Interventions for Addressing Moral Distress and Moral Injury in Long-Term Care Staff: A Scoping Review

Abstract

Context: The mental health of staff working in long-term care (LTC) homes is a major concern. Moral distress (and the more severe ‘moral injury’) may occur when staff perpetrate, bear witness to, or fail to prevent an activity that is incompatible with their own moral beliefs. The frequency of moral distress and moral injury has increased during the COVID-19 pandemic and may lead to burnout. Objectives: The purpose of this scoping review was to examine interventions to alleviate moral distress and moral injury in LTC staff. Method: Five databases were accessed through the University of Waterloo Library and searched for English research articles published between 2000 and 2023. Search terms included: moral distress, moral injury, PTSD, long-term care, intervention, and treatment. Findings: The initial search revealed 349 articles; 145 duplicates were removed. Thirty-four articles underwent full-text review, three were included. The reference sections of these papers were hand-searched, revealing 61 potential papers; 23 duplicates were removed. Fourteen of these articles underwent full-text review, three were included. Review of the final six papers revealed interventions focussed on resources for LTC staff to address moral distress and reflect on ethical decision-making. Interventions were shown to reduce the impact of moral distress and assist in ethical decision-making. Implications: The scoping review revealed very few existing interventions for moral distress and moral injury in LTC staff. We must act quickly and proactively to address the potential ‘second pandemic’ of mental health concerns in health human resources, including interventions specific to those working in LTC.

Keywords

• long-term care
• moral distress
• moral injury
• intervention
• treatment