Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis: Developing a Blueprint for Awareness, Prevention, and Mitigation

Details

• Personal Author:
  Purcell NJ
• Description:
  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 post-traumatic 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. Using a combination of quantitative and qualitative methods, we examined drivers of risk for moral injury, mental health symptoms, and burnout among frontline healthcare workers in high-risk Veterans Affairs (VA) clinical settings during the COVID-19 pandemic. Across 21 VA medical centers, 2,004 healthcare workers completed an online survey assessing potential risk factors for moral injury, posttraumatic stress, depression, and burnout. These potential risk factors included: pandemic exposures and events; individual worker characteristics; aspects of workplace/organizational culture; and facility-level performance on standardized measures of care quality, patient satisfaction, and employee satisfaction. Forty-six surveyed workers also completed a follow-up qualitative interview about experiences of moral distress in the workplace. We found that 39% of surveyed workers were at risk for moral injury, 41% for posttraumatic stress, 27% for depression, and 25% for persistent burnout. Significant predictors of moral injury risk included perceived management support for worker health/safety, supervisor support, coworker support, and empowerment to make job-related decisions-all modifiable workplace factors. Pandemic-related risk factors for moral injury included prolonged short-staffing, denying patient-family visits, and high work-family conflict. Predictors of posttraumatic stress, depression, and burnout were similar. Interview themes aligned closely with survey findings. Qualitative analysis identified protective factors that may reduce moral injury risk, including a collaborative workplace community, engaged leadership, empowerment to make changes in the workplace, and opportunity to process distressing events. Recommendations to mitigate moral injury risk in healthcare organizations stemming from this project include: involving workers in discussions of high-stakes decisions that will affect them, creating consistent and clear channels of communication between the frontlines and leaders of the organization, practicing leadership rounding to improve leaders' understanding of the daily work of frontline teams, and collaborating to understand how existing processes and policies may contribute to safety risks and moral conflict. [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-family Conflict Work Organization
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-21
• NIOSHTIC Number:
  nn:20070036
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-012201, 2024 Jul; :1-21
• Contact Point Address:
  Natalie J. Purcell, PhD, Northern California Institute for Research and Education, 4150 Clement Street (151-NC), San Francisco, CA 94121
• Email:
  natalie.purcell@va.gov
• Federal Fiscal Year:
  2024
• Performing Organization:
  Northern California Institute for Research and Education, San Francisco
• Peer Reviewed:
  False
• Start Date:
  20210901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20230831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:965fdae8d76dbcae70db07f4fe60e54067de3a34148aff7f47ffc0ed9d654628651166e0bf6efba825202584dab3ed765d584c147fe7fb5d7b6152770ca1cd9f
• Download URL:
  https://stacks.cdc.gov/view/cdc/219270/cdc_219270_DS1.pdf
• File Type:
  [PDF - 1.72 MB ]