An Upstate Collaborative Chronicles Moral Distress in 'Non-Essential' Healthcare Workers

Sep 11, 2020

Ann Blair Kennedy is a co-founder of Project COPE, which seeks to chronicle the experiences of healthcare workers on (and not on) the frontlines of the coronavirus pandemic.
Credit Scott Morgan / South Carolina Public Radio

The mental health crisis among healthcare workers in the pandemic is, in large part, one of moral crisis.  

We’ve reported on the emotional toll COVID-19 can take on frontline healthcare workers. But what about the toll it’s taking on professionals at the further reaches of the healthcare continuum?

While dentists and physical therapists and massage therapists and the like may be spared the visceral suffering COVID patients experience, they were unflatteringly relabeled as “non-essential” at the beginning of the outbreak. The reason: They had no immediate value in an emergency.

At least that’s how it felt, as a team of researchers from around South Carolina is finding out. By asking these non-critical care professionals what they’re experiencing, the team is learning that these sidelined professionals are trying to process what amounts to moral distress.

Moral distress, says Chloe Wilson, is what happens when someone knows the right thing to do but is prevented from doing it. In the pandemic, that prevention has come from the medical establishment itself. So the dilemma is that a range of healthcare professionals, from optometrists to pharmacists to chiropractors, want to be able to help, but have been told they have no seat at the table.

Wilson, a Clemson doctoral student specializing in moral distress and occupational health psychology, is part of Project COPE – “Chronicling healthcare prOviders' Pandemic Experiences,” as it is written – which seeks to learn how healthcare workers not necessarily on the frontlines of the pandemic are dealing with their experiences, or lack thereof.

The project’s main co-founders are Ann Blair Kennedy, a clinical assistant professor at the University of South Carolina School of Medicine in Greenville and longtime massage therapist, and Smith Heavner-Sullivan a registered nurse who specialized in ER care but who is now a researcher and doctoral student in applied health and evaluation at Clemson. COPE is a collaboration between Clemson, Prisma Health, the University of South Carolina, Furman University, and Appalachian Regional Healthcare System.

It’s a hard concept to grasp in real time, but it’s all right to be upset by upsetting things.

Fundamentally, COPE is striving to collect and share the experiences of healthcare workers and students, whether they’re on the frontlines or not. Since March, the project has received input from almost 900 healthcare workers in 13 countries across 20 distinct medical fields. It has also received about 150 videos, most around three minutes or so, from participants chronicling their days in the pandemic.

Data collected is not yet available to the public (or the press), but it is being shared among healthcare colleagues far and wide. The researchers say the aim is simple – collect and share healthcare workers’ experiences so that no matter where they fall on the professional continuum, they know they’re not alone.

That sense of isolation in crisis is a real – and heavy – thing. Kennedy says that something this pandemic has brought out is a better understanding of the need we all have to connect with other people – not to mention the value of hearing someone in your field say that they don’t feel great about what’s going on.

“I’m seeing that people are more willing to listen now to, you’re not necessarily expected to always be fine,” she says.

Back in March, when healthcare students were unceremoniously let out of school with everyone else, one asked Kennedy how she was doing. She answered that she has good days and bad, and today wasn’t a good one.

“And he just came back with, ‘Thank you for not telling me that everything is sunshine and roses, because it’s not,’” she says. “And I’m seeing more and more people acknowledge that.”

It’s a hard concept to grasp in real time, but it’s all right to be upset by upsetting things; and this is much of the point behind Project COPE. It’s designed to be real, warts and all – which is, the researchers say, surprisingly helpful in staving off the feelings of inadequacy and guilt so commonly found in healthcare workers these days.

Heavner-Sullivan says the connection respondents are getting through the project also helps the frontline workers, the ones who have not been spared the visceral suffering of COVID patients, hold onto precious cargo – their humanity.

“You have to hold onto that piece of recognizing how big of a difference you make for someone,” he says.

That’s coming from a guy who has held the hands of dying patients who’ve thanked him for simply being there, for giving them pain medicine as they slipped away, for being company and comfort at the end of their lives. And from a guy who’s been the target of railing patients angry that they’re not going to make it.

So to say it can be a hard job that can try to take healthy bites out of you is an understatement. But the Rx for these medical and healthcare workers, whether their job is to hold your hand or work the stress out of your muscles, is communication.

Project COPE is still running and still looking for more input from healthcare professionals. More information is available by clicking here.

And don’t forget to listen to the story by clicking the play button below.

This story is part of a multi-story look at mental health among healthcare workers in the pandemic. Other installments include a look at the human toll COVID can take on frontline emergency care workers and some perspective from a doctor who survived Sierra Leone's Ebola crisis six years ago

Scott Morgan is the Upstate Multimedia Reporter for South Carolina Public Radio. Follow Scott on Twitter @ByScottMorgan. And follow South Carolina Public Radio @SCPublicRadio, and on Facebook.