Measuring moral distress and moral injury: A systematic review and content analysis of existing scales

Houle, Stephanie A.; Ein, Natalie; Gervasio, Julia; Plouffe, Rachel A.; Litz, Brett T.; Carleton, R. Nicholas; Hansen, Kevin T.; Liu, Jenny J.W.; Ashbaugh, Andrea R.; Callaghan, Walter; Thompson, Megan M.; Easterbrook, Bethany; Smith-MacDonald, Lorraine; Rodrigues, Sara; Bélanger, Stéphanie A.H.; Bright, Katherine; Lanius, Ruth A.; Baker, Clara; Younger, William; Bremault-Phillips, Suzette; Hosseiny, Fardous; Richardson, J. Don; Nazarov, Anthony

doi:10.1016/j.cpr.2023.102377

Cited by 14 publications

(2 citation statements)

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“…The necessity of rising awareness of moral distress and injury, the need for trust and support among colleagues, and an understanding of the visible signs of moral injury, as well as a safe space to vent concerns, have also emerged as key themes ( Table 3 ). Senior staff should be trained in identifying moral injury pre-emptively and introduce the use of validate scales to prevent and plan educational interventions [ 48 , 93 ].…”

Section: Discussionmentioning

confidence: 99%

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Beadle,

Walecka,

Sangam

et al. 2024

PLoS ONE

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Objective At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress and injury in Health and Social Care Workers (HSCW) employed across a range of clinical settings with the aim of understanding how to mitigate the effects of moral distress and identify potential preventative interventions. Methods A systematic review was conducted and reported according to recommendations from Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted and updated regularly until January 2024 on 2 main databases (CENTRAL, PubMed) and three specialist databases (Scopus, CINAHL, PsycArticles), alongside hand searches of study registration databases and other systematic reviews reference lists. Eligible studies included a HSCW sample, explored moral distress/injury as a main aim, and were written in English or Italian. Verbatim quotes were extracted, and article quality was assessed via the CASP toolkit. Thematic analysis was conducted to identify patterns and arrange codes into themes. Specific factors like culture and diversity were explored, and the effects of exceptional circumstances like the pandemic. Results Fifty-one reports of 49 studies were included in the review. Causes and triggers were categorised under three domains: individual, social, and organisational. At the individual level, patients’ care options, professionals’ beliefs, locus of control, task planning, and the ability to make decisions based on experience, were indicated as elements that can cause or trigger moral distress. In addition, and relevant to the CoVID-19 pandemic, was use/access to personal protection resources. The social or relational factors were linked to the responsibility for advocating for and communication with patients and families, and professionals own support network. At organisational levels, hierarchy, regulations, support, workload, culture, and resources (staff and equipment) were identified as elements that can affect professionals’ moral comfort. Patients’ care, morals/beliefs/standards, advocacy role and culture of context were the most referenced elements. Data on cultural differences and diversity were not sufficient to make assumptions. Lack of resources and rapid policy changes have emerged as key triggers related to the pandemic. This suggests that those responsible for policy decisions should be mindful of the potential impact on staff of sudden and top-down change. Conclusion This review indicates that causes and triggers of moral injury are multifactorial and largely influenced by the context and constraints within which professionals work. Moral distress is linked to the duty and responsibility of care, and professionals’ disposition to prioritise the wellbeing of patients. If the organisational values and regulations are in contrast with individuals’ beliefs, repercussions on professionals’ wellbeing and retention are to be expected. Organisational strategies to mitigate against moral distress, or the longer-term sequalae of moral injury, should address the individual, social, and organisational elements identified in this review.

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Section: Discussionmentioning

confidence: 99%

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Beadle,

Walecka,

Sangam

et al. 2024

PLoS ONE

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“…Дослідники сходяться у думці, що солдат може отримати моральну травму через акти насильства, які він вчинив або був співучасником [4]. Моральна шкода -термін, який в основному виник у військовому середовищі в контексті вивчення здоров'я військовослужбовців, яке було визначено S. Houle зі співавторами як тривалі психологічні, біологічні, духовні, поведінкові та соціальні наслідки, які порушують глибоко укорінені моральні переконання та очікування [5].…”

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Специфіка Моральних Засад У Військовослужбовців З Різним Рівнем Агресивності

Пономаренко

2024

Наука

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In the contemporary military context, understanding the moral foundations of military personnel is crucial as they determine behavior and relationships within the military collective. A study on the moral foundations of military personnel becomes relevant due to their influential role in task effectiveness, discipline enforcement, lawful behavior, and morale maintenance among military personnel. Scientific sources indicate that an in-depth understanding of this issue can contribute to optimizing approaches to shaping the moral-ethical environment in military units, enhancing their professional and psychological level, and preventing aggressive behavior. Theoretical analysis has identified the main trends and factors influencing the moral competence of military personnel with different levels of aggression, which is important for further research development in this area. The article actualizes the issue of the impact of aggression on the formation and manifestation of moral foundations in the military environment, which, in turn, will contribute to a deeper understanding of the relationships between these concepts. The aim of the article is to study the specifics of moral foundations in military personnel with low and high levels of aggression. The study sample consisted of 63 military personnel, who were divided into three groups based on aggression level: low, medium, and high. Psychodiagnostic tools, such as the «Hostility Inventory» by A. Buss and A. Durkee, and the «Moral Foundations Questionnaire (MFQ)» by J. Graham and co-authors, were utilized to achieve the set goal. Empirical research has investigated the characteristics of moral foundations in military personnel with different levels of aggression. Using various scales, it was found that military personnel with high levels of aggression demonstrated greater care and fairness, as well as higher scores on autonomy and progressivism scales compared to military personnel with low levels of aggression. At the same time, the latter showed greater loyalty and integrity, as well as higher scores on the community Журнал «Наукові інновації та передові технології» № 5(33) 2024

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Enhancing the Utility of the Moral Injury Experience Wheel: Manualized Applications for Diverse Contexts

Fleming,

Smigelsky

2024

J Relig Health

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Measuring moral distress and moral injury: A systematic review and content analysis of existing scales

Cited by 14 publications

References 55 publications

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

Специфіка Моральних Засад У Військовослужбовців З Різним Рівнем Агресивності

Enhancing the Utility of the Moral Injury Experience Wheel: Manualized Applications for Diverse Contexts

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