Morally Distressing Experiences, Moral Injury, and Burnout in Florida Healthcare Providers during the COVID-19 Pandemic

Abstract

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.

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

“…Healthcare workers from all medical specialties were faced with dramatic pressures to ensure proper patient care, with officials asking the EU for help with medical supplies and the relocation of surgeries, through the EU Civil Protection Mechanism [ 4 ]. This type of crisis was shown to be a fertile ground for potentially morally injurious events (PMIEs) [ 5 , 6 , 7 , 8 , 9 ].…”

Increased Autonomic Reactivity and Mental Health Difficulties in COVID-19 Survivors: Implications for Medical Providers

“…Interventions should be implemented in the workplace to encourage resilience and psychological wellbeing through the employment-related services and social/emotional support ( 52 ). This is a promising avenue for individuals working in healthcare because prior research shows that healthcare providers who do not feel supported by their leadership in the workplace are more likely to experience exhaustion and disengagement ( 29 ). Thus, integrating interventions into their workplace environments may alleviate some of the stressors that contribute to dysregulation, which is essential when considering the vital role that healthcare providers play during this time.…”

“…One study found significantly higher rates of anxiety about spreading the virus to loved ones, mental exhaustion, and posttraumatic stress symptoms in healthcare workers placed in the COVID-19 unit compared to healthcare workers in other units ( 28 ). Another study found high rates of moral injury in healthcare providers that were related to how much COVID-19 impacted their work life, concerns about COVID-19 protective equipment, and how supported they felt by their administrative leadership ( 29 ).…”

The ‘Myth of Zero-COVID’ Nation: A Digital Ethnography of Expats’ Survival Amid Shanghai Lockdown during the Omicron Variant Outbreak

“…Additionally, during the time of the COVID-19 pandemic, numerous medical staff and healthcare providers have been making collective efforts to support patients and normalize the explosive chain of lethal transmission. Despite their endeavors, they often face job burnout and moral injury that could harm their professionalism such as righteousness, knowledge, and ethical behaviors upon dominant ideology and social norms [ 15 ]. Our study identified the adaptive nature of humans, even with different cultural values to survive and overcome the unexpected socio-ecological system crisis.…”

“…Moreover, exploring the nexus between anxiety and coping during a lockdown can increase our understanding of the perceived impact and wrong information sources, which can accelerate the level of emotional unrest, especially social media effects on ordinary people [ 14 ]. It is also crucial to pay close attention to potential moral injury that could influence job burnout during a long-term pandemic time; medical professionals, healthcare providers, and community volunteers can face a moral dilemma, “when one is aware of the right thing to do but is unable to do so because of occupational constraints” [ 15 ]. From these perspectives, the current study expands on previous scholars’ claims about the importance of host nation citizens at a time when expats feel confused and uncertain about their life changes.…”