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Disclosures: Song reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
December 01, 2021
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Health care workers faced moral injury during pandemic

Disclosures: Song reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Health care professionals experienced fear of infection, short staffing and inadequate protective equipment during the pandemic in 2020, resulting in emotional distress, according to results of a qualitative study published in JAMA Network Open.

Ye Kyung Song

“We reported in a previously published study that moral injury had increased during the pandemic,” Ye Kyung Song, MD, PhD, of the department of psychiatry and behavioral sciences at Duke University Medical Center in North Carolina, told Healio Psychiatry. “We hoped to better understand through the participants' self-reported experiences why this was the case. Through the stories our participants shared, it became clear that moral injury was more than just someone being forced to act against their own moral code, but rather, we had to take morally injurious work environments into consideration as well.”

In the current study, Song and colleagues examined the potential factors that correlated with moral injury among health care professionals who helped care for patients during the COVID-19 pandemic in 2020, before vaccine availability. They defined moral injury as “emotional distress resulting from events or transgressive acts that create dissonance within one’s very being due to a disruption or violation of their existential orientation and values system.”

They recruited health care professionals to answer a survey in two phases of 5 weeks each: April 24, 2020, to May 30, 2020 (phase one; n = 335; 86% women), and October 24, 2020, to Nov. 30, 2020 (phase two; n = 1,009; 90.5% women). They received responses from 1,831 individuals on demographic questions and assessments for moral injury, intrinsic religiosity and burnout. Among these participants, 1,344 answered open-ended questions. As the exposure, the researchers used working in a patient care setting during the COVID-19 pandemic before vaccine availability. Dominant emotions and common stressors linked to moral injury, identified via inductive thematic analysis of open-response survey answers, served as main outcomes and measures.

Phase one participants were mostly nurses, physicians, advanced practice practitioners and chaplains. Phase two participants were mostly nurses, physicians and advanced practice practitioners. Health care professionals experienced a variety of stressors, including fear of contagion, stigmatization, short-staffing and inadequate personal protective equipment. They experienced emotions including fear in phase one, followed by fatigue in phase two; isolation and alienation; and betrayal.

“We frame moral injury as a result of work environments and by doing so, we thus call upon leadership to identify and address these stressors to effectively support health care professionals materially, mentally and emotionally,” Song said.