Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 11:2:841244.
doi: 10.3389/frhs.2022.841244. eCollection 2022.

Moral Injury Among Frontline Long-Term Care Staff and Management During the COVID-19 Pandemic

Kristin A Reynolds  1   2 , Lily Pankratz  1 , Barbie Jain  1 , Bronwen Grocott  1 , Lynette Bonin  1 , Gillian King  3 , Jordana L Sommer  1 , Renée El-Gabalawy  1   2   4   5 , Ryan J Giuliano  1 , Maia Kredentser  4 , Natalie Mota  1   2   4 , Leslie E Roos  1   6
Affiliations

Moral Injury Among Frontline Long-Term Care Staff and Management During the COVID-19 Pandemic

Kristin A Reynolds et al. Front Health Serv. .

Abstract

Background: A growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is a lack of research examining the experiences of moral injury among those working in long-term care settings during the COVID-19 pandemic. Given the drastic impact that the COVID-19 pandemic has had on long-term care facilities in Canada, it is important to understand the experiences of moral injury among those working in long-term care settings to inform the development of effective prevention and intervention strategies.

Objectives & method: The objectives of this study were to understand the experiences and impact of moral injury among Canadian frontline long-term care workers (staff and management) during the COVID-19 pandemic. Participants (N = 32 long-term care staff and management working in Ottawa and Manitoba) completed in-depth, semi-structured qualitative interviews and clinical diagnostic assessments (Mini International Neuropsychiatric Interviews; MINI; Version 7.0.2) between March 2021-June 2021.

Findings: The core category of our qualitative grounded theory model of moral injury in long-term care exemplified four shared types of morally injurious experiences, paired with cognitive, affective, and physiological symptom domains. Seven associated main themes emerged, contributing to the experiences and impact of moral injury in long-term care: 1) Beliefs about older adults and long-term care; 2) Interpretation of morally injurious experiences; 3) Management of morally injurious experiences; 4) Long-term care pandemic impacts; 5) Personal pandemic impacts; 6) Structural impacts in long-term care; and 7) Mental health needs and supports. Clinical assessments demonstrated anxiety disorders (n = 4) and feeding and eating disorders (n = 3) were among the most frequently classified current psychiatric disorders among long-term care workers.

Conclusions: This is the first Canadian study to examine the experiences and impact of moral injury in long-term care during the COVID-19 pandemic using qualitative and clinical diagnostic methodologies. Implications and insights for screening and intervention are offered.

Keywords: COVID-19; Canada; clinical symptoms; grounded theory analysis; long-term care; moral injury; qualitative.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Grounded theory model of moral injury in long-term care (LTC).
See this image and copyright information in PMC

References

    1. Litz B, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, et al. . Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. (2009) 29:695–706. 10.1016/j.cpr.2009.07.003 - DOI - PubMed
    1. Shay J. Moral injury. Psychoanal Psychol. (2014) 31:182–91. 10.1037/a0036090 - DOI
    1. Ames D, Erickson Z, Youssef NA, Arnold I, Adamson CS, Sones AC, et al. . Moral injury, religiosity, and suicide risk in U.S. veterans and active-duty military with PTSD symptoms. Mil Med. (2019) 184. 10.1093/milmed/usy148 - DOI - PubMed
    1. Kopacz MS, Connery AL, Bishop TM, Bryan CJ, Drescher KD, Currier JM, et al. . Moral injury: A new challenge for complementary and alternative medicine. Complement Ther Med. (2016) 24:29–33. 10.1016/j.ctim.2015.11.003 - DOI - PubMed
    1. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. . Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. (2015) 90:1600–13. 10.1016/j.mayocp.2015.08.023 - DOI - PubMed

LinkOut - more resources