Moral injury and well-being in essential workers during the COVID-19 pandemic: local survey findings

BackgroundEssential workers have faced many difficult situations working during the pandemic. Staff may feel that they, or other people, have acted wrongly and be distressed by this. This represents moral injury, which has been linked with significant mental ill health.MethodsThis survey asked essential workers in County Durham and Darlington about their experiences during the first wave of the pandemic and anything they felt would help. Well-being and moral injury were rated using sliders.ResultsThere were 566 responses. A majority of respondents reported feeling troubled by other people’s actions they felt were wrong (60% scored over 40, where 0 is ‘not at all troubled’ and 100 ‘very troubled’, median score=52.5). Respondents were generally less troubled by their own actions (median score=3). Well-being and moral injury scores varied by employment sector (eg, National Health Service (NHS) staff were more troubled by the actions of others than non-NHS staff).Staff suggestions included regular supervisor check-ins, ensuring kindness from everyone, fair rules and enforcement and improving communication and processes. Respondents offered simple, practical actions that could be taken by leaders at team, organisation, societal and governmental levels to tackle moral injury and the underlying causes of moral injurious environments.ConclusionUsing these findings to develop a strategy to address moral injury is important, not only for staff well-being, but staff retention and continued delivery of vital services in these challenging times. Working together, we can seek to reduce and mitigate ‘moral injury’ the same way we do for other physical workplace ‘injuries’.

Clinical Characteristics Associated with Physical Violence in the Elderly: A Retrospective Multicenter Analysis

Background: Elder abuse is predicted to increase with the rapid population ageing in many countries. Violent injury is influenced by individual factors as well as interpersonal and social relationships, with different manifestations based on changes in the socioeconomic position of older adults. We comparatively investigated the clinical and injury characteristics of physical violence in the elderly with those in another age group. Methods: We included elderly patients (age ≥65 years) who visited six emergency departments (ED) with violence-induced injuries in 2017. The control group comprised patients aged 45–64 years, selected by 1:2 matching based on hospital and sex. Data were extracted from the National Emergency Department Information System and electronic medical records. Both groups were compared for injury mechanism, injury location, activity during injury, diagnosis, and clinical outcomes. Results: Among the 316,944 patients who presented to the 6 ED, 89,178 (28.1%) had traumatic injuries, and 1.6% and 4.5% of injuries were sustained due to violence in the ≥65 and 45–64 year age groups, respectively. There were no significant intergroup differences in the perpetrator (P=0.27), body parts affected (P=0.63), and diagnosis (P=0.23), whereas the older adult group had a significantly higher proportion of traumatic injury by fall (P=0.01), at road and traffic facilities (P=0.01), during work (P=0.01), and multiple injuries (P<0.01). Conclusion: The increase in non-regular workers in the elderly after retirement may have increased the risk of traumatic workplace injuries. As workplace injuries may be a new risk factor for physical violence in the elderly, institutional workplace injury prevention policy is needed.

She'll be wrong: Rethinking corporate and officer responsibility under the Health and Safety Reform Bill

<p>New Zealand has a poor health and safety record with alarming rates of workplace injuries and fatalities. The current health and safety regime fails to promote corporate and director responsibility and leaves New Zealand open to potentially catastrophic harm. This was demonstrated in 2010 with the Pike River disaster which revealed an urgent need for reform. This paper analyses the Health and Safety Reform Bill. The Bill represents the most comprehensive overhaul of New Zealand’s health and safety regime in 22 years. The focus in the Bill is no longer on the status of the employment relationship meaning better protection for workers. This paper argues that corporate and officer responsibility is crucial to turning things around. The Bill drives responsibility through the introduction of a proactive due diligence duty on officers and stronger deterrence mechanisms. Placing obligations on officers means those in the best position to monitor and reduce risks have a legal obligation to do so. The Bill targets those who have the ability to initiate change and requires these people to take a proactive approach to managing health and safety. This paper concludes that the Bill represents a positive step forward in New Zealand’s health and safety regime.</p>

She'll be wrong: Rethinking corporate and officer responsibility under the Health and Safety Reform Bill

