Studying moral distress (MD) and moral injury (MI) among inpatient and outpatient healthcare professionals during the COVID-19 pandemic

BACKGROUND

COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). MD and MI were studied among inpatient and outpatient HCPs during March 2022.

OBJECTIVES

We sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on their background.

METHODS

A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at 2 academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings.

RESULTS

There was a moderate association between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded 8 sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability.

CONCLUSIONS

While interrelated conceptually, MD and MI should be viewed as distinct constructs. HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being and work satisfaction.

Influence of time of feeding on time of parturition in beef cows

The influence of time of feeding pregnant beef cows on the timing of parturition was investigated. The results suggest that the distribution of calvings between 'day' and 'night' can be altered by time of feeding. The calculations, based on a small quantity of data, suggest that feeding at 22.00 would result in 79 per cent of cows calving between 06.00 and 22.00. On the same basis of calculation the traditional 09.00 time of feeding would result in 57 per cent of cows calving during the 'day' period. There appears to be some evidence that by feeding pregnant beef cows in the evening better supervision of calving with a smaller proportion of cows calving at night can be achieved.