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Have the pressures of the COVID-19 pandemic forced you to do things at work that go against your moral principles? You may be experiencing moral injury and its symptoms of guilt, anger, and detachment, writes Kristy Hill from CRANAplus' Mental Health & Wellbeing Team.
As health care workers across Australia move into their third year of managing the COVID-19 pandemic, we have never been more grateful for their courage, resilience, sacrifices and persistence.
You are noticed and appreciated.
Despite their incredible strength and resilience, they are understandably exhausted from the relentless uncertainty, stress, trauma and grief. Many health workers have experienced numerous and continuous traumatic events which will, in many instances, negatively affect their psychological wellbeing.
In this ever-changing environment, many health care workers are facing situations that have the potential to be morally challenging, stressful and result in ongoing moral injury.
Moral injury has emerged in the health care discussion quite recently because of the difficulties and challenges health care workers and health care systems face in the context of the COVID-19 pandemic.
Moral injury is described as the ‘psychological, social and spiritual impact of events involving betrayal or transgression of one’s own deeply held moral beliefs and values occurring in high stakes situations’¹.
It was first described in the early 1990s, by US psychiatrist Dr Jonathan Shay when he began using the term “moral injury” to describe a particular kind of trauma he observed in the Vietnam veterans he was treating². Moral injury occurred, he believed, when soldiers had been involved in events that contravened their deeply held moral convictions.
The literature describes two broad types of moral transgression events:
Photo Credit: dmytro_khlystun — stock.adobe.com
Moral injury has been observed in health care workers who have faced situations that do not allow them to deliver care in the way they have been trained (that is, to help people and do no harm), such as when there are insufficient hospital beds, and insufficient equipment or access to equipment.
It has also been observed in health workers who have been forced to decide who receives life-saving treatment and who does not.
They may have had to prevent family members from being at the side of a dying relative or to follow clinical directions they felt were unethical. When health workers experience these situations, it can lead to moral injury.
Phoenix Australia describes the symptoms of moral injury to include feeling:
On a positive note, it is important to recognise that while some people exposed to moral stressors may experience significant distress and injury, others may experience post-traumatic growth. With this growth, people can take new meaning from their experiences and live their lives in a different way. This may include an improved appreciation of life, improved relationships with others, and increased personal strength⁴.
Experts are advocating the need to prioritise a range of preventative and early intervention strategies to reduce risks and maximise protective factors for workers. As a result, Phoenix Australia has collaborated with the Canadian Centre for Excellence – PTSD to develop a The Moral Stress Amongst Healthcare Workers During COVID-19: A Guide to Moral Injury¹.
This Guide provides organisations and individuals with an understanding of moral injury and outlines an approach to manage and mitigate the risk of moral injury amongst health care workers. It makes a range of practical recommendations including:
If you need to talk things through with someone, you can contact the Bush Support Line on 1800 805 391 anytime to have a confidential chat with one of our psychologists.
Thank you for all that you do.
Manager Education and Resources
Mental Health & Wellbeing Services CRANAplus
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