Moral Injury in Social Work: Responses, Prevention, and Advocacy

Abstract

Throughout social work’s history, some practitioners and their employing organizations have caused harm. This article explores the concept of moral injury and its relevance to the social work profession. The author explores essential components of a meaningful response to moral injury in social work that simultaneously acknowledges the impact of moral injury on individual victims and addresses the need for structural reform. The author discusses the nature and causes of moral injury, prevention strategies (including the need for practitioner self-care and organizational and community advocacy), the role of apology, restorative justice, and moral courage.

The Association of Moral Injury and Healthcare Clinicians’ Wellbeing: A Systematic Review

“…This issue could be addressed by using existing theoretical frames to articulate the role of power/imbalance in the experience of moral injury. Specifically, using systems-level theory aligns with the concept of moral injury, as moral injury speaks to systems-level causes and solutions as opposed to burnout, which generally alludes to individual level causes, symptoms, and solutions [ 72 , 73 , 74 ].…”

Exploring trauma-informed care with the Acquired Brain Injury and Concussion Services program

“…As a war veteran, Boudrea (2011) wrote from his own personal experiences stating that moral injury describes the wounds a person inflicts on themselves when they inflict wounds on another person, this can include feelings of shame and guilt (Blinka & Harris, 2016). While there are several working definitions of the concept, most researchers report moral injury is present when 1) there has been a betrayal of what is right, 2) by someone who holds legitimate authority, and 3) in a high-stake situation (Blinka & Harris, 2016;Dombo et al, 2013;Fenton & Kelly, 2017;Reamer, 2021). The term 'moral injury' was coined by Johnathan Shay, a psychiatrist who worked with Vietnam veterans experiencing moral distress and emotional pain (Reamer, 2021).…”

“…While there are several working definitions of the concept, most researchers report moral injury is present when 1) there has been a betrayal of what is right, 2) by someone who holds legitimate authority, and 3) in a high-stake situation (Blinka & Harris, 2016;Dombo et al, 2013;Fenton & Kelly, 2017;Reamer, 2021). The term 'moral injury' was coined by Johnathan Shay, a psychiatrist who worked with Vietnam veterans experiencing moral distress and emotional pain (Reamer, 2021). A common example of moral injury occurred when military personnel or war veterans reported wounding or killing innocent civilians during a raid, with individuals stating they had failed to uphold their moral values and beliefs (Hossain & Clatty, 2021;Litz et al, 2009).…”

“…With further discussion, moral injury has expanded to include other professionals, especially healthcare (Reamer, 2021). However, some scholars argue that the concept of moral injury is inappropriate for medical professionals, given that the concept was coined specifically for war veterans and their unique experiences (Hossain & Clatty, 2021).…”

“…Nurses specifically report difficulty in translating their moral decisions into moral actions, especially when case counts increase, and they are forced to let patients die without family or friends present (Hossain & Clatty, 2021). In social work, moral injury can occur when a clinician feels a sense of guilt about their involvement in the removal of children from their homes, termination of services to vulnerable clients, or involuntary hospitalization of clients who have had traumatic experiences in medical settings (Litz et al, 2009;Reamer, 2021). In the literature, there is an ongoing discussion as to where moral injury stands in relation to the diagnosis of PTSD.…”