Document Type

Presentation

Publication Date

11-3-2022

Keywords

california; plcmmc; covid-19; nurse; moral injury

Abstract

Background

Moral Injury (MI) was defined by Jonathan Shay in 1994 as committing acts that betray one’s moral compass in high-stakes situations, while under the authority of another, that severely affect one’s well-being. MI was measured solely in the military prior to the COVID pandemic.

Aims

1.Explore the relationship between moral injury (MI) and perceived work performance in hospital nurses following the pandemic surges. 2. Determine relationships between MI and select participant demographics and between work performance and select demographics.

Sample

A convenience sample of 191 nurses from seven Southern California Hospitals participated in the study from March to June 2022. The mean years of experience of participants was 15, 84% worked full-time, 53% were Caucasian, and 97% cared for COVID-19 patients.

Design

Cross-sectional multi-site survey.

Variables and Instruments

The DV was MI. The IVs were work performance and nurse demographics. The Moral Injury Symptom Scale was revised for use with Health Professionals (MISS-HP) and used in this study. Perceived work performance was measured using the Nurse Performance Index (NPI).

Data Analysis

Descriptive analysis was used to calculate scale scores and demographics. Correlational and linear regression analysis were used to examine relationships between dependent and independent variables and specifically to determine if MISS-HP scores were a predictor of NPI scores.

Findings

Increased levels of moral injury were a significant predictor of decreased levels of perceived work performance. Younger and less experienced nurses had greater levels of moral injury. Levels of MI due to the traumatic situations that nurses experienced during the pandemic negatively affected self-reported work performance. Nurses reported at times having to modify their standards to get their work done.

Implications

Nurse well-being programs and improved working conditions for nurses are needful to avoid compromising quality nursing care and patient safety. In-hospital care programs for nurses that include sacred spaces like Tea for the Soul, serenity lounges, and provision for consistent break times with adequate staffing, are imperative in optimizing nurse performance and thus optimizing patient care outcomes as well as organizational outcomes.

Area of Special Interest

Mental Health

Specialty/Research Institute

Nursing

Specialty/Research Institute

Infectious Diseases

Specialty/Research Institute

Behavioral Health

Comments

References for the Poster

Adibe, B. (2020). Creating wellness in a pandemic: A practical guide for health systems responding to COVID-19. Rush Wellness.

Bodenheimer, T. & Sinsky, C. (2014). From Triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573-576.

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. https://doi.org/10.1080/08854726.2021.1932134

Callis (Browning), A. (2020). Application of the Roy Adaptation Theory to a care program for nurses. Applied Nursing Research, 56. https://doi.org/10.1080/08854726.2021.1932134

Cartolovni, A., Stolt, M., Scott, P.A., & Suhonen, R. (2021) Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics, 1-13. https://doi.org/10.1177%2F0969733020966776

Fitzpatrick, J., Pignatiello, G., Kim, M., Jun, J., Mathuna, D., Duah, H., Taibl, J. & Tucker, S. (2022). Journal of Nursing Administration, 52(7-8), 392-398.

Florida, P., Barone, M., Manoukian, M., Xu, W. & Kim, L. (2022). Effective holistic approaches to reducing nurse stress and burnout during COVID-19. American J of Nurstin,22(5), 40-47.

Frutchey, K. (2021). [Unpublished thesis on the lived experience of registered nurses during the COVID- 19 pandemic]. Vanguard University, Costa Mesa, CA.

Greenberg, N. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ, 368(1211). doi: 10.1136/bmj.m1211

Gregory, D. (2021). Code Lavender: Designing healthcare spaces to enhance caregiver wellness. https://doi.org/10.1177/1937586721993785

Hossain, F. & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during COVID- 19 pandemic. Nursing Ethics, 28(1), 23-32.

Kessler, R., Barber, C., Beck, A, Berglund, P., Cleary, P., McKenas, D., Pronk, N., Simon, G., Stang, P., Ustun, T. & Wang, P. (2003). The world health organization health and work performance questionnaire. American College of Occupational and Environmental Medicine, 45(2), 156-174.

Koenig, H., Ames, D., Youssef, N, Oliver, J., Volk, F., Teng, E., Haynes, K., Erickson, Z., Arnold, I, O’Garo, K. & Pearce, M. (2018a). The moral injury symptom scale-military version. Journal of Religion and Health, 5, 249-265.

Litz, BT, Stein, N., Delaney, E., et al. (2009). Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychol Rev, 29(8), 695-706.

Mannelli, C. (2020). Whose life to save? Scarce resources allocation in the COVID-19 outbreak. J Med Ethics, 46(60), 364-366.

Mantri, S., Lawson, J.M., Wang, Z. & Koenig, H. (2020). Identifying moral injury in healthcare professionals: The moral injury symptom scale-HP. Journal of Religion and Health, 59, 2323– 2340.

Mantri, S., Lawson, J., Wang, Z., & Koenig, H. (2021). Prevalence and predictors of moral injury symptoms in health care professionals. The Journal of Mental and Nervous Disease, 209(3), 174- 180.

Meretoja, R., Isoaho, H. & Leino-Kilpi, H. (2004). Nurse competence scale: Development of psychometric testing. Journal of Advanced Nursing, 47(2), 124-133).

Rushton, C. H. (2018). Moral resilience. Transforming moral suffering in healthcare. Oxford University Press.

Rushton, C.H. & Uveges, M. K. (2021). Invisible moral wounds of the COVID-19 pandemic: Are we experiencing moral injury? AACN Advanced Critical Care, 32(1), 119-225.n,

Rushton, C.H., Thomas, T., Antonsdottir, I., Nelson, K., Boyce, D., Vioral, A., Swavely, D., Ley, C. & Hanson, G. (2022). Moral injury and moral resilience in health care workers during Covid-19 pandemic. Journal of Palliative Medicine, 25(5), 712-719.

Sangherian, K., Steegy, L., Geiger-Brown, J. & Harrington, D. (2018). The nursing performance instrument: Exploratory and confirmatory factor analyses in registered nurses. Journal of Nursing Research, 26(2), 130-137.

Schwirian, P. M. (1978). Evaluating the performance of nurses: A multidimensional approach. Nursing Research, 27(6), 347-351.

Shay, J. (1994). Achilles in Vietnam: Combat Trauma and the Undoing of Character. Scribner.

Sherman, N. (2015). Afterwar: healing the moral wounds of our soldiers. Oxford University Press.

Simmons, A., Rivers F., Gordon S., & Yoder, L. (2018). The role of Spirituality among military en route care nurses: Source of strength of moral injury? Critical Care Nurse. 38(2), 61-67. https://doi.org/10.4037/ccn2018674

Thompson, L. J. (2018). Moral Injury. In R.W. Kolb (Ed.), Encyclopedia of business ethics and society. Sage Publications, 2340-2343.

White, D. & Lo, B. (2020). A framework for rationing ventilators and critical care beds during the COVID-19 Pandemic. JAMA, 323(18), 1773-1774.

Williams R, D., Brundage J.A. & Williams E.B. (2020). Moral injury in times of COVID-19. J Health Serv Psychol. DOI: 10.1007/s42843-020-00011-4.

Wocial, L. (2020). Resilience as an incomplete strategy for coping with moral distress in critical care nurses. Critical Care Nurse, 40(6)), 62-66

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