News: COVID-19 pandemic inflicts moral injury on healthcare professionals, study shows

A study published by the Journal of the American Medical Association (JAMA) shows that healthcare professionals on the frontlines of the COVID-19 pandemic experienced significant levels of moral injury, HealthLeaders reported.

“Moral injury is 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,” study authors wrote. Additionally, moral injury has been associated with clinician burnout, medical errors, and suicidal thoughts, the study notes.

The study is based on data collected from 1,300 healthcare professionals in 2020 before COVID-19 vaccines were available. The study was conducted in two phases, one from April 24 to May 30, 2020, and the second from October 24 to November 30, 2020. Survey respondents included nurses, physicians, advanced practice practitioners, and chaplains answering open-ended questions such as “What has been your greatest source of fear during the pandemic?”

Several key findings were revealed in the study:

• Stressors during the first year of the pandemic included fear of contagion, stigmatization, short-staffing, and inadequate PPE
• Fear was the primary emotion experienced in the first phase of the study
• Fatigue was the primary emotion experienced in the second phase of the study
• Survey respondents reported feeling isolated from non-healthcare professionals
• Respondents reported feeling alienated from patients
• Survey respondents reported feeling betrayed by coworkers, administrators, and the public

The findings suggest that the moral injury experienced injury was not only experienced after a single moral dilemma, but also from working in morally injurious environments, HealthLeaders reported. Study authors wrote “these experiences can serve as potential starting points for organizations to engender and enhance organizational and individual recovery, team building, and trust. System-level solutions that address shortages in staffing and personal protective equipment are needed to promote healthcare professionals’ well-being.”

The shift of healthcare professionals’ primary emotions from fear in the first phase to fatigue in the second phase is particularly noteworthy. According to the study, fears during the first phase were predominantly associated with catching COVID-19 and becoming ill or spreading it. Some participants noted fear of COVID-19 transmission to higher risk people, such as those who are pregnant or have medical comorbidities. Additionally, the availability and effectiveness of PPE equipment was another source of fear during the first study phase.

The emotion of fear shifted to one of fatigue with the second phase of the study, noting that “most participants stated that as there was more knowledge about COVID-19, there was a decrease in fear: they were ‘over it’ and experiencing ‘COVID fatigue.’ There was also resignation around adapting to the ‘new normal.’ ”

In the first phase of the study, the lack of PPE fed a sense of betrayal among some survey respondents, noting they felt their lives were more disposable than their PPE was. Some respondents still felt betrayed over PPE by phase two, saying that they simply have gotten better at protecting themselves, but their hospital doesn’t do much for them, HealthLeaders reported.

The feeling of betrayal came from several sources, with study authors writing “healthcare professionals felt betrayed and unsupported by management, administrators, institutions, the healthcare system more broadly, and the government. Many pointed to a disconnect between leadership and ‘those of us doing the hard work.’”

Editor’s note: This article was originally published by HealthLeaders. Additional ACDIS coverage of COVID-19 can be found here.