Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK.
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
Int J Environ Res Public Health. 2022 Aug 4;19(15):9593. doi: 10.3390/ijerph19159593.
(1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual's moral beliefs and elicits adverse emotional responses. (2) Method: A systematic review was conducted to explore the prevalence, predictors, and psychological experience of MI and MD in the aforementioned population during the COVID-19 pandemic. The databases CINAHL, APA PsychINFO, APA PsychArticles, Web of Science, Medline, and Scopus were systematically searched for original research studies of all designs, published in English, with no geographical restrictions, and dating from when COVID-19 was declared a public health emergency on the 30 January 2020 to the 3 January 2022. Out of 531 studies screened for eligibility, 8 studies were selected for review. A thematic analysis was undertaken to examine the major underpinning themes. (3) Results: MI, MD, and related constructs (notably secondary traumatic stress) were evidenced to be present in staff, although most studies did not explore the prevalence or predictors. The elicited major themes were resource deficits, role challenges, communication and leadership, and emotional and psychosocial consequences. (4) Conclusions: Our findings suggest that moral injury and moral distress were likely to be present prior to COVID-19 but have been exacerbated by the pandemic. Whilst studies were generally of high quality, the dearth of quantitative studies assessing prevalence and predictors suggests a research need, enabling the exploration of causal relationships between variables. However, the implied presence of MI and MD warrants intervention developments and workplace support for nursing and care home staff.
（1）背景：在 COVID-19 大流行期间，护理和养老院的工作人员经历了老年居民死亡率上升和职业及心理社会压力增加。该文献之前发现，该群体有出现心理健康问题、道德伤害（MI）和道德困境（MD）的风险。后两个术语是指感知到的违反个人道德信仰并引起负面情绪反应的道德不当行为。（2）方法：系统综述旨在探索在 COVID-19 大流行期间，上述人群中 MI 和 MD 的流行率、预测因素和心理体验。系统地搜索了 CINAHL、APA PsychINFO、APA PsychArticles、Web of Science、Medline 和 Scopus 数据库中的所有设计的原始研究，以英语发表，无地理限制，时间范围从 2020 年 1 月 30 日 COVID-19 被宣布为公共卫生紧急事件到 2022 年 1 月 3 日。在筛选出的 531 项合格研究中，有 8 项研究入选进行综述。采用主题分析方法检查主要的基础主题。（3）结果：尽管大多数研究并未探讨流行率或预测因素，但研究表明，工作人员中存在 MI、MD 和相关结构（特别是继发性创伤应激）。得出的主要主题是资源短缺、角色挑战、沟通和领导以及情绪和心理社会后果。（4）结论：我们的研究结果表明，在 COVID-19 之前，道德伤害和道德困境可能已经存在，但大流行加剧了这种情况。虽然这些研究总体质量较高，但缺乏评估流行率和预测因素的定量研究表明存在研究需求，这可以探索变量之间的因果关系。然而，MI 和 MD 的存在暗示需要为护理和养老院工作人员制定干预措施和提供工作场所支持。
