Top

Published in:

07-04-2023 | COVID-19 | ORIGINAL PAPER

The Perceptions of Healthcare Staff Regarding Moral Injury and the Impact on Staff Life and Work During COVID-19: A Scoping Review of International Evidence

Authors: Fiona J. G. Jack, Grigorios Kotronoulas

Published in: Journal of Religion and Health | Issue 4/2023

Abstract

The COVID-19 response introduced legal restrictions on social distancing globally, affecting healthcare staff personally and professionally. These restrictions suspended routine hospital visiting, which may have left staff feeling they had to compromise on the care they provided. Such conflict may be experienced as moral injury. This scoping review aimed to synthesise international evidence, to answer this question: “Have COVID-19 restrictions affected healthcare staff’s experiences of moral injury? If so, how?” Nine studies met the search criteria. Although healthcare staff seemed to be aware of the risks and effects of moral injury, they were still reluctant to “name” it. Healthcare staff’s own emotional and spiritual needs were mostly ignored. Although psychological support is often the recommended approach by organisations, a greater focus on spiritual and emotional support is recommended.

Available only for authorised users

Alexander, D. W. (2020). Walking together in exile: Medical moral injury and the clinical chaplain. Journal of Pastoral Care and Counseling, 74(2), 82–90. https://doi.org/10.1177/1542305020912263CrossRefPubMed

Alexander, M. (2021, April 12). NHS staff are suffering from ‘moral injury’, a distress usually associated with war zones. The Guardian. https://www.theguardian.com/commentisfree/2021/apr/12/nhs-staff-moral-injury-distress-associated-with-war-zones-pandemic

Alharbi, J., Jackson, D., & Usher, K. (2020). The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing, 29(15–16), 2762–2764. https://doi.org/10.1111/jocn.15314CrossRefPubMedPubMedCentral

Ames, D., Erickson, Z., Geise, C., Tiwari, S., Sakhno, S., Sones, A. C., Tyrrell, G., Mackay, R. B., Steele, W., Van Hoof, T., Weinreich, H., & Koenig, H. G. (2021). Treatment of moral injury in U.S. veterans with PTSD using a structured chaplain intervention. Journal of Religion and Health, 60, 3052–3060. https://doi.org/10.1007/s10943-021-01312-8CrossRefPubMed

Andrist, E., Clarke, R. G., & Harding, M. (2020). Paved with good intentions: Hospital visitation restrictions in the age of coronavirus disease. Pediatric Critical Care Medicine, 21(10), e924–e926. https://doi.org/10.1097/PCC.0000000000002506CrossRefPubMedPubMedCentral

Association for Pastoral Supervision and Education. (2021). Definition and ethos. https://www.pastoralsupervision.org.uk/definition-and-ethos

Borders, A. (2020). Beliefs, traits and motivations underlying rumination. In A. Borders (Ed.), Rumination and related constructs (pp. 239–277). Cambridge: Academic Press.CrossRef

Busfield, L. (2020). Listening on the outside—screaming on the inside: Reflections from an acute hospital chaplain during the first weeks of COVID-19. Health and Social Care Chaplaincy, 8(2), 218–222. https://doi.org/10.1558/hscc.41807CrossRef

Carey, L. B., & Hodgson, T. J. (2018). Chaplaincy, spiritual care and moral injury: Considerations regarding screening and treatment. Frontiers in Psychiatry, 9(619), 1–10. https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00619/full

Chandra, A., & Vanjare, H. (2020). Coping by the healthcare workers during COVID-19 pandemic in developing countries–a review. Anaesthesia, Pain and Intensive Care, 24(3), 346–353. https://doi.org/10.35975/apic.v24i3.1288CrossRef

Critical Appraisal Skills Programme. (2021). CASP checklists. https://casp-uk.net/casp-tools-checklists/

Davda, L., Gallagher, J., & Radford, D. (2018). Migration motives and integration of international human resources of health in the United Kingdom: Systematic review and meta-synthesis of qualitative studies using framework analysis. Human Resources for Health. https://doi.org/10.1186/s12960-018-0293-9CrossRefPubMedPubMedCentral

