Violence, Stigma, and Moral Injury in Nursing During the COVID-19 Pandemic: A Qualitative Analysis From 18 Countries in Latin America and the Caribbean.

Workplace violence against nurses and midwives intensified during the COVID-19 pandemic, exposing and amplifying longstanding structural marginalization in health systems across Latin America. This study analyzes how different forms of violence were experienced and described by nursing professionals during this period. A secondary qualitative analysis was conducted using text-based responses from an international online survey developed by the Global Consortium, which included 3860 nurses and midwives from 18 Latin American and Caribbean countries. Data were examined through Descending Hierarchical Classification using IRaMuTeQ, followed by reflective thematic analysis for interpretive integration. The analysis identified five lexical classes, reorganized into three interconnected themes: direct violence related to care delivery and system collapse; stigma, fear, and disruption of social belonging; and ethical-political suffering associated with structural blame, moral suffering, and moral injury. Despite contextual differences across countries, narratives revealed recurring patterns of emotional overload, professional delegitimization, and exposure to multiple forms of violence. These findings position violence against nursing professionals during the pandemic as a structural and multifaceted phenomenon rooted in historical inequities and institutional fragility, underscoring the need for sustained policies that strengthen workforce protection, ethical accountability, and institutional support in both routine healthcare settings and future public health emergencies.