Moral injury, a type of post-traumatic stress disorder, is felt by frontline healthcare workers at about the same rate as veterans who served in combat after 9/11.
Healthcare workers on the front lines of the COVID-19 pandemic have suffered the same kind of trauma as veterans, researchers have found.
the studypublished on April 5 in the Journal of General Internal Medicine by researchers at Duke University, Vanderbilt University and the Department of Veterans Affairs, was based on data from 618 veterans who served in combat after 9/11 and a new survey of more than 2,000 people who have worked in the health sector during the pandemic.
The study found that soldiers who experienced combat and healthcare workers who treated COVID patients both suffered potential life-threatening injuries (PMI) at about the same rate, reports Yahoo News.
“While ‘burnout’ is often used to describe the effects of continued stress at work, moral injury is used to describe damage to the conscience or identity of people who may witness, cause or not prevent acts that go against their own moral standards,” said Nieuwsma. “You can imagine, for example, a combat situation where maybe a military fired at a vehicle that didn’t stop at a checkpoint to find there were civilians inside.”
For healthcare workers during the pandemic, this included staff shortages, rationing of care and personal protective equipment, watching patients die and not allowing families to visit dying relatives, according to the study. One respondent said he and his colleagues had to ration care for patients “who we thought were best placed”.
PMI was also reported after seeing others around them refuse to take recommended actions to slow the spread of the virus, according to Spectrum News. About 24% of veterans and 18% of healthcare workers said they were troubled by the violation of their own morals and values, while 46% of veterans and 51% of healthcare workers said they were troubled by the immoral behavior of others.
“The worst thing is people who openly express their distrust of the medical and scientific community after all we have done for them,” wrote one medical professional.
Moral damage can also cause people to lose trust in their peers or authorities. One respondent expressed frustration with “community and government responses and participation in CDC guidelines. Cities and states that end mask mandates too soon are incredibly disappointing.
“Morbidity and mortality are increasing for patients WITHOUT covid due to chaos and lack of accountability throughout the hospital system,” another person wrote. “The excuse is always, ‘things are crazy right now because of Covid.’ Before December, I had never seen a patient die because of a doctor’s negligence – I have now had two.
The latest findings align with how psychologists understand moral hurt and how it can develop when people believe they have been betrayed by authorities, the study found.
“Perhaps there are lessons to be learned from the way we approach hurt feelings at Veterans Affairs,” Vanderbilt’s Dr. Keith Meador said. “Our study is suggestive of the importance of workplace culture and leadership for moral harm in health care. I think the role of the community, whether at work or elsewhere, is really central.
Brian Klassen, clinical director of a veterans program at Rush University Medical Center in Chicago, said feelings of betrayal about moral injury have long been reported among the military, according to Yahoo News.
“What we often hear is that leaders don’t care about the suffering that’s going on,” Klassen said. “Or maybe the leaders knew more about the situation and weren’t transparent about the situation a person was in.”
While there are therapies that can help, Klassen said awareness and specific treatments for moral injuries are lacking.
“What we need to do is work to roll out effective treatments to populations who need them,” he said. “It’s a formidable challenge, but it’s not insurmountable.