Dunford, D., Dale, B., Stylianou, N., Lowther, E., Ahmed, M., & de la Torre Arenas, I. (2020, April 7). Coronavirus: the world in lockdown in maps and charts. British Broadcasting Corporation. https://www.bbc.co.uk/news/world-52103747

Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual Behavioral Science, 6(4), 391–397. https://doi.org/10.1016/j.jcbs.2017.07.003CrossRef

Galek, K., Flannelly, K. J., Greene, P. B., & Kudler, T. (2011). Burnout, secondary traumatic stress, and social support. Pastoral Psychology, 60(5), 633–649. https://doi.org/10.1007/s11089-011-0346-7CrossRef

Ghebreyesus, T.A. (2020, March 11). WHO director-general's opening remarks at the media briefing on COVID-19–11 March 2020. World Health Organization. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ, 368, m1211. https://doi.org/10.1136/bmj.m1211CrossRefPubMed

Harding, M. (2021). Representation of women in the armed forces. UK Parliament, House of Commons Library. https://commonslibrary.parliament.uk/representation-of-women-in-the-armed-forces/

Hines, S. E., Chin, K. H., Glick, D. R., & Wickwire, E. M. (2021). Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the covid-19 pandemic. International Journal of Environmental Research and Public Health, 18(2), 1–11. https://doi.org/10.3390/ijerph18020488CrossRef

Hodgson, T. J., & Carey, L. B. (2017). Moral Injury and definitional clarity: Betrayal, spirituality and the role of chaplains. Journal of Religion and Health, 56(4), 1212–1228. https://doi.org/10.1007/s10943-017-0407-zCrossRefPubMed

Holm, N. (2009). Practising the ministry of presence in chaplaincy. Journal of Christian Education, 52, 29–42. https://doi.org/10.1177/002196570905200305CrossRef

Hossain, F., & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic. Nursing Ethics, 28(1), 23–32. https://doi.org/10.1177/0969733020961825CrossRefPubMed

Jameton, A. (2017). What moral distress in nursing history could suggest about the future of health care. American Medical Association Journal of Ethics, 19(6), 617–628. https://doi.org/10.1001/journalofethics.2017.19.6.mhst1-1706CrossRefPubMed

Judkins, S., & Eldridge, C. (2001). Let’s put “caring” back into healthcare. Journal of Nursing Administration, 31(11), 509–511.CrossRefPubMed

Kelly, E. (2019). Formation and the intentional use of self. In E. Kelly & J. Swinton (Eds.), Chaplaincy and the soul of health and social care: Fostering spiritual wellbeing in emerging paradigms of care. London: Jessica Kingsley Publishers.

Kennedy, H., & Kennedy, J. (2022). “It’s real, it’s much more real”: An exploration of values based reflective practice® as a reflective tool. Health and Social Care Chaplaincy, 10(1), 78–92. https://doi.org/10.1558/hscc.19832CrossRef

Kinsella Frost, C. (2019). Art in debrief: A small-scale three-step narrative inquiry into the use of art to facilitate emotional debriefing for undergraduate nurses. Journal of Research in Nursing, 24(3–4), 197–209. https://doi.org/10.1177/1744987118812539CrossRefPubMedPubMedCentral

Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., Haynes, K., Erickson, Z. D., Arnold, I., O’Garo, K., & Pearce, M. (2018). The Moral Injury Symptom Scale-Military Version. Journal of Religion and Health, 57(1), 249–265. https://doi.org/10.1007/s10943-017-0531-9CrossRefPubMed

Kwak, J., Rajagopal, S., Handzo, G., Hughes, B. P., & Lee, M. (2022). Perspectives of board-certified healthcare chaplains on challenges and adaptations in delivery of spiritual care in the COVID-19 era: Findings from an online survey. Palliative Medicine, 36(1), 105–113. https://doi.org/10.1177/02692163211043373CrossRefPubMed

Litz, B. T., Plouffe, R. A., Nazarov, A., Murphy, D., Phelps, A., Coady, A., Houle, S. A., Dell, L., Frankfurt, S., Zerach, G., & Levi-Belz, Y. (2022). Defining and assessing the syndrome of moral injury: Initial findings of the moral injury outcome scale consortium. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2022.923928CrossRefPubMedPubMedCentral

