Toward a Dimensional Contextual Model of Moral Injury: A Scoping Review on Healthcare Workers

Abstract

Abstract Purpose of Review Healthcare workers (HCWs) may be exposed to potentially morally injurious events (PMIEs) while on the job and consequently experience acute, functional moral distress to prolonged, impairing moral injury. Recent Findings We reviewed 185 articles on moral distress and/or injury among HCWs. This included 91 empirical studies (approximately 50% of the retained articles), 68 editorials (37%), 18 reviews (10%), and 8 protocol papers (4%). Themes were explored using bibliometric network analysis of keyword co-citation. Empirical studies found evidence of PMIE exposure among a considerable proportion of HCWs. Greater moral distress severity was associated with worse mental and occupational health outcomes, especially among women (vs. men), younger HCWs (vs. older), nurses (vs. physicians), those who worked more hours, and HCWs with less experience. Programs to prevent and treat moral injury among HCWs lack empirical evidence. Summary Efforts to maintain the well-being and effectiveness of HCWs should consider the potential impact of moral injury. To that end, we introduce a dimensional contextual model of moral injury in healthcare settings and discuss recommendations for prevention and treatment.