Moral injury describes a type of psychological distress that can occur when a person’s deeply held moral beliefs and values are violated or compromised. It can occur when people are faced with situations that challenge their sense of right and wrong. In the context of healthcare, moral injury can occur when individuals are asked to make decisions that conflict with their moral or ethical values, or when they witness or are involved in events that violate their sense of what is right.
Some signs of moral injury may include:
Feelings of guilt, shame, or anger.
Self-doubt or questioning one’s competence.
Avoidance or withdrawal from patients or colleagues.
Depression, anxiety, or other mental health issues.
Increased substance use or other risky behaviours.
Loss of meaning or purpose in work.
There are several factors that can lead to moral injury including:
Exposure to traumatic events or situations.
Organisational policies or cultures that prioritise profit over patient care.
Pressures to prioritise productivity over quality care.
Witnessing or being involved in events that violate one’s moral or ethical values.
Feeling powerless or unsupported in advocating for patients.
Strategies to managing moral injury may involve:
Acknowledging and addressing the factors that contribute to moral injury.
Access opportunities to process and debrief about traumatic events or situations.
Creating supportive and transparent organisational cultures that prioritise patient care.
Encouraging self-care and seeking help from mental health professionals.
Promoting peer support and mentoring programs.
Reaching out to others. Shame and guilt are often two emotions central to moral injury. We tend to withdraw when we feel this way, when reaching out and connecting with others will be helpful.
Managing moral injury may be a long-term process, and individuals may need ongoing support and resources to prevent and manage moral injury over time.