Moral injury in secure mental healthcare part II: experiences of potentially morally injurious events and their relationship to wellbeing in health professionals in secure services

Morris, Deborah; Webb, Elanor Lucy; Devlin, Perry

doi:10.1080/14789949.2022.2111319

Cited by 8 publications

(15 citation statements)

References 46 publications

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“…The PRISMA flowchart delineates the review process (see figure 1). Of the 81 full texts included in the review,6 12–21 43–112 some reported multiple studies in the same paper, so there were 88 separate studies included in the review. Of these, six reported prevalence estimates or average scores that could not be pooled, so they were included in the narrative synthesis only.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Brennan,

Roberts,

Cole

2024

BMJ Open

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ObjectivesOccupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation.DesignA systematic review and meta-analysis.Data sourcesGoogle Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022.Eligibility criteria for selecting studiesObservational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location.Data extraction and synthesisTwo independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews.ResultsIn total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%.ConclusionExposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces.PROSPERO registration numberCRD42020191766.

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Section: Resultsmentioning

confidence: 99%

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Brennan,

Roberts,

Cole

2024

BMJ Open

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“…Restrictive practices are more frequently used in forensic mental health compared to mainstream mental health services (Flammer et al, 2020) and have been associated with nurses' experiences of emotional and psychological distress (Power et al, 2020) and physical injuries (Renwick et al, 2016). Nurses caring for patients who self‐harm are therefore at increased risk of generalized stress response, negatively impacting their well‐being from an accumulative effect of exposure to traumatic events and increased use of risk‐adverse, controlling practices (Morris et al, 2022). Maladaptive coping strategies, such as increased alcohol consumption and changes to diet/eating patterns, in response to accumulative exposure to traumatic events and use of restrictive practices may also affect nurses' physical health (Mistry et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

“…Nurses caring for patients who self-harm are therefore at increased risk of generalized stress response, negatively impacting their well-being from an accumulative effect of exposure to traumatic events and increased use of risk-adverse, controlling practices (Morris et al, 2022). Maladaptive coping strategies, such as increased alcohol consumption and changes to diet/eating patterns, in response to accumulative exposure to traumatic events and use of restrictive practices may also affect nurses' physical health (Mistry et al, 2022).…”

Section: Impact Of Exposure To Patient Aggressionmentioning

confidence: 99%

“…Importantly, exposure to patient aggression negatively impacts the mental and physical health of forensic mental health nurses, including psychological distress in the form of anxiety (Lee et al, 2015; van Leeuwen & Harte, 2017), PTSD symptoms (Ireland et al, 2021; Jankovic et al, 2021; van Leeuwen & Harte, 2017), poor subjective well‐being including stress and burnout (Ireland et al, 2021; Kobayashi et al, 2020; van Leeuwen & Harte, 2017) and moral injury (Morris et al, 2022). Of concern, around a third of forensic mental health nurses experience clinical levels of general distress (Lee et al, 2015), with 17%–22% meeting criteria for a PTSD diagnosis (Ireland et al, 2021; Lee et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross‐sectional survey

Newman,

Roche,

Elliott

2023

Journal of Advanced Nursing

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AimsThe aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences.DesignCross‐sectional survey conducted January to April 2020.MethodsAll 205 nurses working in an Australian high‐security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF‐36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored.ResultsSixty‐eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self‐harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non‐acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self‐harming behaviour was associated with poorer physical health.ConclusionsNurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well‐being. Nurses who are victim of, or witness, physical violence are most likely to take time off work.ImpactThis study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses.No patient or public contribution.

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“…Participants and procedure The current study utilised data collected from staff working in healthcare settings, in either a patient-facing frontline position (Morris et al, 2022) or in a senior leadership role, for two separate studies utilising overlapping measures.…”

Section: Moral Injury and Mental Healthcare Staffmentioning

confidence: 99%

The differential and accumulative impacts of self and other sources of moral injury on well-being in mental healthcare staff

Webb,

Morris,

Lupattelli Gencarelli

et al. 2024

IJWHM

Self Cite

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PurposeResearch has established the prevalence and relevance of moral injury in healthcare workers, though less attention has been paid to the different classes of potentially morally injurious events (PMIEs) experienced by this population and their impact. This exploratory study sought to examine the frequency of self- and other-generated PMIE classes and their associations with demographic characteristics and well-being outcomes among mental healthcare staff.Design/methodology/approachSecondary analysis of data drawn from two cross-sectional surveys of 267 frontline and leadership staff from mental healthcare settings in the UK was conducted. Responses on the Moral Injury Events Scale and the Short Professional Quality of Life Scale were extracted for analysis.FindingsBetrayal by others was most frequently endorsed (61.8%), whilst self-transgressions were least frequently reported (25.5%). After controlling for the number of PMIE classes experienced, betrayal significantly predicted secondary traumatic stress (p = 0.01) and burnout (p = 0.04). Additionally, other transgressions significantly predicted secondary traumatic stress (p = 0.008). The predictive effects of self-transgressions on burnout, secondary traumatic stress and compassion satisfaction were all nonsignificant after controlling for the number of PMIE classes experienced.Practical implicationsFindings highlight differences in the frequency and impact of self and other PMIEs experienced by healthcare professionals. Reducing cumulative exposure to differential PMIE classes appears to be of critical importance to improving occupational well-being in this group.Originality/valueTo our knowledge, this study is the first to explore the associations between PMIE classes and occupational well-being in a mental healthcare population, inclusive of frontline and leadership staff.

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Moral injury in secure mental healthcare part II: experiences of potentially morally injurious events and their relationship to wellbeing in health professionals in secure services

Cited by 8 publications

References 46 publications

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross‐sectional survey

The differential and accumulative impacts of self and other sources of moral injury on well-being in mental healthcare staff

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