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A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19

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  • Priya-Lena Riedel

    (Institute of Psychology, University of Innsbruck, Innrain, 52f, 6020 Innsbruck, Austria)

  • Alexander Kreh

    (Institute of Psychology, University of Innsbruck, Innrain, 52f, 6020 Innsbruck, Austria)

  • Vanessa Kulcar

    (Institute of Psychology, University of Innsbruck, Innrain, 52f, 6020 Innsbruck, Austria)

  • Angela Lieber

    (Department of Art and Design, University of the Arts Bremen, 28217 Bremen, Germany)

  • Barbara Juen

    (Institute of Psychology, University of Innsbruck, Innrain, 52f, 6020 Innsbruck, Austria)

Abstract

Ethical dilemmas for healthcare workers (HCWs) during pandemics highlight the centrality of moral stressors and moral distress (MD) as well as potentially morally injurious events (PMIEs) and moral injury (MI). These constructs offer a novel approach to understanding workplace stressors in healthcare settings, especially in the demanding times of COVID-19, but they so far lack clear identification of causes and consequences. A scoping review of moral stressors, moral distress, PMIEs, and MI of healthcare workers during COVID-19 was conducted using the databases Web of Science Core Collection and PsycINFO based on articles published up to October 2021. Studies were selected based on the following inclusion criteria: (1) the measurement of either moral stress, MD, PMIEs, or MI among HCWs; (2) original research using qualitative or quantitative methods; and (3) the availability of the peer-reviewed original article in English or German. The initial search revealed n = 149,394 studies from Web of Science and n = 34 studies from EBSCOhost. Nineteen studies were included in the review. Conditions representing moral stressors and PMIEs as well as MD and MI as their potential outcomes in healthcare contexts during COVID-19 are presented and discussed. Highlighting MD and MI in HCWs during COVID-19 brings attention to the need for conceptualizing the impact of moral stressors of any degree. Therefore, the development of a common, theoretically founded model of MD and MI is desirable.

Suggested Citation

  • Priya-Lena Riedel & Alexander Kreh & Vanessa Kulcar & Angela Lieber & Barbara Juen, 2022. "A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19," IJERPH, MDPI, vol. 19(3), pages 1-20, February.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1666-:d:739956
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    References listed on IDEAS

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    1. Natasha Smallwood & Amy Pascoe & Leila Karimi & Karen Willis, 2021. "Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(16), pages 1-15, August.
    2. Stella E. Hines & Katherine H. Chin & Danielle R. Glick & Emerson M. Wickwire, 2021. "Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(2), pages 1-11, January.
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    Cited by:

