in Grit-S levels related to program type. Conclusion: Graduate nursing students had high levels of grit. With the challenges faced by nursing professionals during the COVID-19 pandemic, nurses with high grit levels may avoi…

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The Critical Need for a Meaning-Centered Team-Level Intervention to Address Healthcare Provider Distress Now.

COVID-19 has unveiled and amplified the burnout, grief, and other forms of distress among healthcare providers (HCPs) that long preceded the pandemic. The suffering of the healthcare workforce cannot be simply and sufficiently addressed with a single psychotherapeutic intervention. Nevertheless, the National Academies of Sciences, Engineering, and Medicine Studies recommended prioritizing interventions that generate an increased sense of meaning in life and in work to reduce burnout and cultivate clinician wellbeing. Despite their guidance, there is a dearth of interventions for HCPs specifically targeting meaning and purpose as an avenue to reduce HCP distress. In a time when such an intervention has never been more essential, Meaning-Centered Pyschotherapy (MCP), a brief, evidence-based intervention designed for patients with advanced cancer may be key. This piece describes the princip…

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Moral injury in Chinese health professionals during the COVID-19 pandemic.

Objective: Caring for patients during the COVID-19 pandemic has placed considerable stress on health care professionals (HCPs), increasing their risk of moral injury (MI) and clinician burnout. The present study sought to examine the prevalence and correlates of MI among physicians and nurses in mainland China during the pandemic. Method: A cross-sectional study was performed via an online survey conducted from March 27, 2020 to April 26, 2020. The 10-item Moral Injury Symptoms Scale-Health Professional version (MISS-HP) was administered along with measures of clinician mental health and burnout. A total of 3,006 physicians and nurses who completed the questionnaire were included in the final analysis. Unconditional logistic regression modeling was performed to determine the associations, including that between COVID-19 patient exposure and the risk of moral injury. Results: MISS-HP scor…

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Moral Elevation, Physician Role Models, and Selected Markers of Professional Identity Formation and Well-Being: A Secondary Analysis from Two National Surveys.

Objectives: Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation. Methods: A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures o…

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Sense of coherence and burnout in nursing home workers during the COVID-19 pandemic in Spain.

Care staff in nursing homes work in a challenging environment, and the COVID-19 pandemic has exacerbated those challenges in an unprecedented way. On the other hand, the sense of coherence (SOC) is a competence that could help these professionals perceive the situation as understandable, manageable and meaningful. This study aims to analyse the extent to which potential risk and protective factors against burnout have affected nursing home workers during the COVID-19 pandemic and to assess the contribution of these factors to their burnout. Three hundred forty professionals who worked in nursing homes in Spain completed a survey and reported on their sociodemographic characteristics and their organisational characteristics of the job related to COVID-19, SOC and burnout. Multiple linear regression analyses were performed. The results showed that the SOC is highly related to the dimension…

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Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey.

Background: "Moral distress" describes the psychological strain a provider faces when unable to uphold professional values because of external constraints. Recurrent or intense moral distress risks moral injury, burnout, and physician attrition but has not been systematically studied among neurosurgeons. Objective: To develop a unique instrument to test moral distress among neurosurgeons, evaluate the frequency and intensity of scenarios that may elicit moral distress and injury, and determine their impact on neurosurgical burnout and turnover. Methods: An online survey investigating moral distress, burnout, and practice patterns was emailed to attending neurosurgeon members of the Congress of Neurological Surgeons. Moral distress was evaluated through a novel survey designed for neurosurgical practice. Results: A total of 173 neurosurgeons completed the survey. Half of neurosurgeons (47…

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Cross-sectional survey of COVID-19-related impacts on mental health of nurses: occupational disruption, organisational preparedness, psychological harm, and moral distress.

Background: The COVID-19 pandemic has presented unprecedented levels of prolonged strain on healthcare systems and healthcare workers (HCWs) globally, with nurses at the forefront. Objectives: To describe types and prevalence of occupational disruptions and exposure to COVID-19, and their impacts on mental health, moral distress, coping strategies, and help-seeking behaviours of Australian nurses. Design: A cross-sectional online anonymous survey distributed amongst Australian HCWs between 27 August and 23 October 2020.Methods: Data was collected on demographics, workplace disruption, personal relationships, and mental health. Predictors of mental health impacts and coping strategies were identified through multivariate regression analyses. Results: 7845 complete responses were returned, of which 3082 (39.3%) were from nurses and 4763 (60.7%) were from all other professions ('other HCWs'…

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Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers.

Background: Moral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic. Objective: To compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans and healthcare workers (HCWs) surveyed during the COVID-19 pandemic. Design: Cross-sectional surveys of veterans (2015-2019) and HCWs (2020-2021) in the USA. Participants: 618 military veterans who were deployed to a combat zone after September 11, 2001, and 2099 HCWs working in healthcare during the COVID-19 pandemic. Main measures: Other-induced PMI (disturbed by others' immoral acts) and self-induced PMI (disturbed by having violated own morals) were the primary outcomes. Sociodemographic variables, combat/COVID-19 experience, depression, quality of life, and burnout were measured as correlates. Key results: 46.1% of post-9/11 veteran…

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Moral Injury and Burnout in Health Care Professionals During the COVID-19 Pandemic.

The coronavirus pandemic (COVID-19) is predicted to increase burnout in health professionals (HPs), but little is known about moral injury (MI) in this context. We administered the Moral Injury Symptoms Scale for Health Professionals (MISS-HP) and the abbreviated Maslach Burnout Inventory via online survey to a global sample of 1831 HPs in April and October 2020. Mean MISS-HP increased from 27.4 (SD, 11.6) in April to 36.4 (SD, 13.8) in October (p < 0.001), with an accompanying increase in personal accomplishment (April: 4.7; SD, 3.1; October: 9.3; SD, 3.1; p < 0.001) and no change in other burnout subscales. In April, 26.7% of respondents reported at least moderate functional impairment from MI, increasing to 45.7% in October (p < 0.001). Predictors of MISS-HP included younger age and being a nurse. Odds of functional impairment were higher in respondents who were widowed, divorced, nev…

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COVID-19: lessons for junior doctors redeployed to critical care.

Approximately 4% of patients with coronavirus disease 2019 (COVID-19) will require admission to an intensive care unit (ICU). Governments have cancelled elective procedures, ordered new ventilators and built new hospitals to meet this unprecedented challenge. However, intensive care ultimately relies on human resources. To enhance surge capacity, many junior doctors have been redeployed to ICU despite a relative lack of training and experience. The COVID-19 pandemic poses additional challenges to new ICU recruits, from the practicalities of using personal protective equipment to higher risks of burnout and moral injury. In this article, we describe lessons for junior doctors responsible for managing patients who are critically ill with COVID-19 based on our experiences at an urban teaching hospital.

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