The Relationship between Shame and Guilt Proneness, Moral Injury, Professional Role, Self-compassion and Post-Traumatic Stress Symptoms in Critical Care Healthcare Professionals During Covid-19.

Paper one is a literature review that explores the experiences of UK healthcare professionals who provided direct care to Covid-19 patients. Twelve papers were identified following a systematic search of the literature. The papers were thematically synthesised and identified four main themes: ‘Safety Compromised’, ‘Trauma Experiences’, ‘Professional Identity’ and ‘Compromised Care’. The review highlighted factors which increased levels of distress including experiencing high death rates, fears for safety, poor leadership, uncertainty, moral dilemmas, and challenges in providing adequate patient care. Professional commitment and strong team cohesion were highlighted as key to coping during Covid-19. Methodological quality varied, however most studies were found to be of high quality. Clinical implications and recommendations for further research are discussed. The second paper describes a cross-sectional study which explored the relationship between exposure to moral injury, self-compassion, professional role, shame and guilt proneness and post-traumatic stress symptoms (PTSD) in healthcare professionals who provided direct care during Covid-19. Fifty-six healthcare professionals were recruited for the study. Multiple regression analyses and a mediation analysis were conducted. The results suggest that lower levels of self-compassion predict higher levels of PTSD, none of the other predictors were significant. Self-compassion was found to mediate the relationship between exposure to moral injury and PTSD symptoms. Therefore, exposure to moral injury increases PTSD symptoms, through lower levels of self-compassion. The findings suggest that self-compassion-based interventions may be beneficial for individuals and organisations to manage experiences of PTSD symptoms. Clinical implications and recommendations for future research are discussed. Paper three is an executive summary of the research study carried out in this thesis and is written for healthcare professionals in critical care as well as senior leaders and professionals who may provide psychological support to healthcare professionals. This paper was created in consultation with individuals from critical care who provided care during Covid-19.