The term ‘moral injury’ originated in the military as a way to describe psychological stress caused by events that are interpreted as unjust. In the context of the COVID-19 pandemic, the term is being applied to refer to the emotionally difficult and unique circumstances that healthcare providers are facing, and there is significant concern that these moral injuries may have long-term adverse effects on the healthcare workers who endure them.

To address the growing relevance of these moral injuries among healthcare workers, research is being undertaken to help describe moral injury and its implications and to find ways to identify and potentially treat moral injury. In this vein, a new study has characterized and evaluated a measure for identifying moral injury. Participants included 181 healthcare professionals who were recruited from the Duke University Health System in North Carolina. Of these healthcare providers, 71% were physicians.

The measure that the researchers evaluated – called the Moral Injury Symptom Scale – Healthcare Professional version (MISS-HP) – includes 10 items that measure different aspects of moral injury, including guilt, shame, betrayal, moral concerns, religious struggle, loss of religious/spiritual faith, loss of meaning/purpose, loss of trust, difficulty forgiving, and self condemnation. The scale produces scores ranging from 10 to 100.

Based on their evaluation, the researchers determined that the MISS-HP is both reliable and valid for measuring symptoms of moral injury in healthcare professionals. According to their analysis, the authors of the study concluded that a score of 36 or higher could identify symptoms of moral injury likely to cause moderate to severe problems with social and professional functioning with 84% sensitivity and 93% specificity.

As more research accumulates to determine how to best identify moral injury in healthcare workers, it will become easier to determine how best to mitigate the negative effects of these injuries as well. While there will be clear applications with respect to what healthcare workers have endured with respect to COVID-19, the insights are likely to be relevant in other contexts as well and should provide value to healthcare workers both now and in the future.

References

1. Mantri, S. (2020). Identifying more enjoyment in healthcare professionals: The moral injury symptom scale-HP. Journal of Religious Health. doi: 10.1007/s10943-020-01065-w
2. Santarone K., McKenney M., & Elkbuli, A. (2020). Preserving mental health and resilience in frontline healthcare workers during COVID-19. Am J Emerg Med. doi:10.1016/j.ajem.2020.04.030
3. Greenberg N., Docherty M., Gnanapragasam S., & Wessely S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. doi:10.1136/bmj.m1211