Moral Injury in Healthcare

by Rosabel Zohfeld, APRN, MSN-Ed, FNP-C

What is moral injury? Is this a new term? It used to be that moral injury was associated with the experiences of soldiers at war. But is it modern healthcare a battleground? It seems that moral injury in healthcare comes from ethical and moral dilemmas that healthcare professionals face daily.

One can define moral injury in healthcare as the psychological distress resulting from actions or inactions that are conflictive within an individual’s moral or ethical beliefs. These conflicts often arise when healthcare professionals are forced to make decisions that compromise their values. This can happen due to organizational constraints, resource limitations, conflicting interests, or complex patient cases.

What causes moral injury in healthcare?

Healthcare professionals frequently face challenges in allocating limited resources, such as time, personnel, medical supplies, which can lead to difficult decisions that may conflict with their ethical principles and or moral principles. Balancing patient care with financial pressures, corporate interests, or professional responsibilities can create moral conflicts within, causing distress and disillusionment among healthcare providers. Conflicting priorities, where administrative demands overshadow patient-centered care, can also create moral dilemmas for healthcare professionals, leading to moral injury.

What are the consequences?

Burnout and Psychological Distress. Both can induce compassion fatigue, and other psychological challenges, impacting the mental well-being of healthcare professionals.

Decreased Job Satisfaction, disengagement, and a decline in the overall quality of care provided.

Negative impact on patient care. The effects of moral injury can affect decision-making, patient interactions, and treatment outcomes, potentially undermining the quality of patient care.

What can we do to mitigate moral injury?

1. Provide healthcare professionals with a comprehensive ethical education and training that can help them navigate moral dilemmas effectively.
2. Encourage open dialogue and creating support systems within healthcare organizations to allow professionals to discuss and process moral challenges.
3. Establish clear ethical guidelines, policies, and ethics committees within healthcare organizations to help healthcare professionals address complex ethical situations and conflicts.

Conclusion

Moral injury in healthcare is a critical concern that warrants the immediate attention and action from healthcare organizations, policymakers, and society as a whole. By understanding the causes and consequences of moral injury, implementing mitigation strategies, and fostering a culture of ethics and support, we can work towards creating a healthcare environment that is conducive to both the well-being of healthcare professionals and the provision of high-quality patient care.