Building organizational and individual resilience in times of moral distress.

Introduction

The COVID 19 pandemic is unique in its severity and tenacity. The modern world has suffered an unprecedented amount of crippling health, moral, economic, and psychological distress during this time and continues to do so. Moral distress is a growing problem that impacts health care providers at multiple levels in all health care settings [1]. Moral distress can lead to burnout, broken interprofessional relationships, and a dearth of health care workers. Most importantly, it affects the safety and quality of care and leads to poor outcomes. Having a strong culture of resilience in the organization, and building skills among individuals to promote individual resilience can counteract the effects of moral distress during crisis situations. Yet, few interventions to enhance resilience on an individual and organizational basis during moral distress have been examined or found to be effective [2]. Organizational Resilience is “the ability of an organization to anticipate, prepare for, respond and adapt to incremental change and sudden disruptions” in order to survive and prosper [3]. Individual resilience involves “behaviors, thoughts, and actions that promote personal wellbeing and mental health” [4]. It refers to a person's ability to withstand, adapt to, and recover from adversity. Individuals can develop coping skills to deal with stress and maintain a state of stable mental. Resilience has been shown to improve work satisfaction and over all engagement, adding a sense of purpose, which lowers stress levels [5].

Strategies for organizational and individual resilience

Research has shown that resilience is not purely an individual characteristic. Individuals can become more resilient in the process of finding interpersonal connections in the most challenging times. For leaders who led and continue to lead organizations during the COVID 19 pandemic the added burden of the responsibility for the safety of the team working without adequate protection during the first surge, the risk of personal infection and potential illness and death, making tough triage decisions in the face of limited resources and loss of revenue from lock downs and cancelled elective procedures adds to the burden of moral distress [6].Organizational resilience is built upon strong culture, relationships and networks within organizations and revolves around the ability of these organizations to reposition and reimagine themselves along the lines of the crisis situation. By reimagining and repositioning itself the organization can negotiate the crisis in a way which can avert disaster. Strong interpersonal relationships from the top down within organizations help shift work or manage surges, make sense of people during stressful situations and their mental health, help us self-advocate and find a path forward. Organizations that succeed in mitigating the effects of moral distress always prioritize the human capital they have and are in touch with the needs of their people. This culture of empathic support goes a long way in releasing negative emotions, help us find purpose in our work and also broaden our perspective [7]. Whilst individual fortitude and strength comes from personal qualities as well, it is often interpersonal networks that bolster this resilience when facing such trying times. When leaders can rely on strong teams and use their reimagined vision to reposition the organization on a path to success the stress levels often come down. The trickle-down effect of this trust when properly and frequently communicated to members can enhance individual resilience. Also, exposure to a diverse group of people across the hierarchy in organizations lead us to learn from people from differing walks of work life (each with their own unique struggles and paths). The toolkit we subconsciously develop builds on the experiences of others in managing, crises and sharpens our relational skills, in addition to cultivating empathy and emotional intelligence [8].

In our organization, frequent town halls by leaders, weekly briefings and transparency in shifting work domains and pathways to circumvent a fall out from the deep moral and psychological distress during the surges helped build trust, showed compassion and alleviated loss of confidence. Sending powerful positive messages through a weekly newsletter to the department also helped in disseminating a feeling of camaraderie and shared purpose. In short, organizational resilience is found in not just building a network of support but also in connecting with these individuals and interactions that validate the plans, reframe the perspective and encourage people to get back up in times of failure and strife [9]. Such networks and culture are not built overnight. It takes a lifetime for people to cultivate relationships where they may be seen as a motivational and inspiring source. These authentic connections come from many aspects of one's life. These spheres broaden identity and allow inclusion of broad and deep dimensions which all go towards building the moral fibre that is required to deal with stress. A well-developed network can help an organization to help its members to rebound from setbacks. Relational sources of resilience come from connections that show empathy, help us shift work or be flexible according to our needs, connections that manage politics, connections that help us self-advocate and see a path forward, connections that help us maintain perspective and remind us of our purpose and finally connections that help us maintain a sense of humor. These rich variety of connections help us grow and manage a sense of strength during our struggles [10].

Conclusion

COVID 19 has created significant moral distress and transition for all of us. For most the setbacks and challenges in work and life have been relentless and profound. But this is a phenomenon that is prevalent globally in various degrees and has struck a resonance across all of society. Often the most long lasting growth occurs in the throes of the deepest despair and wrestling with ethical and moral choices. In summary, meaningful investment in interpersonal relationships broadens our resilience and builds an organizational culture of fortitude in dealing with moral distress in times of calm or chaos. Many areas of emphasis have been highlighted in the past 2 years since the pandemic started. These have broadened the realm of ethical thought beyond the usual discussions.

With that in mind this Special Issue on Ethics highlights some of the present debate ongoing in the World around the pandemic. The moral courage and grit shown by countries and people is exemplary. The issues discussed by the contributing authors serve to illustrate the ethical dilemmas at hand and to be considered in the future. Hayes et al. have talked about the importance of these values in critical care leadership during the pandemic. Ben-Jacob et al. discuss how end of life care have drastically taken a turn, whilst Bunnik et al. opine about ways to mitigate the loneliness of delivering end of life care. Van Regenmortel et al. evaluate three triage tools for resource allocation which can lessen the moral and ethical distress of dispensing these when resources are limited. Patel et al. talk about the role of social media on mechanisms of mechanical ventilation during the pandemic. Williams opines on trust issues surrounding vaccines whilst Jabaley et al. suggest a new approach. Finally, Nurok et al. deliberate on the influence of market forces and how the economic demand can be managed during a national health crisis. These topics underscore real world points of reflection where a new paradigm of ethical and moral reflection during these times of extreme tension, hopefully shining a light on the quagmire of issues and opinions, showing a way forward.