Compassion fatigue, moral distress and moral residue facing health-care providers

Health-care providers of all stripes, in all parts of the country, are burned out—they are physically and mentally exhausted and, in some cases, they suffer from compassion fatigue. Compassion fatigue is where the trauma of others is experienced by health-care providers as their own trauma which makes it difficult, if not impossible, for them to provide effective patient care. Imagine, for example, the trauma experienced and, in some cases, internalized by those who witnessed untold deaths as a direct result of the COVID-19 pandemic. For some health-care providers, moral distress and moral residue are layered on top of this. Moral distress arises when there is a disconnect between what a person sincerely believes should be done and what they actually do. This can be the result of institutional constraints, hierarchical structures, errors of judgment, personal failings, or other circumstances beyond a person’s control. Consider, for example, the decision to discharge frail patients when they are not medically or functionally ready in an effort to free-up beds or to alleviate pressure in the emergency room. Perhaps the equipment required for safe discharge is not available. Perhaps community services and home care are unable to provide the necessary supports because they are already at full capacity. Moral residue is the emotional remnant of moral distress. It is what a person carries with them from those times when they were unable do the right thing. Taken together, compassion fatigue, moral distress and moral residue account for high levels of absenteeism. They also explain why some health care providers have chosen to work part-time or to retire early. The resulting staff shortages have increased the workload for others which, in turn, has increased stress in an already heavily burdened and fractured health-care system. To date, responses to the labour shortages have been many and varied. Across the country there has been increased use of information technology and artificial intelligence in operational and administrative tasks, increased use of video communications, increased efforts at worker retention, compressed training programs for nurses, an expanded role for pharmacists, and increased use of nurse practitioners and certified physician assistants. Nurse practitioners are registered nurses with additional training and experience. Physician assistants are medical professionals with a two-year degree modeled on the training provided to physicians. These various responses have proven insufficient, however. Against this backdrop, the question arises: can the federal government help the health-care system contend with inadequate staffing and worker retention? As health is a shared responsibility, this is a complicated question. My best answer at this time is for the federal government to complement ongoing efforts by the provinces and territories to financially shore up the existing heath-care system while at the same time making targeted investments in creative design projects aimed at revamping the current system to better address the needs and challenges of the 21st century. To be clear, this is not a call for yet another report on how to fix a health-care system which appears to be collapsing under the weight of unrelenting demands at a time of decreasing personnel and financial resources. Rather, it is a call for a new kind of sustained commitment to co-operative federalism to achieve the goal of providing Canadian residents with high quality health care. To this end, the federal government, in the role of convenor, could facilitate important grassroot conversations among care providers and residents about hopes and expectations for health and wellness. At this time, access to health care is a high priority for Canadians. This has translated into calls for more primary care physicians without much discussion about the current hub and spoke model where “information flows through and decisions are made by” the primary care physician (the hub). This is not the only way to provide care. Moreover, there are many good reasons to think that it may not be the best way to provide patient-centred care. Critical questions to consider are: do we need more primary care physicians or more primary care? And how might these be different? Françoise Baylis, CM, ONS, PhD, FRSC, FCAHS, FISC, is a member of the Governing Board of the International Science Council, and a distinguished research professor emerita for Dalhousie University. The Hill Times

Compassion fatigue, moral distress and moral residue facing health-care providers

This is not a call for yet another report on how to fix a health-care system which appears to be collapsing under the weight of unrelenting demands at a time of decreasing personnel and financial resources. It's a call for a new kind of sustained commitment.

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Compassion fatigue, moral distress and moral residue facing health-care providers

This is not a call for yet another report on how to fix a health-care system which appears to be collapsing under the weight of unrelenting demands at a time of decreasing personnel and financial resources. It's a call for a new kind of sustained commitment.

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