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What Healthcare Professionals Need to Know About Moral Injury

Have you been feeling shame, guilt, or disgust when thinking about some of your clinical care over the past year?

Maybe you’ve noticed having more negative thoughts about yourself or your coworkers.

You’re not alone. What you’re experiencing might be moral injury.

What is moral injury?

Moral injury was first identified in military personnel but can occur in other work settings, like healthcare, that place individuals at odds with their ethical principles or beliefs.

The U.S. Department of Veteran Affairs National Center for PTSD defines moral injury as occurring “when someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs.”

Moral injury is not a mental illness. However, moral injury can cause significant emotional distress.

People with moral injury often report shame, guilt, alterations in cognitions and beliefs, as well as maladaptive coping responses.

Ignoring moral injury can lead to more difficulties such as depression, post-traumatic stress, and even suicidal ideation.

Moral injury during the pandemic.

It’s no surprise that moral injury has emerged for many HCPs during the COVID pandemic. Few were fully prepared for how the pandemic impacted taking care of sick people.

The pandemic created various high-stress clinical situations for HCPs:

  • Rationing treatments and procedures.

  • Making clinical decisions out of alignment with core values.

  • Witnessing decisions and practices not felt to be in the best interest of patients.

  • Lack of personal protective equipment.

  • Worries about spreading the virus to loved ones.

  • Providing ineffectual care.

  • Exposure to high patient morbidity and mortality.

  • Inability to allow family to be with their very sick or dying loved ones.

How can you address moral injury.

Understanding moral injury can help demystify our own experiences and address difficult feelings such as guilt, shame, and disgust.

Reframe your thoughts Try changing your expectations given the reality of the situation.

Instead of thinking, “I made a bad decision,” consider, “I made the best decision I could in this situation.”

Find safe people and places Whether in personal or professional circles, positive social support can help mitigate stress and create a feeling of care and belonging.

Try spiritual or faith-based practices Many find that a connection to a higher power creates a sense of peace and purpose.

For some, a faith life offers an additional source of community and support.

Focus on self-care I decided early in the pandemic that it was important to pay attention to my own mental wellbeing.

I started with the basics:

  • Sleep

  • Diet

  • Exercise

  • Social connection

  • Quiet time

A solid plan of self-care can help build emotional, mental, and physical resilience.

Reach out The vulnerability in asking for support or help can feel intolerable. We all want to be seen as competent and whole by our patients and peers.

We can reach out to our peers when we believe they’re struggling.

Start by listening.

Offer simple words of support.

“It sounds like it’s been really difficult for you,” or “I’m here for you.”

You can also support peers in getting more help if they need it.

Most importantly, seek support from a mental health professional if you are struggling to manage emotional or psychological issues on your own.

The end of the pandemic will not mark the end of its impact. However, by naming our experiences, we can begin to heal and carve a path forward.


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