Study: Pre-Vaccine Pandemic Expanded Moral Injury to All Healthcare Workers December 3, 2021

We know moral injury was on the rise prior to the COVID-19 pandemic and the pandemic has been a traumatic event. In case there was any doubt that it has compounded moral injury in the healthcare workforce, a new study confirms what we have all experienced.

Publish last week in the JAMA Network Open, the study surveyed professionals during two time periods ("phases") before a COVID vaccine became available: April 24-May 30, 2020 and October 24-November 30, 2020. The survey captured over 1,800 individual responses from the physician, nursing, advanced practice practitioner, and chaplain professions. The authors concluded from the data that moral injury came not from one event but from continued exposure and morally injurious environments. 

Studying responses showed the following:

• Moral injury in the first phase of questions came from fear of the virus and infection, but in the second phase moral injury came from the routinization of treating people infected with the virus.
• Lack of PPE was a major driver in moral injury in phase 1 but decreased substantially as more PPE was available on phase 2.
• Over both phases respondents reported increased isolation due to fear of being infected or assuming people were infected and hiding their symptoms. The increased distance - physical and emotion - was a self-reported cause of much moral injury.
• Over both phases, healthcare practitioners felt burned out due to a physical distance from patients, due to COVID protocols and reliance on telemedicine.
• Many practitioners felt betrayed by employers in phase 1 due to PPE shortages and requirements. One respondent wrote, "I felt our lives were more disposable than our PPE was".

The study concludes that the workplace bears a large responsibility to address to moral injury the last two years has caused. Urging employers to move beyond slogans like, "heroes work here", the authors propose proactive treatments such as:

• Providing adequate PPE
• Available PTO
• Support for childcare needs
• Nearby lodging for individuals on rapid-cycle shifts