A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers

Abstract

Medical leaders have warned of the potential public health burden of a “parallel pandemic” faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 –March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., “I acted in ways that violated my own moral code or values”), but not perceived betrayal (e.g., “I feel betrayed by leaders who I once trusted”), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.

Injurious Memories from the COVID-19 Frontline: The Impact of Episodic Memories of Self- and Other-Potentially Morally Injurious Events on Romanian Nurses’ Burnout, Turnover Intentions and Basic Need Satisfaction

“…Participants were then asked to recall episodic memories of self- and other-PMIEs, according to the experimental condition to which they had been randomly assigned, after being presented with definitions and examples of the two constructs, as explained in Appendix A . Then, we administered the nine-item Moral Injury Events Scale (MIES) modified to assess PMIEs among healthcare workers during the COVID-19 pandemic [ 68 ] (e.g., “I acted in a way that violated my own moral code or values in this instance.”). The scale was tested and used on Romanian healthcare workers [ 6 ].…”

“…Answers ranged from 1—“Strongly Agree” to 6—“Strongly Disagree”. To assess whether memories were perceived as PMIEs, we dichotomized the total scores, with responses of “Moderately Agree” to “Strongly Agree” on any of the nine items coded as exposure to a PMIE [ 68 ], excluding participants not recalling PMIEs.…”

The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic Psychological Needs

“…Then, we administered the 9-item Moral Injury Events Scale (MIES) modified to assess PMIEs among healthcare workers during the COVID-19 pandemic [33] (e.g., "I acted in a way that violated my own moral code or values in this instance"). The scale was tested and used on Romanian healthcare workers [5].…”

“…Answers ranged from 1-"Strongly Agree" to 6-"Strongly Disagree". To assess whether memories were perceived as PMIEs, we dichotomized the total scores, with responses of "Moderately Agree" to "Strongly Agree" on any of the 9 items coded as exposure to a PMIE [33], excluding participants not recalling PMIEs.…”

Moral Injury and Recovery in Uniformed Professionals: Lessons From Conversations Among International Students and Experts

“…The toll of moral injury (MI) associated with making difficult moral decisions ( 10 , 11 ) is significant. Notably, facing and making difficult decisions can play a role in the development of post-traumatic stress disorder (PTSD) and MI - the persistent distress that individuals may develop when exposed to events that involve perpetrating or witnessing actions that violate one’s core beliefs ( 12 ), or experiencing betrayal ( 13 ).…”