    1. Sherman, Melina & Klinenberg, Eric, 2024. "Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge," Social Science & Medicine, Elsevier, vol. 340(C).
    2. Cordelia Cho & Wendy Y. K. Ko & Olivia M. Y. Ngan & Wai Tat Wong, 2022. "Exploring Professionalism Dilemma and Moral Distress through Medical Students’ Eyes: A Mixed-Method Study," IJERPH, MDPI, vol. 19(17), pages 1-18, August.
    3. Mihaela Alexandra Gherman & Laura Arhiri & Andrei Corneliu Holman & Camelia Soponaru, 2022. "The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic P," IJERPH, MDPI, vol. 19(13), pages 1-22, June.
    4. Daniela Lemmo & Roberta Vitale & Carmela Girardi & Roberta Salsano & Ersilia Auriemma, 2022. "Moral Distress Events and Emotional Trajectories in Nursing Narratives during the COVID-19 Pandemic," IJERPH, MDPI, vol. 19(14), pages 1-12, July.
    5. Dominik Hinzmann & Katharina Schütte-Nütgen & Arndt Büssing & Olaf Boenisch & Hans-Jörg Busch & Christoph Dodt & Patrick Friederich & Matthias Kochanek & Guido Michels & Eckhard Frick, 2022. "Critical Care Providers’ Moral Distress: Frequency, Burden, and Potential Resources," IJERPH, MDPI, vol. 20(1), pages 1-14, December.
    6. Mihaela Alexandra Gherman & Laura Arhiri & Andrei Corneliu Holman & Camelia Soponaru, 2022. "Protective Factors against Morally Injurious Memories from the COVID-19 Pandemic on Nurses’ Occupational Wellbeing: A Cross-Sectional Experimental Study," IJERPH, MDPI, vol. 19(18), pages 1-42, September.
    7. 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 , 2023. "The Hidden Crisis: Understanding Potentially Morally Injurious Events Experienced by Healthcare Providers during COVID-19 in Canada," IJERPH, MDPI, vol. 20(6), pages 1-12, March.
    8. Amoneeta Beckstein & Marie Chollier & Sangeeta Kaur & Ananta Raj Ghimire, 2022. "Mental Wellbeing and Boosting Resilience to Mitigate the Adverse Consequences of the COVID-19 Pandemic: A Critical Narrative Review," SAGE Open, , vol. 12(2), pages 21582440221, May.
    9. Esther Alonso-Prieto & Holly Longstaff & Agnes Black & Alice K. Virani, 2022. "COVID-19 Outbreak: Understanding Moral-Distress Experiences Faced by Healthcare Workers in British Columbia, Canada," IJERPH, MDPI, vol. 19(15), pages 1-14, August.
    10. Mihaela Alexandra Gherman & Laura Arhiri & Andrei Corneliu Holman & Camelia Soponaru, 2022. "Injurious Memories from the COVID-19 Frontline: The Impact of Episodic Memories of Self- and Other-Potentially Morally Injurious Events on Romanian Nurses’ Burnout, Turnover Intentions and Basic Need ," IJERPH, MDPI, vol. 19(15), pages 1-25, August.
    11. Evija Nagle & Sanita Šuriņa & Ingūna Griškēviča, 2023. "Healthcare Workers’ Moral Distress during the COVID-19 Pandemic: A Scoping Review," Social Sciences, MDPI, vol. 12(7), pages 1-17, June.
    12. Andrea M. D’Alessandro-Lowe & Mauda Karram & Kim Ritchie & Andrea Brown & Heather Millman & Emily Sullo & Yuanxin Xue & Mina Pichtikova & Hugo Schielke & Ann Malain & Charlene O’Connor & Ruth Lanius &, 2023. "Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 20(19), pages 1-17, September.
    13. Ngqabutho Moyo & Anita D. Bhappu & Moment Bhebhe & Farai Ncube, 2022. "Perceived Risk of COVID-19 and Employee Decision-Making: How Psychological Distress during the Pandemic Increases Negative Performance Outcomes among Healthcare Workers," IJERPH, MDPI, vol. 19(11), pages 1-16, June.
    14. Wirpsa, M.J. & Galchutt, P. & Price, C.S. & Schaefer, B. & Szilagyi, C. & Palmer, P.K., 2023. "Mandatory COVID-19 vaccination for healthcare workers: The experience of chaplains evaluating religious accommodation requests from coworkers," Social Science & Medicine, Elsevier, vol. 332(C).
    15. Linda Schweitzer & Sean Lyons & Chelsie J. Smith, 2023. "Career Sustainability: Framing the Past to Adapt in the Present for a Sustainable Future," Sustainability, MDPI, vol. 15(15), pages 1-21, July.
    16. Pedro Ángel Caro-Alonso & Beatriz Rodríguez-Martín & Julián Rodríguez-Almagro & Carlos Chimpén-López & Cristina Romero-Blanco & Ignacio Casado Naranjo & Antonio Hernández-Martínez & Fidel López-Espuel, 2023. "Nurses’ Perceptions of Ethical Conflicts When Caring for Patients with COVID-19," IJERPH, MDPI, vol. 20(6), pages 1-20, March.
    17. Karina Nielsen & Claire Agate & Joanna Yarker & Rachel Lewis, 2024. "“It’s Business”: A Qualitative Study of Moral Injury in Business Settings; Experiences, Outcomes and Protecting and Exacerbating Factors," Journal of Business Ethics, Springer, vol. 194(2), pages 233-249, October.

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