It is human nature to take access to excellent health care for granted. Citizens of the Western world are more likely to have better and quicker access to medical care than in poor and developing countries.
The United States spends almost 17% of its annual GDP on its health care network.
And the United States has access to more innovative and expensive medical equipment than most other countries.
According to a World Health Organization quality of health service fact sheet released in July 2020, over 8.4 million people living in poor and developing countries die every year due to non-access or access to poor quality health services.
And the average American life span is about 77 years.
A lot of caveats can be applied to these statistics upon further viewing. For example, many Americans seek treatment for extremely preventable medical conditions and diseases.
But the point is that deep in the moral fiber of every American is the right that they deserve speedy access to quality health care.
And yet, who cares about the morals or moral injuries heaped upon the medical professionals tasked with providing quality health care to patients who take it for granted?
Doctors, nurses, and medical staff are trained to leverage knowledge, skill, and emotion accordingly when doing their jobs. But what to do when an innate moral code or strictly observed set of beliefs clashes with a life and death medical circumstance?
Should moral injuries amongst health care workers be ignored or minimized for the public good? What about the accumulated psychological trauma of moral injuries on health care workers and the long-term effects on their vocational viability?
And how to mitigate the issues that moral injuries afflict on health care workers?
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Related: OptiMed Hospitalists – Our Story
What is Moral Injury?
A moral injury is a deeply psychological, emotional, and spiritual trauma that occurs when choices or experiences irrevocably clash with a person’s moral and ethical beliefs.
Moral injuries occur in high-intensity situations when urgent quality health care decisions and actions must be decided as possible to ensure a positive medical outcome. And moral injury occurs when a health care provider has to choose a medical course of action that deeply clashes with a personal moral code.
And when it comes to pain, a psychological and emotional injury can be just as grievous a physical injury. A moral injury is a deep transgression or betrayal of a moral code or personal ethics espoused by a health care worker.
The aftereffects of a moral injury can include intense feelings of anger, shame, anxiety, sadness, guilt, and helplessness. Health care workers suffering from moral injuries can start to feel intensely bad about themselves and lose faith in themselves, their talents, and the health care system that they serve.
Health care workers suffering from moral injuries can become deeply depressed, angry, or resentful of the psychological burdens they have to bear around colleagues and in a system that they feel betrayed them.
The term “moral injury” was first coined to describe soldiers returning from war who were psychologically scarred by perpetrating, failing to prevent, or witnessing acts in the horrors of war. Terms like “shell shock” and “PTSD” replaced “moral injury” within this context, and the word was later applied to professionals with psychological and emotional troubles in health care.
And a moral injury is not “burnout.” Burnout is exhaustion, deep cynicism, and other factors that result in reduced professional activity. A moral injury injures health care professionals to their moral core and can cause such irreparable damage that their professional usefulness becomes non-viable.
Possible Sources of Moral Injury for Health Care Workers
To understand the possible sources of moral injury in health care workers, we must first examine what it takes to become a health care worker.
It can take up to 14 years to earn a physician’s doctorate at the cost of $37,000 to $60,000 annually. And it can take anywhere between two to four years to become a registered nurse.
Health care workers treat their vocation as an altruistic calling to help sick people, not just earn a check. Health care workers spend years studying, losing sleep, apprenticing, and experiencing unstable personal lives to perfect their medical skills and craft.
Being a health care worker is an identity of pride, not just a career vocation. And just like a soldier of war who witnesses his colleagues perpetrate a crime but stays silent about it, a moral injury can make health care workers question their hard-earned identity and usefulness.
So, what are some examples of moral injuries?
The act of emergency triage, where medical care and resources are tightly rationed and reserved only for the youngest or most healthy patients, can cause moral injury. When triaging, health care professionals decide who will die, even if in a de facto manner.
Many hospitals are installing automation to compile patient records to mitigate potential lawsuits. Health care workers now deal with so much paperwork and bureaucracy that face-to-face time is reduced. Less patient interaction could cause mistakes that harm patients.
Health care providers without sufficient PPE must decide whether to risk catching Covid-19 or watch people die.
There is no one type of moral injury and no one way that it afflicts health care workers.
Supporting Health Care Workers
Several preventative methods can be used as diagnostic tools to help health care workers suffering from moral injury. And preventative medicine can also be used to diagnose moral injury before it worsens.
Primary Prevention
Primary prevention is the diagnostic process of training and preparing staff for role-specific support positions. Supervisors should be trained to be cognizant of the psychological welfare of colleagues and staff.
Secondary Prevention
Secondary prevention of moral injury involves psychologically knowledgeable supervisors adept at active listening and professionally discussing issues with staff.
Active listening involves:
- Listening to others without interruption or holding judgment.
- Watching out for non-verbal expressions and microaggressions.
- Asking pointed questions based on what was said.
Active listening is listening to comprehend another person’s point of view instead of just obliviously waiting to have your say.
Active listening can help supervisors surmise that a staff member needs mentoring, retraining, time off from work, or psychotherapy based on the circumstance.
Basic Needs
Supervisors and managers should ensure that the basic needs of staff are taken care of in the workplace.
This could include:
- Mandated rest breaks
- Reasonable work shift patterns
- Access to plentiful equipment
- Access to supportive services
Debriefing
Operational debriefings based on workplace occurrences can help supervisors, managers, and staff alike reflect on what has occurred and potentially prevent moral injuries.
However, it is essential for supervisors not to engage in psychological debriefings as they may invade privacy and cause more harm than benefits.
Self-Care Strategies to Reduce Moral Injury
The best defense against moral injury is continual self-confidence and self-awareness of one’s psychological being.
And to ask for help when it is needed.
However, asking for help can be hard to do for health care workers. Being a health care worker is an identity that demands selflessness and aiding others in need. And having such an identity may make it hard to ask for help.
Health care workers should also accept that they are human and can’t do everything themselves. And that they do not and should not work in a vacuum – there may be an option to consider that does not result in moral injury.
And modify self-expectations of worth and abilities when it comes to work. There is no future in despair – stay confident and cognizant of feelings.
Support From Coworkers
Coworkers should reach out to colleagues who may be emotionally struggling with moral injury.
Some people may not be open to admitting their psychological or moral struggles, especially health care workers. So, coworkers should be patient and ensure that they are always available to talk when needed.
Support From Leaders
Leaders can be more supportive by actively listening to staff, being available when needed, and attentive to possible signs of moral injury.
Most importantly, leaders should have the contact information of support services at the ready when needed.
Final Thoughts
It is human nature for patients to take the high-quality care they receive from health care workers for granted.
However, health care leaders and supervisors should never take the psychological well-being of themselves or staff for granted. The best defense against moral injury is usually a preventative offense.
Contact OptiMed Hospitalists today to consult our medical professionals about our brand of relationship-based medical care.