The Hidden Crisis: Understanding Potentially Morally Injurious Events Experienced by Healthcare Providers during COVID-19 in Canada

Kim Ritchie; Andrea M D'Alessandro-Lowe; Andrea Brown; Heather Millman; Mina Pichtikova; Yuanxin Xue; Maxwell Altman; Isaac Beech; Mauda Karram; Fardous Hosseiny; Sara Rodrigues; Charlene O'Connor; Hugo Schielke; Ann Malain; Randi E McCabe; Alexandra Heber; Ruth A Lanius; Margaret C McKinnon

doi:10.3390/ijerph20064813

The Hidden Crisis: Understanding Potentially Morally Injurious Events Experienced by Healthcare Providers during COVID-19 in Canada

Int J Environ Res Public Health. 2023 Mar 9;20(6):4813. doi: 10.3390/ijerph20064813.

Authors

Kim Ritchie^{1

2}, Andrea M D'Alessandro-Lowe³, Andrea Brown², Heather Millman², Mina Pichtikova^{2

4}, Yuanxin Xue^{2

5}, Maxwell Altman³, Isaac Beech^{2

6}, Mauda Karram², Fardous Hosseiny^{7

8}, Sara Rodrigues^{7

8}, Charlene O'Connor⁹, Hugo Schielke⁹, Ann Malain⁹, Randi E McCabe^{2

10}, Alexandra Heber^{2

11}, Ruth A Lanius^{9

12}, Margaret C McKinnon^{2

6

10}

Affiliations

¹ Trent/Fleming School of Nursing, Trent University, Peterborough, ON K9L 0G2, Canada.
² Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada.
³ Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 4L8, Canada.
⁴ Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON M5S 1V6, Canada.
⁵ Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
⁶ Homewood Research Institute, Guelph, ON N1E 6K9, Canada.
⁷ Atlas Institute of Veterans and Families, Ottawa, ON K1Z 7K4, Canada.
⁸ Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, ON K1Z 7K4, Canada.
⁹ Homewood Health Centre, Guelph, ON N1E 6K9, Canada.
¹⁰ St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
¹¹ Veteran's Affairs Canada, Ottawa, ON K1H 1A1, Canada.
¹² Lawson Health Research Institute, University of Western Ontario, London, ON N6A 3K7, Canada.

Abstract

Background: Healthcare providers (HCPs) may be at elevated risk for moral injury due to increased exposure to potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic. Identifying PMIEs experienced during the COVID-19 pandemic is a critical first step for understanding moral injury in HCPs. Accordingly, the purpose of the present study was to gain a deeper understanding of the work-related PMIEs experienced by HCPs in Canada during the pandemic.

Methods: Canadian HCPs completed an online survey between February and December 2021 about mental health and functioning, including demographics and the Moral Injury Outcome Scale (MIOS). We conducted a qualitative thematic analysis of PMIEs described extemporaneously by HCPs in the open-text field of the MIOS.

Results: One-hundred and twenty-four (N = 124) HCPs were included in analysis. Eight PMIE-related themes were identified, comprising patients dying alone; provision of futile care; professional opinion being ignored; witnessing patient harm; bullying, violence and divided opinions; resources and personal protective equipment; increased workload and decreased staffing; and conflicting values.

Conclusions: Understanding broad categories of PMIES experienced by Canadian HCPs during the COVID-19 pandemic provides an opportunity to enhance cultural competency surrounding their experiences which will aid the development of targeted prevention and intervention approaches.

Keywords: COVID-19; healthcare providers; moral injury; potentially morally injurious events.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Canada / epidemiology
Health Personnel
Humans
Morals
Pandemics
Stress Disorders, Post-Traumatic* / epidemiology

Grants and funding

Atlas Institute for Veterans and Families; Donation from Homewood Health Inc. to Homewood Research Institute; Canadian Institutes of Health Research; M.C.M. is supported by the Homewood Chair in Mental Health and Trauma at McMaster University; R.A.L. is supported by the Harris Woodman Chair in Psyche and Soma at Western University.