Study analyzes moral injury in health care professionals and veterans

After Sept. 11, 2001, 618 veterans who served in a combat zone were compared to 2,099 health care workers (HCWs) who worked during the COVID-19 pandemic.

The veterans and the HCWs both had similar levels of “potential moral injury,” with 46.1 percent of veterans and 50.7 percent of HCWs reporting PMI.

PMI, defined as a strong cognitive and emotional response to events that violate a person’s moral or ethical code, was divided into two categories: other-induced and self-induced.

Women, race, enlisted vs. officer status, post-battle traumatic experiences, and COVID-19 exposure were all linked to both types. Age, race, working in a high COVID-19 risk setting, and reporting COVID-19 exposure were also linked to both types.

In both samples, PMI was associated with significantly higher depressive symptoms and lower quality of life, as well as higher rates of burnout among HCWs.

“The most common examples of PMI we saw were individuals being expected to do things that made them feel unsure about their participation,” said Keith Meador, MD, ThM, MPH, professor of Psychiatry and Health Policy, director of the Vanderbilt Center for Biomedical Ethics and Society, and author of the report published in the Journal of General Internal Medicine.

Due to the complexities of the ongoing pandemic, “in the context of health care, this may manifest as being unable to provide the level of care desired.” As a result, HCWs were vulnerable to the consequences of potential moral injury and lower mental health quality, as seen in post-9/11 veterans. “

Meador has collaborated with colleagues to identify potential areas for improvement in the mental health of HCWs. Collaboration between chaplains and mental health providers is one area that has shown promising results.

Meador’s work has primarily focused on preparing chaplains to be knowledgeable and aware of PMI in health care and military settings. People often begin to question their sense of self on the front lines of both hospitals and wars.

Even if a person doesn’t believe in God, they often ask chaplains about how their professional identity and sense of purpose work together.

Meador, along with Jason Nieuwsma, Ph.D., adjunct associate professor in the Practice of Integrative Chaplaincy at Vanderbilt Divinity School and associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, and the paper’s first author, have established a Doctor of Ministry program at Vanderbilt that trains chaplains in evidence-based practices to care for people with PMI.

“These findings send a clear message about how stressful the last few years have been for our healthcare workers and the importance of mindfulness in dealing with those issues in order to best support them,” Meador said.

We’re working to alleviate moral suffering and increase resilience. In order to support healthcare workers, we must use a variety of preventative and primary interventions. “