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003CrossRefPubMed

Lizarondo, L., Stern, C., Carrier, J., Godfrey, C., Rieger, K., Salmond, S., Apostolo, J., Kirkpatrick, P., & Loveday, H. (2020). Mixed methods systematic reviews. In E. Aromataris & Z. Munn (Eds.), JBI Manual for evidence synthesis. Adelaide: The Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-20-09CrossRef

Maben, J., Taylor, C., Reynolds, E., McCarthy, I., & Leamy, M. (2021). Realist evaluation of Schwartz rounds® for enhancing the delivery of compassionate healthcare: Understanding how they work, for whom, and in what contexts. BioMed Central Health Services Research, 21(1), 709. https://doi.org/10.1186/s12913-021-06483-4CrossRefPubMedPubMedCentral

Mantri, S., Lawson, J. M., Wang, Z., & Koenig, H. G. (2020). Identifying moral injury in healthcare professionals: The moral injury symptom scale-HP. Journal of Religion and Health, 59(5), 2323–2340. https://doi.org/10.1007/s10943-020-01065-wCrossRefPubMedPubMedCentral

Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel. A guide to designing interventions. Silverback Publishing.

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42CrossRefPubMedPubMedCentral

Microsoft. (2023). Excel. Microsoft Corporation https://www.microsoft.com/en-us/microsoft-365/excel

Musto, L., & Rodney, P. (2018). What we know about moral distress. In C. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 9–20). Cham: Springer. https://doi.org/10.1007/978-3-319-64626-8_2CrossRef

NHS England. (2021). NHS celebrates the vital role hundreds of thousands of women have played in the pandemic. https://www.england.nhs.uk/2021/03/nhs-celebrates-the-vital-role-hundreds-of-thousands-of-women-have-played-in-the-pandemic/

Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646–652. https://doi.org/10.7205/MILMED-D-13-00017CrossRefPubMed

Neville, S. (2021, June 15). ‘Undervalued’ nurses depart, leaving NHS with staffing shortage. Financial Times. https://www.ft.com/content/f2ace7d9-59ce-406c-9db6-a844e6806e05

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

Papazoglou, K., & Chopko, B. (2017). The role of moral suffering (moral distress and moral injury) in police compassion fatigue and PTSD: An unexplored topic. Frontiers in Psychology, 8, 1999. https://doi.org/10.3389/fpsyg.2017.01999CrossRefPubMedPubMedCentral

Paterson, M. (2019). Discipled by praxis: Soul and role in context. Practical Theology, 12(1), 7–19. https://doi.org/10.1080/1756073X.2018.1562689CrossRef

Rokach, A. (2019a). The loneliness of clinicians. In A. Rokach (Ed.), The psychological journey to and from loneliness (pp. 237–244). Cambridge: Academic Press. https://doi.org/10.1016/B978-0-12-815618-6.00010-2CrossRef

Rokach, A. (2019b). Addressing loneliness. In A. Rokach (Ed.), The psychological journey to and from loneliness (pp. 245–272). Cambridge: Academic Press. https://doi.org/10.1016/B978-0-12-815618-6.00011-4CrossRef

Rose, L., Cook, A., Casey, J., & Meyer, J. (2020). Restricted family visiting in intensive care during COVID-19. Intensive and Critical Care Nursing, 60, 102896. https://doi.org/10.1016/j.iccn.2020.102896CrossRef

Royal College of Nursing. (2015). Stress and you: a guide for nursing staff. https://www.rcn.org.uk/professional-development/publications/pub-004966

Schwartz, R., Sinskey, J. L., Anand, U., & Margolis, R. D. (2020). Addressing postpandemic clinician mental health: A narrative review and conceptual framework. Annals of Internal Medicine, 173(12), 981–988. https://doi.org/10.7326/M20-4199CrossRefPubMed

Scottish Government. (2020). Staff wellbeing and support: employers' duty of care during COVID-19 pandemic. Scottish Government Health Workforce Division. https://www.sehd.scot.nhs.uk/dl/DL(2020)08.pdf

Scottish Government .(2022). Health and social care—staff experience: report 2021. Health Workforce Directorate. https://www.gov.scot/publications/health-social-care-staff-experience-report-2021/pages/20/

