4,479
Views
32
CrossRef citations to date
0
Altmetric
Basic Research Article

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

‘Duele tu corazón’: experiencias de daño moral durante la pandemia de COVID-19 en trabajadores de la salud de primera línea

‘它伤了你的心’:在 COVID-19 疫情期间一线医护人员的道德伤害经历

ORCID Icon, , , , , , , , , , , , & show all
Article: 2128028 | Received 31 May 2022, Accepted 30 Aug 2022, Published online: 18 Oct 2022

References

  • Aiken, L. H., Sloane, D. M., Bruyneel, L., van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824–1830. https://doi.org/10.1016/S0140-6736(13)62631-8
  • Barnes, H. A., Hurley, R. A., & Taber, K. H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. The Journal of Neuropsychiatry and Clinical Neurosciences, 31(2), A4–103. https://doi.org/10.1176/appi.neuropsych.19020036
  • Bayerle, H., Ike, J., Logan, R., & Parker, R. (2022). Sophocles’ philoctetes and moral injury in the COVID-19 pandemic. Journal of Health Communication, https://doi.org/10.1080/10810730.2022.2054032
  • Bhaskar, R. (1994). Plato etc.: The problems of philosophy and their resolution. Verso
  • Best, J. (2021). Undermined and undervalued: How the pandemic exacerbated moral injury and burnout in the NHS. BMJ, 374, n1858. https://doi.org/10.1136/bmj.n1858
  • Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238
  • Bruce, C. R., Miller, S. M., & Zimmerman, J. L. (2015). A qualitative study exploring moral distress in the ICU team: The importance of unit functionality and intrateam dynamics. Critical Care Medicine, 43(4), 823–831. https://doi.org/10.1097/CCM.0000000000000822
  • Danermark, B., Ekström, M., Jakobsen, L., & Karlsson, J. C. (2002). Explaining Society: An Introduction to Critical Realism in the Social Sciences. Routledge.
  • Detert, J., Treviño, L., & Sweitzer, V. (2008). Moral disengagement in ethical decision making: A study of antecedents and outcomes. Journal of Applied Psychology, 93(2), 374–391. https://doi.org/10.1037/0021-9010.93.2.374
  • Epstein, E., & Delgado, S. (2010). Understanding and addressing moral distress. OJIN: The Online Journal of Issues in Nursing, 15(3). https://doi.org/10.3912/OJIN.Vol15No03Man01
  • Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual Behavioral Science, 6(4), 391–397. https://doi.org/10.1016/j.jcbs.2017.07.003
  • Fletcher, A. (2017). Applying critical realism in qualitative research: Methodology meets method. International Journal of Social Research Methodology, 20(2), 181–194. https://doi.org/10.1080/13645579.2016.1144401
  • French, L., Hanna, P., & Huckle, C. (2021). “If I die, they do not care”: U.K. National Health Service staff experiences of betrayal-based moral injury during COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001134
  • Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. The BMJ, 368, https://doi.org/10.1136/bmj.m1211
  • Greene, T., Harju-Seppänen, J., Adeniji, M., Steel, C., Grey, N., Brewin, C. R., Bloomfield, M. A., & Billings, J. (2021). Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19. European Journal of Psychotraumatology, 12(1), https://doi.org/10.1080/20008198.2021.1882781
  • Haller, M., Norman, S. B., Davis, B. C., Capone, C., Browne, K., & Allard, C. B. (2020). A model for treating COVID-19–related guilt, shame, and moral injury. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S174–S176. https://doi.org/10.1037/tra0000742
  • Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONN’s Clinical Issues in Perinatal and Women’s Health Nursing, 4(4), 542–551.
  • Jinkerson, J. (2016). Defining and assessing moral injury: A syndrome perspective. Traumatology, 22(2), 122–130. https://doi.org/10.1037/trm0000069
  • Kreh, A., Brancaleoni, R., Magalini, S. C., Chieffo, D. P. R., Flad, B., Ellebrecht, N., & Juen, B. (2021). Ethical and psychosocial considerations for hospital personnel in the Covid-19 crisis: Moral injury and resilience. PLoS ONE, 16(4 April), https://doi.org/10.1371/journal.pone.0249609
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9 validity of a brief depression severity measure.
  • Lamb, D., Gnanapragasam, S., Greenberg, N., Bhundia, R., Carr, E., Hotopf, M., Razavi, R., Raine, R., Cross, S., Dewar, A., Docherty, M., Dorrington, S., Hatch, S., Wilson-Jones, C., Leightley, D., Madan, I., Marlow, S., McMullen, I., Rafferty, A. M., … Wessely, S. (2021). Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: Initial baseline data from a cohort study collected during the first wave of the pandemic. Occupational and Environmental Medicine, 78(11), 801–808. https://doi.org/10.1136/oemed-2020-107276
  • Lamb, D., Greenberg, N., Hotopf, M., Raine, R., Razavi, R., Bhundia, R., Scott, H., Carr, E., Gafoor, R., Bakolis, I., Hegarty, S., Souliou, E., Rafferty, A. M., Rhead, R., Weston, D., Gnangapragasam, S., Marlow, S., Wessely, S., & Stevelink, S. (2021). NHS CHECK: Protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers. BMJ Open, 11(6), https://doi.org/10.1136/bmjopen-2021-051687
  • Lang, A. J., & Stein, M. B. (2005). An abbreviated PTSD checklist for use as a screening instrument in primary care. Behaviour Research and Therapy, 43(5), 585–594. https://doi.org/10.1016/j.brat.2004.04.005
  • Liberati, E., Richards, N., Willars, J., Scott, D., Boydell, N., Parker, J., Pinfold, V., Martin, G., Dixon-Woods, M., & Jones, P. B. (2021). A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic. BMC Psychiatry, 21(1), https://doi.org/10.1186/s12888-021-03261-8
  • Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
  • MacLeish, K. (2018). On ‘moral injury’: Psychic fringes and war violence. History of the Human Sciences, 31(2), 128–146. https://doi.org/10.1177/0952695117750342
  • Mantri, S., Song, Y. K., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Moral injury and burnout in health care professionals during the COVID-19 pandemic. The Journal of Nervous and Mental Disease, 209(10), 720–726. https://doi.org/10.1097/NMD.0000000000001367
  • Marvaldi, M., Mallet, J., Dubertret, C., Moro, M. R., & Guessoum, S. B. (2021). Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 126, 252–264. https://doi.org/10.1016/j.neubiorev.2021.03.024
  • Molendijk, T. (2018). Toward an interdisciplinary conceptualization of moral injury: From unequivocal guilt and anger to moral conflict and disorientation. New Ideas in Psychology, 51, 1–8. https://doi.org/10.1016/j.newideapsych.2018.04.006
  • Nash, W. P., Marino Carper, T. L., Alice Mills, M., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646–652. https://doi.org/10.7205/MILMED-D-13-00017
  • NHS Digital. (2021). NHS Workforce Statistics—September 2021. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/september-2021
  • NHS Staff Survey 2021 National results briefing. (2022).
  • Nieuwsma, J. A., O’Brien, E. C., Xu, H., Smigelsky, M. A., & Meador, K. G. (2022). Patterns of potential moral injury in post-9/11 combat veterans and COVID-19 healthcare workers. Journal of General Internal Medicine, https://doi.org/10.1007/s11606-022-07487-4
  • Ons.gov.uk. (2022). Deaths involving COVID-19 by month of registration, UK – Office for National Statistics. Retrieved July 28, 2022, from https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsinvolvingcovid19bymonthofregistrationuk/current
  • Patterson, J. E., Edwards, T. M., Griffith, J. L., & Wright, S. (2021). Moral distress of medical family therapists and their physician colleagues during the transition to COVID-19. Journal of Marital and Family Therapy, 47(2), 289–303. https://doi.org/10.1111/jmft.12504
  • Reith, T. P. (2018). Burnout in United States Healthcare professionals: A narrative review. Cureus, https://doi.org/10.7759/cureus.3681
  • Roberts, T., Hirst, R., Sammut-Powell, C., Reynard, C., Daniels, J., Horner, D., Lyttle, M. D., Samuel, K., Graham, B., Barrett, M. J., Foley, J., Cronin, J., Umana, E., Vinagre, J., Carlton, E., Kane L., Mackenzie L., Sharma Hajela S., Phizacklea J., … Vinagre J.(2021). Psychological distress and trauma during the COVID-19 pandemic: Survey of doctors practising anaesthesia, intensive care medicine, and emergency medicine in the United Kingdom and Republic of Ireland. British Journal of Anesthesia, 127(1), e78–e80. https://doi.org/10.1016/j.bja.2021.05.013
  • Rushton, C. H., Thomas, T. A., Antonsdottir, I. M., Nelson, K. E., Boyce, D., Vioral, A., Swavely, D., Ley, C. D., & Hanson, G. C. (2021). Moral injury and moral resilience in health care workers during COVID-19 pandemic. Journal of Palliative Medicine, https://doi.org/10.1089/jpm.2021.0076
  • Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182–191. https://doi.org/10.1037/a0036090
  • Sibeoni, J., Bellon-Champel, L., Mousty, A., Manolios, E., Verneuil, L., & Revah-Levy, A. (2019). Physicians’ perspectives about burnout: A systematic review and metasynthesis. Journal of General Internal Medicine, 34(8), 1578–1590. https://doi.org/10.1007/s11606-019-05062-y
  • Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder The GAD-7. https://jamanetwork.com/
  • Wang, Z., Harold, K. G., Tong, Y., Wen, J., Sui, M., Liu, H., Zaben, F. A., & Liu, G. (2021). Moral injury in Chinese health professionals during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, https://doi.org/10.1037/tra0001026
  • Wiegand, D. L. (2012). Consequences of clinical situations that cause critical care nurses to experience moral distress. Nursing Ethics, 19(4), 479–487. https://doi.org/10.1177/0969733011429342
  • Williamson, V., Stevelink, S., & Greenberg, N. (2018). Occupational moral injury and mental health: Systematic review and meta-analysis. The British Journal of Psychiatry, 212(6), 339--346. https://doi.org/10.1192/bjp.2018.55
  • Williamson, V., Murphy, D., Stevelink, S. A. M., Allen, S., Jones, E., & Greenberg, N. (2020). The impact of trauma exposure and moral injury on UK military veterans: A qualitative study. European Journal of Psychotraumatology, 11(1), 1704554. https://doi.org/10.1080/20008198.2019.1704554
  • Williamson, V., Lamb, D., Hotopf, M., Raine, R., Stevelink, S., Wessely, S., Docherty, M., Madan, I., Murphy, D., & Greenberg, N. (2022). Moral injury and psychological wellbeing in UK healthcare staff (p. 2022.06.16.22276476). medRxiv. https://doi.org/10.1101/2022.06.16.22276476
  • Zerach, G., & Levi-Belz, Y. (2021). Moral injury and mental health outcomes among Israeli health and social care workers during the COVID-19 pandemic: A latent class analysis approach. European Journal of Psychotraumatology, 12(1), https://doi.org/10.1080/20008198.2021.1945749
  • Zhizhong, W., Koenig, H. G., Yan, T., Jing, W., Mu, S., Hongyu, L., & Guangtian, L. (2020). Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry, 20(1), https://doi.org/10.1186/s12888-020-02954-w