Moral injury refers to the distress resulting from actions (or inactions) that violate a person’s moral or ethical code. It has been seen more frequently among health and social care practitioners during the COVID-19 pandemic and its aftermath, in response to the difficult decisions or actions that many have been obliged to take (Williamson et al., 2020).
It is crucial to raise awareness of the risks of moral injury and encourage people to discuss their feelings. A workplace culture that supports ethical practice is helpful but ensuring that professional psychological support is readily accessible and opportunities for informal support by peers and leaders will also be effective. Practitioners also need to develop ‘moral resilience’ to recognise when their integrity is threatened and be aware of the actions needed to support ethical practice.
There are several ways of increasing moral resilience:
- Preparing people for the moral challenges of healthcare work through frank discussions and realistic training that includes exposure to scenarios such as moral challenges.
- Ensuring that practitioners are aware that, despite their best efforts, undesirable outcomes (e.g. mistakes and deaths) may occur.
- Fostering a culture within which practitioners routinely talk about potentially morally injurious events and the impact on them.
- Encouraging practitioners to define or refine their personal moral compass by considering how they might react in ethically challenging situations they could experience.
- Defining a personal code of ethics: setting this out in writing can be helpful.
- Developing practitioner’s coping skills; for instance cultivating mindfulness to improve focus and mental clarity.
- Helping practitioners enhance self-awareness and understanding that it is necessary to take a step back and adopt a broader perspective following morally challenging situations.
- Developing self-regulation skills to disrupt negative patterns of thinking and behaviour will help to restore balance when difficulties or ethical challenges occur.
For further information see Williamson et al. (2020); Williamson et al. (2021); Rosen et al. (2022)