Navigating the contradiction: balancing patient care and caregiver protection. From heroes to victims

Abstract

The COVID emergency has accelerated professional and organizational transformations, prompting a re-signification of activity systems, routines, professional visions, concrete daily operations. An unforeseen scenario emerges, highlighting elements of uncertainty, fatigue, and discomfort, linked, on the one hand, to the challenge raised towards the professional identities of the various players, called to deal with the new organizational constraints, to reposition themselves in changing contexts. On the other hand, the challenge refers to the possibility to achieve a good balance between offering services aimed at the promotion and protection of health and, at the same time, to guarantee working safety and security conditions, in increasingly complex contexts in which tensions and contradictions coexist with reduction of resources and requests for more effective services. At risk is the possibility to cope with increasing situations of social conflicts (i.e. the no vax manifestations) and events such as those related to the aggressiveness of patients, the verbal and often physical aggression against the health professionals, exposed to the temptation to abandon work and devote oneself to something else. Tackling with patients taken in charge by the Services and with characteristics of aggressive behavior, decidedly above the sustainability thresholds (death threats; screams and insults; raids on the service; stalking; shadowing of operators, ... with situations of requesting emergency intervention by the police, which could only be limited to a light intervention in the absence of an explicit complaint against the person), generates understandable fears and dynamics of avoidance/expulsion. These are, more and more (even though not exclusively) at the basis of resignations and retirement from work. This is in evident contrast with the mission of the health service and therefore with the identification of personnel with the aim of taking care of every user with a need. Hence a situation of impasse (disenchantment/impotence/give up/avoidance), having to deal with balancing the threshold of the limit(boundary) and the limit(boundary) of the threshold, defining conditions of survival, of joint elaboration, of collective action agreed. The possibility of conceiving oneself as an emancipatory limit(boundary), avoiding fantasies of ‘expulsive killerage’ and ‘regulatory stiffening’, relies on a collective system alliance, capable of considering both realistic fears with respect to personal safety to be protected, and the elaboration of one's own defensive dynamics in the face of exposure to external aggression. At stake is the lacerating dilemma between the identification with a service that must take charge of the needs (whatever they may be) of a user/patient and, at the same time, with the need to protect one's own and others' (other patients) safety conditions to be able to fulfill the professional task to which one is called.