Working with hospital-based staff wellbeing professionals to address moral distress and moral injury amongst healthcare staff

There was heightened recognition of the importance of healthcare staffs' wellbeing during the Covid-19 pandemic. One area that has been of particular concern is the increasing incidents of moral distress and moral injury amongst healthcare staff. Discussion of moral distress and injury amongst healthcare staff increased substantially during the Covid-19 pandemic. A British Medical Association survey of its members in 2021 found that for 78.4% of respondents' moral distress resonated with their experiences at work and 51.1% said the same about moral injury. Moral injury has been seen as 'one of the greatest challenges reported by UK NHS frontline hospital staff.'

Operationally, the NHS is now 'living with Covid-19', which involves continuing infection control measures, dealing with new surges in Covid-19 admissions, and managing the backlog of elective care. This shift from pandemic to endemic Covid-19 has occurred against an economic backdrop of austerity and ongoing funding restrictions. All these factors have resulted in increased and sustained pressure on NHS staff. In this context, experiences of moral distress and moral injury are continuing and are likely to become more prevalent, with the potential to (further) negatively impact standards of patient care, and healthcare staff wellbeing and retention.

This follow-on-funding proposal is based on our UKRI AHRC Reset Ethics Project. This project identified that NHS hospital staff working in the pandemic were frequently exposed to circumstances that resulted in moral distress, due to their ongoing inability to carry out professional duties to what they saw as a morally acceptable standard. The provision of acceptable or optimal care was hampered by social distancing, personal protective equipment, and changes in service provision. The findings, reinforced by a direct request by clinical psychologists working with hospital staff, identified a need to help wellbeing professionals in hospitals (clinical psychologists, counsellors, welfare teams), collectively referred to here as 'hospital-based wellbeing professionals' to support staff who might be experiencing moral distress and moral injury.

Our aim in this proposal is to disseminate our previous research findings to a new community, hospital-based wellbeing professionals, so that they are better able to support healthcare staff who are experiencing moral distress and moral injury.

We will engage with this new community of users (of our research) to raise awareness and understanding of moral distress and moral injury amongst hospital-based wellbeing professionals. To do this, we will build a community of practice of hospital-based wellbeing professionals concerned with 'supporting healthcare staff experiencing moral distress and moral injury'.

To meet the follow-on-funding project goals, we will undertake the following activities:
Hold four workshops (two face to face and two online) on moral distress and injury amongst healthcare staff for hospital-based wellbeing professionals.
Produce web-based resources to help hospital-based wellbeing professionals to support healthcare staff dealing with moral distress and injury.
Hold a one-day showcase event bringing academic, professional, and policy perspectives together to stimulate debate and research.

These outputs and activities will be designed to increase awareness and provide practical guidance and resources for hospital-based wellbeing professionals in their work with healthcare staff experiencing forms of moral distress and injury. Incidents of moral distress and injury appear to be increasing rather than abating across healthcare systems both in the UK and globally and therefore there will be a large audience for our project outputs.