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

Abstract

Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someones moral code, values or expectations. During the COVID-19 pandemic, increased exposure to potentially morally injurious events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) (Nash et al., 2013) at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement.

The effect of the COVID-19 pandemic on health-care workers

“…Frontline health-care workers from several countries participating in qualitative research are also reporting experiences of stress, burnout, moral injury, and vicarious traumatisation. 6 , 7 Despite these experiences not being classified as mental disorders, they are often associated with the onset of mental health problems and incur a considerable mental health burden on those affected. 8 Although understandably outside of the remit of the study by Scott and colleagues, it is crucial for future research to investigate and quantify these experiences.…”