Development and validation of the Moral Injury Symptom Scale - Clinician Version - Short Form (MISS-CV-SF).

BACKGROUND: Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy. OBJECTIVE: To develop the Moral Injury Symptom Scale - Clinician-Short Form and validate it among United States based acute care nurses. . METHODS: The Moral Injury Symptom Scale - Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve. RESULTS: Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. . CONCLUSIONS: The Moral Injury Symptom Scale - Clinician Version - Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations. .

A Rapid Review of the Effects of the COVID-19 Vaccine Among Individuals Taking Clozapine.

BACKGROUND: The COVID-19 pandemic prompted the rapid development of vaccines to combat the virus. Several COVID-19 vaccines have proven effective in preventing infection, hospitalization, and death. Vaccination has been especially recommended for vulnerable populations, such as individuals with psychiatric illnesses who face increased risks due to comorbidities and socioeconomic factors. This rapid review identifies and analyzes the effects of COVID-19 vaccines among individuals taking clozapine. METHODS: The review included articles from PubMed, OVID, Clinical Key, Web of Science, and Google Scholar, published between September 2020 and December 2023. Inclusion criteria were peer-reviewed journals, English language, patients on clozapine receiving a COVID-19 vaccine, and documented vaccine-related adverse effects. RESULTS: Twelve articles were included, consisting of 8 case reports, 1 cross-sectional study, and 3 prospective observational studies, involving 298 subjects, with 9 subjects from case reports. After the first vaccine dose, 27 of 248 subjects experienced adverse effects, with 1 case report advising a temporary halt and dose reduction of clozapine. The subject in this case was admitted in a delirious state 4 days after vaccination with repeated falls and urinary incontinence; active infectious and neurologic etiologies were ruled out. Second dose data were available for 261 subjects, with 31 reporting adverse effects. Adverse effects included hematological changes, delirious state, seizures, and fever. CONCLUSIONS: The review suggests that individuals on clozapine receiving COVID-19 vaccines may experience adverse effects. Clozapine levels and immune system interactions should be monitored in these cases.