A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19.

Priya-Lena Riedel,Barbara Juen,Vanessa Kulcar,Alexander Kreh,Angela Lieber

doi:10.3390/ijerph19031666

Abstract

Ethical dilemmas for healthcare workers (HCWs) during pandemics highlight the centrality of moral stressors and moral distress (MD) as well as potentially morally injurious events (PMIEs) and moral injury (MI). These constructs offer a novel approach to understanding workplace stressors in healthcare settings, especially in the demanding times of COVID-19, but they so far lack clear identification of causes and consequences. A scoping review of moral stressors, moral distress, PMIEs, and MI of healthcare workers during COVID-19 was conducted using the databases Web of Science Core Collection and PsycINFO based on articles published up to October 2021. Studies were selected based on the following inclusion criteria: (1) the measurement of either moral stress, MD, PMIEs, or MI among HCWs; (2) original research using qualitative or quantitative methods; and (3) the availability of the peer-reviewed original article in English or German. The initial search revealed n = 149,394 studies from Web of Science and n = 34 studies from EBSCOhost. Nineteen studies were included in the review. Conditions representing moral stressors and PMIEs as well as MD and MI as their potential outcomes in healthcare contexts during COVID-19 are presented and discussed. Highlighting MD and MI in HCWs during COVID-19 brings attention to the need for conceptualizing the impact of moral stressors of any degree. Therefore, the development of a common, theoretically founded model of MD and MI is desirable.

Highlights

Received: 15 December 2021Morally stressful events, potentially morally injurious events (PMIEs), moral distress (MD), and moral injury (MI) have drawn scholarly focus in the wake of the current pandemic and previous pandemics due to lack of resources and changes in nursing practice [1,2,3]
healthcare workers (HCWs) have been conceptualized as individuals who actively engage in the protection and the improvement of the health of society [24]
Scores of Moral Injury Symptoms Scale-Health Professional (MISS-HP) were positively correlated with depression (r = 0.44), anxiety (r = 0.41), low well-being(r = −0.50), and emotional exhaustion (r = 0.41); 41% of HCWs experience MI

Summary

Introduction

Potentially morally injurious events (PMIEs), moral distress (MD), and moral injury (MI) have drawn scholarly focus in the wake of the current pandemic and previous pandemics due to lack of resources and changes in nursing practice [1,2,3]. In previous pandemics, having to choose between the ethics of professional duties and one’s individual fundamental values presented morally distressing situations [4]. HCWs have been conceptualized as individuals who actively engage in the protection and the improvement of the health of society [24]. During the COVID-19 pandemic, HCWs have faced risks to patients’ lives as well as health risks to themselves. HCWs have been confronted with increased workloads and insufficient resources, such as time, in phases of rising infection rates. HCWs are confronted with fears of infecting

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