‘It hurts your heart’: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic

Figures & data

Table 1. Demographic characteristics of sample (n = 30).

		Qualitative study sample	NHS CHECK full cohort	NHS in England
Sex
	Male	10 (33.3%)	4,300 (18.6%)	23%
	Female	20 (66.7%)	18,673 (80.1%)	77%
Occupation
	Nurse	15 (50%)	5,680 (37.9%)	26%
	Doctor	2 (6.7%)	1,736 (11.6%)	10%
	Occupational Therapist	1 (3.3%)	730 (4.9%)	46%
	Speech and Language Therapist	1 (3.3%)	305 (2.0%)
	Psychological Therapist	3 (10%)	1,615 (10.8%)
	Radiographer	1 (3.3%)	236 (1.6%)
	Physiotherapist	1 (3.3%)	485 (3.2%)
	Pharmacist/Pharmacy Technician	3 (10%)	421 (2.8%)
	Midwife	1 (3.3%)	284 (1.9%)
	Healthcare Assistant	2 (6.7%)	1,861 (12.4%)
Ethnicity
	White	18 (60%)	19,732 (85.6%)	78%
	Asian	6 (20%)	1,527 (6.6%)	22%
	Black	2 (6.7%)	1,004 (4.4%)
	Mixed	3 (10%)	566 (2.5%)
	Other	1 (3.3%)	217 (0.9%)
Mental Health Status^a
	GAD-7 case (≥10)	10 (33.3%)	2,205 (22.2%)	N/A
	PHQ case (≥10)	14 (46.7%)	2,553 (25.8%)
	PCL case (≥14)	14 (46.7%)	3,456 (32.2%)
	No to mild symptoms^b	14 (46.7%)	5,536 (56.9%)
PMIE exposure type
	Omission	16 (53.3%)	1,459 (14.7%)	N/A
	Commission	9 (30%)	491 (5.0%)
	Betrayal	24 (80%)	2,167 (22.0%)

^aCan meet threshold for >1 probable mental health condition. In total 53.34% of participants met criteria for any mental disorder, including 2 (6.7%) of participants who met criteria for one, 6 (20%) of participants met criteria for two, and 8 (26.7%) who met criteria for three mental disorders.

^b No to mild symptoms indicates scoring 0–4 on PHQ-9, 0–4 on GAD-7, and 6–9 on PCL-6.

Table 2. Themes and sub-themes.

1. Ill-equipped and under-supported to respond to crisis

i. Feeling betrayed by the government

ii. Systemic issues within the NHS

iii. Strained working relationships with management

2. Feeling unable to fulfil one’s duty of care to patients

3. Avoiding moral dissonance

4. Psychological toll of PMIEs

i. Anger and guilt

ii. Disillusionment with NHS

iii. Deteriorating mental health

5. Adaptively managing moral distress

i. Resolution of moral distress

Data availability statement

The data that support the findings of this study are available from the corresponding author (NG), upon reasonable request. The data have not been made publicly available due to the personal and sensitive content of participants’ experiences.