I was honored to present my research at this acclaimed Conference on the Impact of Moral Injury on Nurse Work Performance Following COVID-19 Surges. As director or Graduate Nursing at VU, I work intricately with working professional nurses in designing and implementing thesis research projects that seek to improve current nursing practice and patient care / population outcomes.
Considering my previous research on Moral Distress in Nurses and more currently Care Programs for Nurses such as Tea for the Soul, I became interested in the psychological repercussions in Health Care Professionals because of the global pandemic.
The pandemic exacerbated compassion fatigue, secondary traumatic stress, and burnout on the nursing workforce in environments where these phenomena were already at high levels.
The pandemic caused severe burdens of care for nurses that undermined their ability to deliver best care. Unprepared healthcare systems were caught off guard by the pandemic, creating understaffing, under resourcing, and heavier workloads, perpetuating situations that required complex ethical decision-making.
What is Moral Injury?
Moral Injury (MI) is a construct identified by Dr. Shay, a psychiatrist working with Vietnam veterans in 1994. Studied primarily in the military prior to the pandemic MI is:
- A Form of intense moral suffering
- Caused by acting against one’s moral compass
- Classic Example: A soldier kills an enemy, and inadvertently kills a civilian
Moral Injury occurs with moral transgressions in high stake situations and results in:
- Serious and longstanding adverse effects
- Violation and haunting of one’s sense of goodness and human dignity
(Shay, 1994; Sherman, 2015)
- During the pandemic warlike terminology related to the work of nursing became commonplace.
- Such terms as frontline nurses, it was like a war zone, in the trenches, and on the battlefield were used to describe COVID-19 experiences.
- One nurse, reassigned to a COVID unit, reported 12 patients dying during 1 shift.
- Circumstances required nurses to make decisions on who to resuscitate and for how long, who to accompany during dying, and who should receive the limited equipment available.
Lack of orientation to newly created COVID units caused deeply disturbing moral conflicts for nurses. Nurses, forced to work within systems with resource shortages were unable to function within organizational and personal core values.
During the pandemic, nurse scientists redesigned the Moral Injury Symptom Scale-Military version to measure MI in Health Care Professionals (MISS-HP).
Many of our graduate nursing students work in local Providence hospitals. The Providence Director of Nursing Research, Dr. Trisha Saul, and I wanted to investigate if the moral injury nurses were experiencing was affecting their performance, thus the impetus for this study. These 2 constructs had not been previously studied in relationship to one another.
A convenience sample of 191 nurses from 7 hospitals in California participated in our multi-site correlational survey-design study.
Our Study Results Found:
- Significant levels of MI occurred in 57% (n=114) of participants.
- There was an inverse correlation between MI and Nurse Work Performance.
- Younger and less experienced nurses reported greater levels of Moral Injury.
- Increased MI in nurses is a predictor of decreased nurse work performance.
- There is a need for research to assist nursing administrators in ameliorating MI in nurses.
- Preparation is needed to address MI impact on the nursing workforce in future crisis situations.
- Nurse Care Programs such as Tea for the Soul are crucial for the well-being of health care professionals. See:
Callis, A. (Browning), Cacciata, M., Wickman, M. & Choi, J. (2021). An effective in-hospital chaplaincy-led care program for nurses: Tea for the soul a qualitative investigation. Journal of Health Care Chaplaincy, 28:4,526-539.
This research has been accepted for publication in the Journal of Nursing Administration (JONA) coming out in March 2024.