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Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic

Author

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  • Stella E. Hines

    (Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA)

  • Katherine H. Chin

    (Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA)

  • Danielle R. Glick

    (Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA)

  • Emerson M. Wickwire

    (Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA)

Abstract

The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.

Suggested Citation

  • Stella E. Hines & Katherine H. Chin & Danielle R. Glick & Emerson M. Wickwire, 2021. "Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(2), pages 1-11, January.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:2:p:488-:d:477410
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    References listed on IDEAS

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    Cited by:

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    7. Esther Alonso-Prieto & Holly Longstaff & Agnes Black & Alice K. Virani, 2022. "COVID-19 Outbreak: Understanding Moral-Distress Experiences Faced by Healthcare Workers in British Columbia, Canada," IJERPH, MDPI, vol. 19(15), pages 1-14, August.
    8. Bram P. I. Fleuren & Lieze T. Poesen & Rachel E. Gifford & Fred R. H. Zijlstra & Dirk Ruwaard & Frank C. van de Baan & Daan D. Westra, 2021. "We’re Not Gonna Fall: Depressive Complaints, Personal Resilience, Team Social Climate, and Worries about Infections among Hospital Workers during a Pandemic," IJERPH, MDPI, vol. 18(9), pages 1-14, April.
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    11. Georgia Libera Finstad & Gabriele Giorgi & Lucrezia Ginevra Lulli & Caterina Pandolfi & Giulia Foti & José M. León-Perez & Francisco J. Cantero-Sánchez & Nicola Mucci, 2021. "Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma," IJERPH, MDPI, vol. 18(18), pages 1-25, September.
    12. Mihaela Alexandra Gherman & Laura Arhiri & Andrei Corneliu Holman & Camelia Soponaru, 2022. "The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic P," IJERPH, MDPI, vol. 19(13), pages 1-22, June.
    13. Shan Parker & Vicki Johnson-Lawrence, 2022. "Addressing Trauma-Informed Principles in Public Health through Training and Practice," IJERPH, MDPI, vol. 19(14), pages 1-14, July.
    14. Katherine Petrie & Natasha Smallwood & Amy Pascoe & Karen Willis, 2022. "Mental Health Symptoms and Workplace Challenges among Australian Paramedics during the COVID-19 Pandemic," IJERPH, MDPI, vol. 19(2), pages 1-15, January.
    15. Holly Blake & Alisha Gupta & Mahnoor Javed & Ben Wood & Steph Knowles & Emma Coyne & Joanne Cooper, 2021. "COVID-Well Study: Qualitative Evaluation of Supported Wellbeing Centres and Psychological First Aid for Healthcare Workers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(7), pages 1-27, March.
    16. Natasha Smallwood & Amy Pascoe & Leila Karimi & Marie Bismark & Karen Willis, 2021. "Occupational Disruptions during the COVID-19 Pandemic and Their Association with Healthcare Workers’ Mental Health," IJERPH, MDPI, vol. 18(17), pages 1-14, September.
    17. O-Jay B. Jimenez & Sheilla M. Trajera & Gregory S. Ching, 2022. "Providing End-of-Life Care to COVID-19 Patients: The Lived Experiences of ICU Nurses in the Philippines," IJERPH, MDPI, vol. 19(19), pages 1-21, October.
    18. Priya-Lena Riedel & Alexander Kreh & Vanessa Kulcar & Angela Lieber & Barbara Juen, 2022. "A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19," IJERPH, MDPI, vol. 19(3), pages 1-20, February.

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