Examining the nature and consequences of moral injury in frontline nurses during COVID-19
Project Description:
Addressing causal factors of nurse turnover is imperative in the maintenance of a healthy workforce and community. Approximately 33% of registered nurses leave the profession in the first five years1 and the U.S. Bureau of Labor Statistics projects a deficit of 1 million nurses by 20262. These statistics were released before the COVID-19 pandemic, which has taken a tremendous toll on frontline nurses. The role of burnout has been well studied as a factor in nurses’ exit from practice3; however, this literature suggests that individual characteristics alone contribute to nurse turnover and neglects the impact of moral dilemmas that nurses face in the workplace. We believe that moral injury, a relatively new construct in the trauma literature, best captures the psychological and occupational impact of the challenges that nurses face. Moral injury refers to psychological reactions that occur after perpetrating, failing to prevent, or bearing witness to events that transgress one’s deeply held moral beliefs and expectations4. What is known about morally injurious events is that they occur in high stakes (e.g., life-or-death) situations in which contextual factors (e.g., chaos, power and rank) affect in- the-moment decision making and the moral appraisals that individuals make regarding these events5. The COVID-19 pandemic has created fertile ground for morally injurious events to occur among frontline nurses, particularly in under-resourced areas due to the outstripping of medical resources. In collaboration with Sharp HealthCare, the proposed study will use a longitudinal mixed-methods approach to establish 1) what experiences contribute to moral injury, 2) the environmental and psychological conditions that increase risk for morally-injurious workplace events, and 3) how morally injurious workplace events affect psychological and occupational outcomes among frontline nurses during the COVID-19 crisis. This project will lay the groundwork for the development of a novel intervention aimed at preventing moral injury among frontline nurses.
The Impact of COVID-19 on School Nurses and School Health Services
Project Description:
School nurses (SNs) are the school health care providers charged with advancing student well- being and academic achievement. 1,2 Grounded in public health, the school nurse role encompasses broad responsibilities that support student health: emotional, behavioral, physical, and social. 1 All California public SNs must be licensed by the California Board of Registered Nursing, have a bachelor’s degree, and state school nurse credentialing.
In response to the COVID-19 crisis, CA schools closed March 2020. 5 Schools rapidly shifted to remote learning, requiring significant adjustments to this new “lifestyle”, and associated uncertainties. School nurses had to pivot their focus to COVID-19 related functions, to ensure the safety of the students/school community.
The overall purpose of this project, to be carried out through a new collaboration between UCI and School Nurses of California Foundation (SNOCF), is to describe the impact of COVID-19 on California school nurses and school health services. Questions to be addressed are: 1) How does the role of the SN mitigate the impact of COVID-19 on the health and academic challenges of students, families, and staff; 2) What are the unique and vital skills of SNs that no other school employee can perform; 3) What is the SN involvement in pre/current/ongoing COVID-19 mitigation — plans/protocols, implementation, outcome metrics, and strategy modification; and, 4) How are SNs coping with their own health/safety? This study will inform on the gap of the perspective of school nurses on the differences between their pre-COVID-19 core responsibilities and additional COVID-19 functions. It is also aligned with the SNOCFs mission to improve the well-being of California students and school communities. Most importantly, this study will foster the collaboration between UCI and SNOCF and establish the infrastructure for joint data collection and analysis critical for future studies.
PrisonPandemic: Capturing Stories of People Incarcerated in California’s Prisons
Project Description:
COVID-19 is spreading rapidly in prisons across our communities. In California prisons, home to one of the nation’s largest prison systems, there have been nearly 20,000 COVID-19 cases and 86 deaths. In California’s San Quentin State Prison, the site of the second largest cluster in the country, more than 70% of people incarcerated have tested positive. Nationally, the largest outbreaks of COVID-19 cases are occurring in prisons and jails.
Yet there are no systematic accounts of how prisoners, their loved ones, and the staff and officers who work in prisons are experiencing this public health crisis. In fact, widespread lockdowns and outside visitor prohibitions have cut off prisoners from most outside contact. We will create a digital archive to bring greater transparency to the COVID-19 crisis in prisons. The archive will serve as a resource for understanding the pandemic’s unequal toll.
COVID-19 in prisons is a crisis. First, this is a public health crisis. Prisons are overcrowded, under-resourced, and house individuals with high rates of underlying health conditions. Second, this is a mental health crisis. The stress of enduring COVID-19 in prison is amplifying depression and anxiety among the vulnerable. Third, this is a racial justice crisis. Those incarcerated are disproportionately people of color, exacerbating racial disparities in health. Fourth, this is a community crisis. People in prison are family members, and more than 95% will return to their neighborhoods. People working in correctional facilities cycle back and forth, spreading COVID-19 beyond prison walls.
We are applying for capacity-building funds to pay our community partners. These funds will allow us to maintain a relationship with VNON, a non-profit that will help us do outreach to collect narratives from incarcerated individuals and connect us to other nonprofits. It is critical to compensate our community partners for their time.
