Moral Injury Awareness & Prevention in Healthcare Organizations: A Blueprint Informed by the COVID-19 Pandemic

Details

• Personal Author:
  Bertenthal D ; Griffin B ; Hysong S ; Maguen S ; McGrath S ; Mehlman H ; Purcell N ; Seal K ; Spetz J ; Usman H
• Description:
  Moral Injury Basics: Moral injury is lasting psychological and spiritual distress that stems from violating one's values or feeling betrayed by a trusted institution or authority. Moral injury is associated with posttraumatic stress (PTSD), depression, anxiety, substance use, functional impairments, and suicide risk. Healthcare workers whose jobs put them in high-stakes life-or-death situations, and who may experience intense and prolonged work stress, may be especially vulnerable to moral injury. Moral Injury Prevalence in VA: Morally distressing experiences that could lead to moral injury were reported by 39% of 2,004 surveyed VA healthcare workers in inpatient units, emergency rooms, and community living centers during the COVID-19 pandemic. The most common type of moral injury was betrayal-based moral injury: 30% of surveyed workers felt betrayed by healthcare leaders, coworkers, or others. Among the workers who reported potential moral injury, 79% reported burnout and 60% screened positive for posttraumatic stress (PTSD). Top 5 Causes of Moral Injury during the COVID-19 Pandemic - Interviewed healthcare workers identified these experiences as morally injurious: 1. Feeling betrayed or abandoned by healthcare leaders/managers whose decisions, actions, and/or inaction caused harm to them, their coworkers, or their patients. 2. Following hospital policies that violated their values, such as rules requiring isolation of critically ill patients from loved ones. 3. Feeling powerless to help patients who were suffering or dying. 4. Being unable to provide the standard of care that patients deserved due to inadequate staffing, inadequate time, or lack of supplies and other resources. 5. Feeling bound to deliver care that was futile and caused suffering. Top 5 Protective Factors that May Prevent Moral Injury - Moral injury may be less likely when the following are present in the workplace: 1. Community support: Distressing events are not faced alone, and responsibility is meaningfully shared. 2. Processing & debriefing: There is time and opportunity to process and discuss distressing events; there are breaks that allow for reflection and recovery. 3. Learning & making change: It is possible to make meaningful changes to the situation or environment and to address the factors that caused moral distress. 4. Leadership presence & communication: Leaders/managers are present and visible on the frontlines. Frontline workers feel heard and appreciated by leaders. 5. Shared risks and burdens: There is an effort to share major risks and burdens, and to meaningfully acknowledge workers who must carry more than their share. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Health Personnel Mental Health Nervous System Occupational Health Safety Stress, Psychological
• Keywords:
  Burnout COVID-19 Health Care Workers Job Stress Mental Health Post-traumatic Stress Disorder Psychological Effects PTSD Work Organization
• Publisher:
  Healthforce Center at UCSF
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Guidance
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-25
• NIOSHTIC Number:
  nn:20070037
• Citation:
  San Francisco, California: Healthforce Center at UCSF, 2024 Apr; :1-25
• Email:
  Natalie.Purcell@ucsf.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  Northern California Institute for Research and Education, San Francisco
• Peer Reviewed:
  False
• Start Date:
  20210901
• Source Full Name:
  Moral injury awareness & prevention in healthcare organizations: a blueprint informed by the COVID-19 pandemic
• End Date:
  20230831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d4a2b387b594b963b2b664e79ba1ad37f86771490a40f0f4faf58bececa4158fbb0366fc87c25464ad146cdf20ec01b701147fbc1bc09201b6e3e522a996aa97
• Download URL:
  https://stacks.cdc.gov/view/cdc/208339/cdc_208339_DS1.pdf
• File Type:
  [PDF - 1.84 MB ]