Abstract
The COVID-19 pandemic has resulted in a still-unfolding series of novel, potentially traumatic moral and ethical challenges that place many healthcare workers at risk of developing moral injury. Moral injury is a type of psychological response that may arise when one transgresses or witnesses another transgress deeply held moral values, or when one feels that an individual or institution that has a duty to provide care has failed to do so. Despite knowledge of this widespread exposure, to date, empirical data are scarce as to how to prevent and, where necessary, treat COVID-19-related moral injury in healthcare workers. Given the relation between moral injury and post-traumatic stress disorder (PTSD), we point here to social and interpersonal factors as critical moderators of PTSD symptomology and consider how this knowledge may translate to interventions for COVID-19-related moral injury. Specifically, we first review alterations in social cognitive functioning observed among individuals with PTSD that may give rise to interpersonal difficulties. Drawing on Nietlisbach and Maercker's 2009 work on interpersonal factors relevant to survivors of trauma with PTSD, we then review the role of perceived social support, social acknowledgment and social exclusion in relation to potential areas of targeted intervention for COVID-19-related moral injury in healthcare workers. Finally, building on existing literature (e.g., Phoenix Australia—Centre for Posttraumatic Mental Health and the Canadian Centre of Excellence—PTSD, 2020) we conclude with individual and organizational considerations to bolster against the development of moral injury in healthcare workers during the pandemic.
Highlights
Healthcare workers around the globe are facing a series of novel, potentially traumatic moral and ethical challenges during the COVID-19 pandemic
Given evidence pointing toward the role of interpersonal factors in moderating symptoms of post-traumatic stress disorder (PTSD), along with the relation between PTSD and moral injury, we suggest here that an interpersonally-focused approach may serve as a useful starting point for prevention, early intervention, and treatment strategies for COVID-19-related moral injury in healthcare workers
Koh et al [59] reported increased work stress and workload among healthcare workers on the frontlines of the SARS crisis in Singapore, with many experiencing social stigmatization and ostracism from family members due to their occupation [55]. Drawing on this pre-pandemic evidence in combination with Nietlisbach and Maercker’s [16] work on interpersonal factors relevant to survivors of trauma with PTSD, we provide a review of the role of perceived social support, social acknowledgment and social exclusion in relation to potential areas of targeted intervention for COVID-19-related moral injury in healthcare workers
Summary
Healthcare workers around the globe are facing a series of novel, potentially traumatic moral and ethical challenges during the COVID-19 pandemic. In interviews with Canadian healthcare workers that our research group has been conducting throughout 2021, for example, healthcare workers have recounted repeatedly struggling with how wrong it feels to helplessly witness the deterioration of human life when caring for critically ill COVIDpositive patients (see Figure 1 for a sample vignette of healthcare workers’ experiences with moral injury). Exposure to such events has the potential to place healthcare workers at an elevated risk for moral injury. Despite widespread exposure during the COVID-19 pandemic, limited empirical data renders it unclear at present how best to prevent and, where necessary, treat moral injury in healthcare workers during the pandemic, among those who go on to develop full-blown mental illness as a result of this exposure
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