Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic

Andrea M. D’Alessandro-Lowe, Mauda Karram, Kim Ritchie, Andrea Brown, Heather Millman, Emily Sullo, Yuanxin Xue, Mina Pichtikova, Hugo Schielke, Ann Malain, Charlene O’Connor, Ruth Lanius, Randi E. McCabe and Margaret C. McKinnon ()
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Andrea M. D’Alessandro-Lowe: Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 4L6, Canada
Mauda Karram: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Kim Ritchie: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Andrea Brown: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Heather Millman: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Emily Sullo: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Yuanxin Xue: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Mina Pichtikova: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Hugo Schielke: Homewood Health Centre, Guelph, ON NIE 6K9, Canada
Ann Malain: Homewood Health Centre, Guelph, ON NIE 6K9, Canada
Charlene O’Connor: Homewood Health Centre, Guelph, ON NIE 6K9, Canada
Ruth Lanius: Homewood Research Institute, Guelph, ON N13 6K9, Canada
Randi E. McCabe: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
Margaret C. McKinnon: Homewood Research Institute, Guelph, ON N13 6K9, Canada

IJERPH, 2023, vol. 20, issue 19, 1-17

Abstract: Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six ( N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI ( p ’s < 0.001), shame-related MI ( p = 0.03 and p = 0.02, respectively) and trust-violation-related MI ( p ’s < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history ( p = 0.02) and self-compassion ( p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees.

Keywords: moral injury; healthcare providers; coping; supports; COVID-19; spirituality; organizational support (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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