“It hurts your heart”: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic
“It hurts your heart”: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic
Abstract BackgroundMoral injury is defined as the strong emotional and cognitive reactions following events which clash with someone’s moral code, values or expectations. During the COVID-19 pandemic, increased exposure to potentially morally injurious events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. ObjectiveWe sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. MethodsWe recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) (Nash et al., 2013) at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. ResultsHCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. ConclusionThese results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HighlightsClinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patientsHCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbanceMost HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress
Hegarty Siobhan、Bhundia Rupa、Doherty Mary Jane、Razavi Reza、Wessely Simon、Marie Anne、Greenberg Neil、Williamson Victoria、Hotopf Matthew、Stevelink Sharon A. M.、Lamb Danni、Dorrington Sarah、Scott Hannah R.、Raine Rosalind
Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreSouth London and Maudsley NHS Foundation TrustKing?ˉs Wellcome Trust EPSRC Centre For Medical EngineeringDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreFlorence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King?ˉs College LondonDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education Centre||Department of Experimental Psychology, Anna Watts Building, University of OxfordDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education Centre||South London and Maudsley NHS Foundation TrustDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreDepartment of Applied Health Research, University College LondonDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreDepartment of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King?ˉs College London, Weston Education CentreDepartment of Applied Health Research, University College London
医药卫生理论医学研究方法神经病学、精神病学
Moral injuryPotentially morally injurious eventsPMIEsMoral distressHealthcare workersNHSNational health serviceCOVID-19Qualitative
Hegarty Siobhan,Bhundia Rupa,Doherty Mary Jane,Razavi Reza,Wessely Simon,Marie Anne,Greenberg Neil,Williamson Victoria,Hotopf Matthew,Stevelink Sharon A. M.,Lamb Danni,Dorrington Sarah,Scott Hannah R.,Raine Rosalind.“It hurts your heart”: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic[EB/OL].(2025-03-28)[2025-05-29].https://www.medrxiv.org/content/10.1101/2022.06.17.22276433.点此复制
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