South Africa

Coping with the realities of moral injury

Executive: Operations
Charisma Healthcare Solutions
4 mins

The Covid-19 pandemic has been like nothing any of us have ever experienced before. It’s been traumatic for populations around the world, but for healthcare workers there has been an additional toll.

In the early days of the pandemic, as frontline workers, many of you may have isolated yourselves from your loved ones or spent long hours on your feet in hospitals and facilities that were unequipped to deal with a flood of Covid-19 patients. Double shifts become the norm as beds filled up. You faced extraordinary challenges in response to shifting protocols, shortages of resources,  triage and the shocking numbers of patients who required care in expedited time constraints.

Everyone in the healthcare sector has felt the fears associated with contracting Covid-19 and bringing it home to families and loved ones. For many months, exhaustion became a way of life. For nurses, managing your mental health and psychosocial well-being became more important than ever as stress and anxiety soared. 

But there is another element that has been placing a large and unprecedented strain on nurses – the realities of moral injury.


From patient-centred to public health care

During the successive waves of the pandemic that we faced, nurses worked long, arduous shifts for extended periods, surrounded by Covid-19 and overwhelmed by the massive number of patients needing care. This alone would have been overwhelming, but what made it worse was the severity of the crisis.

To protect the public as a whole, patient care shifted overnight from patient-centred ethics to public health ethics. Suddenly, instead of following all of your training and empathy telling you to put patient care first, you had to leave patients unattended to serve other patients who were more vulnerable. PPE often meant patients couldn’t see your face and, to add to everyone’s trauma, no family or loved ones were able to visit. Your patients were isolated during their most vulnerable moments, and you were unable to help them. By necessity, the needs of the many had to take precedence over the needs of individuals, even while you all worked hard to save lives.

It’s a moral and ethical dilemma that was completely out of the control of healthcare workers and it has caused significant and ongoing trauma, mainly because most of the decisions made by nurses throughout the pandemic have run against the values instilled by modern patient-centred medicine.


Coping mechanisms to manage the impact of moral injury

If you believe you are suffering from the impact of moral injury, the first and most important step is to recognise that you are not alone. The feelings of stress, anxiety and even guilt that you may be feeling are by no means a reflection that you cannot do your job or that you haven’t done everything you can for patients under the circumstances. However, it’s essential that you focus on your mental health – many nurses are suffering from PTSD and we need to collectively recognise the level of support that nurses need in the wake of the pandemic.


Here are a few strategies you can begin implementing today.

1. Build moral resilience

Moral resilience is the courage and confidence to confront distressful and uncertain situations by following and trusting values and beliefs. Like any mindset or habit, the more you work it, the stronger it will become. Remind yourself why you became a nurse and the vital role you play in patient care. When you feel overwhelmed, go back to your basic values and beliefs. The key is to be mindful of how you are feeling. This will allow you to think positive thoughts and to maintain perspective, even when things feel completely out of control. Being mindful has been proven to help nurses reduce their distress, anxiety, fear, and helplessness as a result of the trauma of Covid-19 clinical settings.

2. Focus on self-stewardship

Self-stewardship is the skill of nurturing one’s own well-being. This may sound obvious, and yet many of us in the nursing profession focus far more on patient well-being than our own health and wellness. However, if you focus on your physical and mental health, you will naturally be more equipped to help patients. In the context of moral injury, mental wellbeing will help you to contextualise the ethical dilemmas of patient-centred care versus public health ethics, allowing you to appreciate that you are doing nothing ‘wrong’ by following public health guidelines.

3. Develop healthy ways to cope with stress 

Take breaks from work, eat healthy foods, exercise, and socialise with friends and family. Do not use drugs and alcohol as a way to cope. Instead, reach out to colleagues and loved ones and share your experiences. Actively listen to others and ask for help when you need it. It’s also important to take time every day to do things you enjoy.

4. Watch for signs of burnout and stress 

These can include poor hygiene, depression, irritability, fatigue and frustration, to more serious signs of being worried too much or easily startled, and having nightmares. One way to watch your own mental well-being and that of your colleagues is to set up a buddy system where you share concerns, talk about stress, watch over each other’s safety and focus on well-being.

Dealing with long-term trauma

We are only beginning to understand the long-term impact of the pandemic. The more we learn, the more we will be able to support each other and heal, together. At Charisma, we are proud of the incredible caregivers that make up our business and we will continue to shine a spotlight on the issues impacting nurses and the healthcare sector.


Charisma nurses and support staff are thoroughly screened and evaluated to ensure they are work-ready thereby offering safe and quality patient care. We understand that each and every client’s needs are unique. View our Healthcare solutions here!

As leaders in workforce solutions, our insights by Adcorp are designed to help businesses grow through their most valuable resources: their people.

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Executive: Operations
Charisma Healthcare Solutions

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