Moral distress and moral injury in the public health workforce during the pandemic
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UK Faculty of Public Health, United Kingdom
University of Applied Sciences Emden /Leer, Germany
University College London, London, United Kingdom
World Federation of Public Health, New Zealand
The Centre for Population Health Sciences, Usher Institute, University of Edinburgh, United Kingdom
EUPHA ethics in public health section, Germany
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1331
Brief Outline:
Moral distress and moral injury are the experience of psychological distress arising from participating in, or witnessing, ethically problematic actions, and the resulting injuries of that distress. Moral distress is said to be “the troubled call of conscience, an expression of fidelity to moral commitments seen as imperiled or compromised”. Feeling ill-prepared or unable to pursue ethically-appropriate action – based on personal integrity or professional obligations – causes moral distress, which can lead to stress, burnout, lack of resilience and mental health issues. The concepts of moral distress and injury were originally described among soldiers during wars and conflict, law enforcement agents, and nurses, with growing interest in their importance in other health professions. Public health professionals routinely face tough ethical decisions and face morally ambiguous situations, and are consequently vulnerable to moral distress. However, to date, this issue has received little attention in the public health arena. The proposed workshop by a multidisciplinary team of researchers and practitioners will share and reflect on their recent robust cross sectional study on moral distress and injury in the public health workforce in the UK during the pandemic. They will outline the scale, nature, frequency, and severity of moral distress in the public health professional workforce during the pandemic and its resulting impact on mental health. There will also be description of a major international longitudinal study among health care workers in hospitals and primary care units in Brazil, Bolivia and Germany considering the issue. It was found that 64% of the public health workforce in the UK had one or more experience of moral distress associated with their own action (or inaction), and 26% reported experiencing moral distress associated with a colleague’s or organisation’s action (or inaction) SINCE THE START OF THE PANDEMIC, AND THAT 14% of those with moral distress, reported MORAL INJURY severe enough to require time off work and/or therapeutic help. The main situations causing moral distress were developing or Implementing National Policy, Guidance and Law, Providing Public Health Advice, and Workplace Relationships and Environments. Moral distress was chiefly precipitated by moral judgements about Having Caused Injury, being Unable to do Good, Dishonest Communications, and Unjust Prioritisation. The researchers will share analysis and insights on possible causes, aggravating factors and impacts in the public health workforce during the pandemic, and options for its prevention, amelioration and care. The workshop will: share recent research and insights on moral distress and injury in the public health workforce and options for its prevention, amelioration and care.Highlight the need to appreciate cultural dimensions and conflicting world views in practicecreate a space sharing knowledge and hearing the insights of the participants as part of interdisciplinary ethical, professional and policy efforts needed to better understand and consider interventions to increase the moral resilience of the workforce.

Key Questions the Workshop Will Address:
What is the nature and impact of moral distress and injury in the public health workforce?What are options for its prevention, amelioration and care?

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