Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis

Moral Distress as Moral Heuristic Missing the Mark

I propose that moral distress may function as a moral heuristic, and one that misses its mark in signifying a fundamental source for nurses' moral suffering. Epistemic injustice is an insidious workplace wrongdoing that is glossed over or avoided in explicit explanations for nurse moral suffering and is substituted by an emphasis on the nurse's own wrongdoing. I discuss reasons and evidence for considering moral distress as a moral heuristic that obfuscates the role of epistemic injustice as a fundamental constraint on nurses' moral reasoning underlying moral suffering.

When Faith and Health Collide: Expressions of Faith Over the Dangers of COVID-19 by Selected Flagellants in the Philippines

For almost three years, the COVID-19 pandemic seriously affected society. Mass gatherings were restricted during the surge, including religious activities and other public practices. However, some Filipinos opted to continue their panata (sacred vow) of self-flagellation during this health crisis, thus putting themselves at risk of being inflicted with the virus or being a spreader. This article explores the experience of selected flagellants who continued to fulfill their religious practice amid the pandemic. It draws inspiration from their narratives about their personal experiences of how they faced, struggled, and hoped to battle the "unseen" virus and the criticisms of others for what they did. Using interpretative phenomenological analysis (IPA), their interview transcripts elicit three recurrent themes: Suffering leads to finding God for support, sacred vow as unity to Christ's suffering, and spiritual reward over physical pain. These themes can contribute to future research on how opposing parties should negotiate when faith and health conflict.

Using Serenity Rooms and Similar Tools to Improve the Workplace during COVID-19: A Rapid Review

This manuscript examines using serenity rooms and similar tools to improve the workplace during COVID-19 for nurses and other practitioners. A rapid review of the literature was conducted and completed from four different databases, including PubMed, CINAHL, Science Direct, and Academic Search Complete. The literature review was completed with the use of a single-string Boolean search to maximize the number of articles returned. The resulting 14 germane articles yielded six facilitator themes and four barrier themes. Facilitator themes included: benefits, assistive adjuncts, places of relaxation, leadership required, availability, and other effects. Barrier themes included: lacking leadership, concerns regarding lack of space, holistic concerns, and negative perceptions. There is a significant lack of research in the literature in this area. Most of the literature reviewed showed widely positive results for institutions that utilized serenity rooms or similar tools for decreasing nurse and practitioner stress and burnout. The use of these tools improved nurse and practitioner compassion, retention, and resiliency.

Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review

OBJECTIVES

We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings.

METHODS

Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its effects on MHP (consequences) were extracted from the studies.

RESULTS

The majority of studies were conducted in the West (n = 26, 74.3%). Contributors to moral injury were found at the individual (e.g. poor competence), practice setting (e.g. lack of resources), and organizational levels (e.g. inconsistent policies). Moral injury had negative repercussions for the individual (e.g. psychological and physical symptoms), healthcare teams (e.g. lack of trust and empathy), and healthcare system (e.g. staff attrition).

CONCLUSIONS

Seen through the moral habitability framework, interventions must include an acknowledgment of the influence of various factors on the ability of MHP to enact their moral agency, and seek to establish safe moral communities within a supportive moral climate.