| dc.description.abstract | SYSTEMATIC REVIEW:
Background: Experiences of moral distress in mental health workers may lower
their wellbeing, contributing to staffing shortages which negatively impact on the
quality and safety of service delivery and patient care. Attempts to alleviate
moral distress by enhancing the resilience of individual workers overlook the
fundamentally relational and power-based nature of workplace ethics. There is
a need to understand how mental health workers can be supported to cope with
moral distress. This systematic review sought to address the question: What
does the qualitative literature tell us about how mental health workers
experience and cope with moral distress?
Methods: To be included in the systematic review, a study had to (i) involve
mental health workers as sole participants (ii) who talked about their
experiences of coping with moral injury or moral distress, (iii) use qualitative
data collection and analysis methods, (iv) be published in the English language,
and (v) be an empirical piece of academic research. Databases were searched
on 15th of April 2022 (OVID Medline, OVID PsychInfo, OVID APA PsycExtra,
Scopus and Web of Science). The quality of included studies were assessed
using the CASP tool. Results were synthesised using the methodology of
thematic synthesis.
Results: There were 11 studies suitable for inclusion in the review,
encompassing 238 participants working in various mental health roles and
services. All studies were from wealthy developed nations, 10 of which have
predominantly white populations. Thematic synthesis produced two analytical
themes encompassing how mental health workers can be supported to cope
with moral distress: Power Dynamics Exacerbate Moral Distress, and
Collaborative Systems Alleviate Moral Distress.
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Conclusions: Moral distress should be understood systemically, and
interventions should focus on enhancing mental health workers’ moral agency
by modifying the culture of the organisations in which they work.
Keywords: moral distress, mental health workers, qualitative, power, systems
EMPIRICAL PAPER:
Background: Staff shortage problems in the UK social care sector have
impacted the quality of care provided to older people. It has been hypothesised
that care workers are leaving their roles because of the traumatic challenges
they experienced during the COVID-19 pandemic, which may have led to an
experience of moral injury (MI), an underdefined concept which has
considerable overlap with the concepts of burnout and PTSD. Whilst pandemicrelated MI received considerable attention in healthcare workers, it was yet to
be investigated in social care workers, despite them seeming to have faced
similar Potentially Morally Injurious Events (PMIEs). This qualitative study
aimed to understand how carers experienced pandemic-related PMIEs.
Methods: Sixty-five participants with experience of directly providing care to
older people as a care worker in a UK residential care home from March 2020
onwards were recruited through social media, and screened for exposure to
PMIEs. Six participants with high PMIE exposure completed online semistructured interviews exploring their experiences. Interview transcripts were
analysed using interpretive phenomenological analysis.
Findings: Three overarching themes were developed: 1) A Thankless Sacrifice;
2) Powerless yet Responsible; 3) Disappointed and Abandoned by People with
Power. In all three themes, participants’ experiences encompassed strong
moral emotions, unhelpful power-dynamics, and other interpersonal challenges.
Findings indicated that some carers had more distressing experiences of PMIEs
than others.
Discussion: Findings emphasised the unique relational phenomenology of the
MI experience, thereby differentiating the concept from burnout and PTSD.
Although moral injury remains conceptually fuzzy, the construct provides a
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useful new frame for understanding the unique phenomenology of care workers’
experiences during the pandemic.
Keywords: moral injury, moral distress, social care workers, carers, IPA | en_GB |