<p>New Zealand has a poor health and safety record with alarming rates of workplace injuries and fatalities. The current health and safety regime fails to promote corporate and director responsibility and leaves New Zealand open to potentially catastrophic harm. This was demonstrated in 2010 with the Pike River disaster which revealed an urgent need for reform. This paper analyses the Health and Safety Reform Bill. The Bill represents the most comprehensive overhaul of New Zealand’s health and safety regime in 22 years. The focus in the Bill is no longer on the status of the employment relationship meaning better protection for workers. This paper argues that corporate and officer responsibility is crucial to turning things around. The Bill drives responsibility through the introduction of a proactive due diligence duty on officers and stronger deterrence mechanisms. Placing obligations on officers means those in the best position to monitor and reduce risks have a legal obligation to do so. The Bill targets those who have the ability to initiate change and requires these people to take a proactive approach to managing health and safety. This paper concludes that the Bill represents a positive step forward in New Zealand’s health and safety regime.</p>

Family-to-Work Interface and Workplace Injuries: The Mediating Roles of Burnout, Work Engagement and Safety Violations

Past research has primarily investigated the role of the negative side (family-to-work conflict; FWC) of the family-to-work interface in workplace safety outcomes and neglected the positive side (family-to-work enrichment; FWE). Moreover, the mechanism underlying the relation between the family-to-work interface and workplace safety has not been well studied. From the perspectives of the job demands-resources model as well as conservation of resources theory, this study endeavors to extend the current literature on workplace safety by evaluating the mediating roles of burnout, work engagement, and safety violations in the associations of FWC and FWE with workplace injuries. Two-wave longitudinal survey data were obtained from 233 Chinese employees in two high-risk industries (nursing and railways). The hypothesized longitudinal mediation model was analyzed with the structural equation modeling technique. It was revealed that the association of FWE with workplace injuries was mediated by work engagement and then safety violations. Burnout was found to mediate the association of FWC with workplace injuries. Safety violations were also found to mediate the association of FWC with workplace injuries. The present findings offer insights into the underlying mechanisms by which the family-to-work interface influences workplace injuries.

Current changes in the epidemiology of fall-related injuries in Al Ain City, United Arab Emirates

Background Falls in the Gulf countries are the second most common cause of injuries. The United Arab Emirates government implemented various preventive measures to decrease injuries in the country. We aimed to evaluate the changes in the epidemiology of fall-related injuries in Al-Ain City over the last decade. Methods Data of hospitalized patients who presented with fall-related injuries to the Al-Ain Hospital during the two periods of March 2003 to March 2006 and January 2014 to December 2017 were compared. This included patients’ demographics, mechanism, location, anatomical distribution and parameters related to injury severity. Non-parametric tests were used for the statistical analysis. Results 882 in the first and 1358 patients in the second period were studied. The incidence of falls decreased by 30.5% over ten years. The number of elderly, female patients, and UAE nationals increased, (p < 0.001, p = 0.004, and p < 0.001). Falls from height decreased by 32.5% (p < 0.001) while fall on the same level increased by 22.5% (p < 0.001). Fall-related injuries at home have increased significantly by 22.6% (p <0.001), while falls in workplaces decreased by 24.4% (p <0.001). Conclusions Our study showed that the overall incidence of falls decreased compared to a decade ago. The preventive measures were effective in reducing falls from height and workplace injuries. Future preventive measures should target falls at the same level and homes.

1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future

Introduction Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic. Method Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology. Results 2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia. Conclusions Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.

Alcohol and the Risk of Injury

Globally, almost four and a half million people died from injury in 2019. Alcohol’s contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol’s causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.

How Does Selective Reporting Distort Understanding of Workplace Injuries?

This study introduces and applies a new method for studying under-reporting of injuries. This method, “one-to-one injury matching”, involves locating and comparing individual incidents within company and insurer recording systems. Using this method gives a detailed measure of the difference in injuries recognised as “work-related” by the insurer, and injuries classified as “recordable” by the company. This includes differences in the volume of injuries, as well as in the nature of the injuries. Applying this method to an energy company shows that only 19% of injuries recognised by the insurer were recognised by the company as recordable incidents. The method also demonstrates where claiming behaviour and claims management have created systematic biases in the disposition of incidents. Such biases result in an inaccurate picture of the severity and nature of incidents, over-estimating strike injuries such as to the hand, and underestimating chronic and exertion injuries such as to the back.