PDF(Pubmed)
Abstract：
During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury; while group care settings increased odds (OR = 1.36 [1.07, 1.74]). Working with COVID+ patients (confirmed+ OR = 1.27 [1.03, 1.55]), PPE inadequacy (OR = 1.54 [1.27, 1.87]), and greater role conflict (OR = 1.57 [1.53, 1.62]) were associated with greater odds of moral injury. Qualitative findings illustrate how outside factors as well as organizational policies and working conditions influenced moral injury. Moral injury experiences affected staff turnover and patient care, potentially producing additional morally injurious effects. Worker- and patient-centered organizational policies are needed to prevent moral injury among healthcare workers. The generalizability of these findings may be limited by our predominantly white and female sample. Further research is indicated to replicate these findings in minoritized samples.
摘要：
在COVID-19大流行期间，在迅速变化的政策以及物质和人员短缺的情况下，医护人员面临着严重的责任。道德伤害,行为违反道德信仰/期望的事件后的心理困扰，在医护人员中增加。我们使用顺序混合方法方法来检查大流行早期与道德伤害相关的工作场所和环境因素。使用TotalWorkerHealth®框架，我们1)研究了2020年5月至8月期间接受调查的活跃医疗专业人员(N=14,145)中与道德伤害相关的因素,2)对随机选择的95名在调查中认可道德伤害的参与者的开放式回答进行了定性分析.与住院医院相比，门诊(OR=0.74[0.65,0.85])或学校诊所设置(OR=0.37[0.18,0.75])与较低的道德伤害几率相关;而团体护理设置增加了几率(OR=1.36[1.07,1.74]).与COVID+患者一起工作（确认+OR=1.27[1.03，1.55]），PPE不足（OR=1.54[1.27，1.87]），更大的角色冲突(OR=1.57[1.53,1.62])与更大的道德伤害几率相关。定性发现说明了外部因素以及组织政策和工作条件如何影响道德伤害。道德伤害经历影响员工流失和病人护理，可能产生额外的道德伤害影响。需要以员工和患者为中心的组织政策来防止医护人员的道德伤害。这些发现的普遍性可能受到我们主要的白人和女性样本的限制。进一步的研究表明，这些发现可以在小型样本中复制。