Seton, J. (1775). To Dr. Joseph Priestly. In The London review of English and foreign literature, p. 527–531

Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182–191. https://doi.org/10.1037/a0036090CrossRef

Snowden, A. (2021). What did chaplains do during the COVID pandemic? An international survey. Journal of Pastoral Care & Counseling, 75(Suppl 1), 6–16. https://doi.org/10.1177/1542305021992039CrossRef

Stirling, I. (2020). COVID-19. The call of Louisa Jordan: The formation of the spiritual care team at NHS Louisa Jordan, Glasgow Scotland. Health and Social Care Chaplaincy, 9(2), 154–174. https://doi.org/10.1558/hscc.42420CrossRef

Temple, S. (2019, May 12). Word clouds are lame. Towards Data Science. https://towardsdatascience.com/word-clouds-are-lame-263d9cbc49b7

Ulrich, C. M., & Grady, C. (2018). Introduction. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 1–7). Cham: Springer. https://doi.org/10.1007/978-3-319-64626-8_1CrossRef

Van Emmerik, A. A. P., Kamphuis, J. H., & Hulsbosch, A. M. (2002). Single session debriefing after psychological trauma: A meta-analysis. Lancet, 360(9335), 766–771. https://doi.org/10.1016/S0140-6736(02)09897-5CrossRefPubMed

Vandenhoeck, A., Holmes, C., Desjardins, C. M., & Verhoef, J. (2021). “The most effective experience was a flexible and creative attitude"—reflections on those aspects of spiritual care that were lost, gained, or deemed ineffective during the pandemic. Journal of Pastoral Care & Counseling, 75(Suppl 1), 17–23. https://doi.org/10.1177/1542305020987991CrossRef

Waugh, W., Lethem, C., Sherring, S., & Henderson, C. (2017). Exploring experiences of and attitudes towards mental illness and disclosure amongst health care professionals: A qualitative study. Journal of Mental Health, 26(5), 457–463. https://doi.org/10.1080/09638237.2017.1322184CrossRefPubMed

Wiklund Gustin, L., & Wagner, L. (2013). The butterfly effect of caring–clinical nursing teachers’ understanding of self-compassion as a source to compassionate care. Scandinavian Journal of Caring Sciences, 27(1), 175–183. https://doi.org/10.1111/j.1471-6712.2012.01033.xCrossRefPubMed

Zajonc, R. B. (1980). Feeling and thinking–preferences need no inferences. American Psychologist, 35(2), 151–175. https://doi.org/10.1037/0003-066X.35.2.151CrossRef

Zhizhong, W., Koenig, H. G., Yan, T., Jing, W., Mu, S., Hongyu, L., & Guangtian, L. (2020). Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BioMed Central Psychiatry, 20, 556–566. https://doi.org/10.1186/s12888-020-02954-wCrossRefPubMedPubMedCentral

Title: The Perceptions of Healthcare Staff Regarding Moral Injury and the Impact on Staff Life and Work During COVID-19: A Scoping Review of International Evidence
Authors: Fiona J. G. Jack
Grigorios Kotronoulas
Publication date: 07-04-2023
Publisher: Springer US
Keywords: COVID-19
Burnout Syndrome
Published in: Journal of Religion and Health / Issue 4/2023
Print ISSN: 0022-4197
Electronic ISSN: 1573-6571
DOI: https://doi.org/10.1007/s10943-023-01803-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Perceptions of Healthcare Staff Regarding Moral Injury and the Impact on Staff Life and Work During COVID-19: A Scoping Review of International Evidence

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2023

“The First Person They Call is Their Pastor”: The Role of New York City Faith Leaders in Supporting Their Congregation’s Health and Well-Being During COVID-19

Investigating the Relationship Between Spiritual Health, Meaning in Life, and Death Attitudes among COVID-19 Patients Discharged from ICUs: A Cross-Sectional Study in Iran

Australian Catholics’ Lived Experiences of COVID-19 Church Closures

An Examination of Culturally Relevant Health Messages in African-American Churches

Spirituality in Critical Care: An Observational Study of the Perceptions of Professionals, Patients and Families, in Spain and Latin America

The Need for Integration of Religion and Spirituality into the Mental Health Care of Culturally and Linguistically Diverse Populations in Australia: A Rapid Review