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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

Author

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  • Andrea M. D’Alessandro-Lowe

    (Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 4L6, Canada
    Homewood Research Institute, Guelph, ON N13 6K9, Canada)

  • Mauda Karram

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada)

  • Kim Ritchie

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
    Trent/Fleming School of Nursing, Trent University, Peterborough, ON K9L 0G2, Canada)

  • Andrea Brown

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada)

  • Heather Millman

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada)

  • Emily Sullo

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada)

  • Yuanxin Xue

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
    Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada)

  • Mina Pichtikova

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
    Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON M5S 1V6, Canada)

  • Hugo Schielke

    (Homewood Health Centre, Guelph, ON NIE 6K9, Canada)

  • Ann Malain

    (Homewood Health Centre, Guelph, ON NIE 6K9, Canada)

  • Charlene O’Connor

    (Homewood Health Centre, Guelph, ON NIE 6K9, Canada)

  • Ruth Lanius

    (Homewood Research Institute, Guelph, ON N13 6K9, Canada
    Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada)

  • Randi E. McCabe

    (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
    St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada)

  • Margaret C. McKinnon

    (Homewood Research Institute, Guelph, ON N13 6K9, Canada
    Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
    St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada)

Abstract

Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six ( N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI ( p ’s < 0.001), shame-related MI ( p = 0.03 and p = 0.02, respectively) and trust-violation-related MI ( p ’s < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history ( p = 0.02) and self-compassion ( p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees.

Suggested Citation

  • 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.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:19:p:6812-:d:1246198
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    References listed on IDEAS

    as
    1. Natalia Budzyńska & Joanna Moryś, 2023. "Anxiety and Depression Levels and Coping Strategies among Polish Healthcare Workers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 20(4), pages 1-16, February.
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    4. Annabel Rushforth & Mia Durk & Gabby A. A. Rothwell-Blake & Ann Kirkman & Fiona Ng & Yasuhiro Kotera, 2023. "Self-Compassion Interventions to Target Secondary Traumatic Stress in Healthcare Workers: A Systematic Review," IJERPH, MDPI, vol. 20(12), pages 1-14, June.
    5. Mauda Karram & Andrea M. D'Alessandro-Lowe & Kimberly Ritchie & Andrea Brown & Yuanxin Xue & Mina Pichtikova & Maxwell Altman & Isaac Beech & Heather Millman & Fardous Hosseiny & Sara Rodrigues & Alex, 2023. "A Qualitative Approach to Understanding Canadian Healthcare Workers’ Use of Coping Strategies during the COVID-19 Pandemic," IJERPH, MDPI, vol. 20(3), pages 1-15, January.
    6. 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.
    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.
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