Working with hospital-based staff wellbeing professionals to address moral distress and moral injury amongst healthcare staff
Lead Research Organisation:
University of Manchester
Department Name: Law
Abstract
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.
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.
| Title | Taking heads: moral harm |
| Description | Videos explaining individuals' experiences of moral harm. • ICU Nurse: An experienced paediatric intensive care unit (PICU) nurse providing 1:1 care. • Consultant Obstetrician: A consultant obstetrician dealing with a patient with a significant cardiac condition who becomes pregnant against medical advice. The scenario highlights the pressures of busy clinics and rushed MDT meetings, leading to feelings of isolation and imposter syndrome. • Mental Health Support Worker: A support worker on a low-secure ward dealing with a no-smoking policy and the provision of vapes as an alternative, and moral discomfort around the limitations of the policy. • Hospital Porter: A porter involved in a major incident with multiple casualties, including children. The scenario focuses on the distress of having to remove a deceased child from grieving parents due to hospital protocol. • F1 Doctor: A junior doctor experiencing moral distress due to the inability to practice in line with training and expectations, leading to a sense of constant failure and ultimately leaving the profession. The registrar's dismissive response ("get used to it, this is normal, toughen up") exacerbates the distress. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2025 |
| Impact | The videos have just been made and will be upload in March 2025. |
| URL | https://www.socialsciences.manchester.ac.uk/research/projects/reset-ethics/#:~:text=written%20and%20... |
| Description | This is a one-year dissemination and public engagement initiative aiming to raise awareness and understanding of moral distress and injury amongst hospital-based wellbeing professionals. The project seeks to build a community of practice and produce web-based resources to support these professionals in helping healthcare staff dealing with moral distress and injury. The project uses a co-creation approach, involving stakeholders in the development of resources. Project Activities & Deliverables • Co-creation Group Meetings: we have held a series of meetings involving stakeholders (including wellbeing professionals, academics, and NHS staff) to co-create resources and training materials. • Short Videos: The project is developing a series of short "talking head" videos featuring fictional scenarios, aiming to help staff recognize moral distress and encourage them to seek help. The videos will address the following topics: • "It's not just you, moral distress can happen to anyone" • "Don't suffer alone, how I reached out for help" • "What my organisation did to tackle moral distress" • "My experiences of supporting colleagues with moral distress" • "Why I left the NHS" • Actor Briefs: Detailed briefs are being created for actors to improvise the videos, outlining character backgrounds, scenarios, and key messages. • 'Ethics Language' Explainer/Training Materials: Accompanying materials will be developed to help distinguish moral harm from other forms of distress. • Web-Based Resources: A freely available website will be created, hosting resources to support NHS wellbeing professionals and workers. This may include Q&A formats, stories/vignettes, podcasts, videos, and articles. • Training Facilitator Guide & PowerPoints: Materials will be developed to support training on moral harm. Illustrative Scenarios: The project uses several scenarios to illustrate the complexities of moral distress: • ICU Nurse: An experienced paediatric intensive care unit (PICU) nurse providing 1:1 care. • Consultant Obstetrician: A consultant obstetrician dealing with a patient with a significant cardiac condition who becomes pregnant against medical advice. The scenario highlights the pressures of busy clinics and rushed MDT meetings, leading to feelings of isolation and imposter syndrome. • Mental Health Support Worker: A support worker on a low-secure ward dealing with a no-smoking policy and the provision of vapes as an alternative, and moral discomfort around the limitations of the policy. • Hospital Porter: A porter involved in a major incident with multiple casualties, including children. The scenario focuses on the distress of having to remove a deceased child from grieving parents due to hospital protocol. • F1 Doctor: A junior doctor experiencing moral distress due to the inability to practice in line with training and expectations, leading to a sense of constant failure and ultimately leaving the profession. The registrar's dismissive response ("get used to it, this is normal, toughen up") exacerbates the distress. Next Steps The project is developing resources and training materials based on feedback from the co-creation group. Dissemination of these resources will be key to achieving the project's objectives of raising awareness and supporting NHS staff experiencing moral distress and injury. To this end a face-to-face dissemination meeting is planned for March 2025. |
| Exploitation Route | The project will develop web-based resources such as short guides, podcasts, and animations. The resources and materials are designed to be accessible and beneficial for all communities, recognizing that different backgrounds may influence perceptions and help-seeking behaviours. The outputs are aimed at hospital well-being staff who support those in their hospital, such as clinical psychologists, chaplins, and other well-being team members. |
| Sectors | Healthcare |
| URL | https://www.socialsciences.manchester.ac.uk/research/projects/reset-ethics/#:~:text=written%20and%20published.-,Reset%20Ethics%20follow%2Don%20work,moral%20injury%20amongst%20healthcare%20staff. |