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When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan
INTRODUCTION: Moral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distres...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545959/ https://www.ncbi.nlm.nih.gov/pubmed/37795516 http://dx.doi.org/10.3389/fpsyt.2023.1244055 |
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author | Fatima, Madah Imran, Nazish Aamer, Irum Iqtadar, Somia Shabbir, Bilquis |
author_facet | Fatima, Madah Imran, Nazish Aamer, Irum Iqtadar, Somia Shabbir, Bilquis |
author_sort | Fatima, Madah |
collection | PubMed |
description | INTRODUCTION: Moral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distress, and impairment in social and occupational functioning. The COVID-19 pandemic predisposed healthcare providers to moral dilemmas, potentially morally injurious events (PMIEs), and MI. We aimed to assess the prevalence and predictors of MI in healthcare providers during the COVID-19 pandemic in Pakistan. MATERIALS AND METHODS: This cross-sectional study was conducted in July–October 2021 among physician/clinician staff working at teaching hospitals in Lahore. The Moral Injury Symptoms Scale-Health Professionals (MISS-HP) was used to collect data. SPSS 26 was used for data analysis applying Wilcoxon Mann–Whitney U and Kruskal–Wallis tests on non-normally distributed data at α = 0.05. Predictors of MI were ascertained through Binary Logistic Regression analysis. RESULTS: Four hundred and twenty physicians responded to the questionnaires. The Median (IQR) MI scores were 37(28–47). Guilt, moral concerns, and shame were higher-scoring MI dimensions. 40.8% (n = 171) suffered from clinically significant distress and impaired functioning while 14.3% (n = 60) from severe distress. Gender, department, and history of psychiatric illness predicted higher levels of distress which were 1.9 times higher in females than males and 2.5 times higher with a history of psychiatric illness. Working on the front lines did not predict MI. CONCLUSION: Our findings highlight the substantial burden of MI in our sample during COVID-19, having implications for healthcare providers’ well-being, healthcare quality, and service delivery. This calls for concerted efforts from all stakeholders to better prepare for future disasters through effective human-resource policies, pre-trauma exposure soft-skills training, effective teamwork and communication strategies; self-stewardship and resilience modules, and mental health support for healthcare providers. The dimensional construct of MI may vary across cultures; hence we recommend further cross-cultural research on MI in healthcare providers, particularly in the context of public health disasters. |
format | Online Article Text |
id | pubmed-10545959 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105459592023-10-04 When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan Fatima, Madah Imran, Nazish Aamer, Irum Iqtadar, Somia Shabbir, Bilquis Front Psychiatry Psychiatry INTRODUCTION: Moral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distress, and impairment in social and occupational functioning. The COVID-19 pandemic predisposed healthcare providers to moral dilemmas, potentially morally injurious events (PMIEs), and MI. We aimed to assess the prevalence and predictors of MI in healthcare providers during the COVID-19 pandemic in Pakistan. MATERIALS AND METHODS: This cross-sectional study was conducted in July–October 2021 among physician/clinician staff working at teaching hospitals in Lahore. The Moral Injury Symptoms Scale-Health Professionals (MISS-HP) was used to collect data. SPSS 26 was used for data analysis applying Wilcoxon Mann–Whitney U and Kruskal–Wallis tests on non-normally distributed data at α = 0.05. Predictors of MI were ascertained through Binary Logistic Regression analysis. RESULTS: Four hundred and twenty physicians responded to the questionnaires. The Median (IQR) MI scores were 37(28–47). Guilt, moral concerns, and shame were higher-scoring MI dimensions. 40.8% (n = 171) suffered from clinically significant distress and impaired functioning while 14.3% (n = 60) from severe distress. Gender, department, and history of psychiatric illness predicted higher levels of distress which were 1.9 times higher in females than males and 2.5 times higher with a history of psychiatric illness. Working on the front lines did not predict MI. CONCLUSION: Our findings highlight the substantial burden of MI in our sample during COVID-19, having implications for healthcare providers’ well-being, healthcare quality, and service delivery. This calls for concerted efforts from all stakeholders to better prepare for future disasters through effective human-resource policies, pre-trauma exposure soft-skills training, effective teamwork and communication strategies; self-stewardship and resilience modules, and mental health support for healthcare providers. The dimensional construct of MI may vary across cultures; hence we recommend further cross-cultural research on MI in healthcare providers, particularly in the context of public health disasters. Frontiers Media S.A. 2023-09-19 /pmc/articles/PMC10545959/ /pubmed/37795516 http://dx.doi.org/10.3389/fpsyt.2023.1244055 Text en Copyright © 2023 Fatima, Imran, Aamer, Iqtadar and Shabbir. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Psychiatry Fatima, Madah Imran, Nazish Aamer, Irum Iqtadar, Somia Shabbir, Bilquis When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan |
title | When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan |
title_full | When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan |
title_fullStr | When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan |
title_full_unstemmed | When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan |
title_short | When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan |
title_sort | when healers get wounded! moral injury in healthcare providers during the covid-19 pandemic in pakistan |
topic | Psychiatry |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545959/ https://www.ncbi.nlm.nih.gov/pubmed/37795516 http://dx.doi.org/10.3389/fpsyt.2023.1244055 |
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