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Psychiatry

Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review

ORCID Icon, ORCID Icon & ORCID Icon
Pages 646-668 | Received 06 Jul 2023, Accepted 28 Sep 2023, Published online: 10 Oct 2023

References

  • Shay J. Achilles in Vietnam: combat trauma and the undoing of character. New York (NY): Touchstone; 1995
  • Litz BT, Stein N, Delaney E, et al. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009;29(8):695–706. doi: 10.1016/j.cpr.2009.07.003
  • Litz BT, Kerig PK. Introduction to the special issue on moral injury: conceptual challenges, methodological issues, and clinical applications. J Trauma Stress. 2019;32(3):341–349. doi: 10.1002/jts.22405
  • Whitehead PB, Herbertson RK, Hamric AB, et al. Moral distress among healthcare professionals: report of an institution-wide survey. J Nurs Scholarsh. 2015;47(2):117–125. doi: 10.1111/jnu.12115
  • Jansen TL, Danbolt LJ, Hanssen I, et al. How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study. BMC Psychiatry. 2022;22(1):212. doi: 10.1186/s12888-022-03832-3
  • Jansen TL, Hem MH, Danbolt LJ, et al. Coping with moral distress on acute psychiatric wards: a qualitative study. Nurs Ethics. 2022;29(1):171–180. doi: 10.1177/09697330211010246
  • Beale C. Magical thinking and moral injury: exclusion culture in psychiatry. BJPsych Bull. 2022;46(1):16–19. doi: 10.1192/bjb.2021.86
  • Albaek AU, Kinn LG, Milde AM. Walking children through a minefield: how professionals experience exploring adverse childhood experiences. Qual Health Res. 2018;28(2):231–244. doi: 10.1177/1049732317734828
  • Walt G, Porteny T, McGregor AJ, et al. Clinician’s experiences with involuntary commitment for substance use disorder: a qualitative study of moral distress. Int J Drug Policy. 2022;99:103465. doi: 10.1016/j.drugpo.2021.103465
  • Tavakol N, Molazem Z, Rakhshan M, et al. Moral distress in Iranian psychiatric nurses: a content analysis. Iran J Psychiat Behav Sci. 2022;16(3):e121885. doi: 10.5812/ijpbs-121885
  • Matthews H, Williamson I. Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital. J Adv Nurs. 2016;72(5):1042–1053. doi: 10.1111/jan.12889
  • Austin W, Bergum V, Goldberg L. Unable to answer the call of our patients: mental health nurses’ experience of moral distress. Nurs Inq. 2003;10(3):177–183. doi: 10.1046/j.1440-1800.2003.00181.x
  • Morris DJ, Webb EL, Devlin P. Moral injury in secure mental healthcare part II: experiences of potentially morally injurious events and their relationship to wellbeing in health professionals in secure services. J Forensic Psychiatry Psychol. 2022;33(5):726–744. doi: 10.1080/14789949.2022.2111319
  • Ghafouri R, Lotfi-Bajestani S, Nasiri M, et al. Psychometrics of the moral distress scale in Iranian mental health nurses. BMC Nurs. 2021;20(1):166. doi: 10.1186/s12912-021-00674-4
  • Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol Theory Pract. 2005;8(1):19–32. doi: 10.1080/1364557032000119616
  • Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097
  • Corley MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics. 2002;9(6):636–650. doi: 10.1191/0969733002ne557oa
  • Cooper S, Cant R, Kelly M, et al. An evidence-based checklist for improving scoping review quality. Clin Nurs Res. 2021;30(3):230–240. doi: 10.1177/1054773819846024
  • Ohnishi K, Kitaoka K, Nakahara J, et al. Impact of moral sensitivity on moral distress among psychiatric nurses. Nurs Ethics. 2019;26(5):1473–1483. doi: 10.1177/0969733017751264
  • Every-Palmer S, Grant ML, Thabrew H, et al. Not heading in the right direction: five hundred psychiatrists’ views on resourcing, demand, and workforce across New Zealand mental health services [published online ahead of print, 2023 Apr 25]. Aust N Z J Psychiatry. 2023;48674231170572.
  • O’Donnell S, Quigley E, Hayden J, et al. Work-related experiences of consultant psychiatrists during the COVID-19 response: qualitative analysis. BJPsych Open. 2023;9(2):e49. doi: 10.1192/bjo.2023.11
  • Tavakol N, Molazem Z, Rakhshan M, et al. Moral distress in psychiatric nurses in covid-19 crisis. BMC Psychol. 2023;11(1):47. doi: 10.1186/s40359-023-01048-y
  • Webb EL, Morris DJ, Sadler E, et al. Predictors of moral injury in secure mental healthcare workers: examining a role for violence and restrictive practices through an intersectional lens. J Forensic Psychol Pract. 2023;1–19.
  • Cranage K, Foster K. Mental health nurses’ experience of challenging workplace situations: a qualitative descriptive study. Int J Ment Health Nurs. 2022;31(3):665–676. doi: 10.1111/inm.12986
  • McCarty EJ, Nagarajan MK, Halloran SR, et al. Healthcare quality during pediatric mental health boarding: a qualitative analysis. J Hosp Med. 2022;17(10):783–792. doi: 10.1002/jhm.12906
  • Söderberg A, Ejneborn Looi GM, Gabrielsson S. Constrained nursing: nurses’ and assistant nurses’ experiences working in a child and adolescent psychiatric ward. Int J Ment Health Nurs. 2022;31(1):189–198. doi: 10.1111/inm.12949
  • Liberati E, Richards N, Willars J, et al. A qualitative study of experiences of NHS mental healthcare workers during the covid-19 pandemic. BMC Psychiatry. 2021;21(1):250. doi: 10.1186/s12888-021-03261-8
  • Musto L, Schreiber R, Rodney PP. Risking vulnerability: enacting moral agency in the is/ought gap in mental health care. J Adv Nurs. 2021;77(5):2458–2471. doi: 10.1111/jan.14776
  • Jansen TL, Hem MH, Dambolt LJ, et al. Moral distress in acute psychiatric nursing: multifaceted dilemmas and demands. Nurs Ethics. 2020;27(5):1315–1326. doi: 10.1177/0969733019877526
  • Oliveira CA, Oliveira DCP, Cardoso EM, et al. Moral distress of nursing professionals of a psychosocial care center. Sofrimento moral de profissionais de enfermagem em um Centro de Atenção Psicossocial. Cien Saude Colet. 2020;25(1):191–198. doi: 10.1590/1413-81232020251.29132019
  • Lewis LF, Jarvis L. Undergraduate nursing students’ experiences and attitudes towards working with patients with opioid use disorder in the clinical setting: a qualitative content analysis. Nurse Educ Today. 2019;73:17–22. doi: 10.1016/j.nedt.2018.11.001
  • Ando M, Kawano M. Relationships among moral distress, sense of coherence, and job satisfaction. Nurs Ethics. 2018;25(5):571–579. doi: 10.1177/0969733016660882
  • Delfrate F, Ferrara P, Spotti D, et al. Moral distress (MD) and burnout in mental health nurses: a multicenter survey. Med Lav. 2018;109(2):97–109. doi: 10.23749/mdl.v109i2.6876
  • Christodoulou-Fella M, Middleton N, Papathanassoglou EDE, et al. Exploration of the association between nurses’ moral distress and secondary traumatic stress syndrome: implications for patient safety in mental health services. Biomed Res Int. 2017;2017:1908712. doi: 10.1155/2017/1908712
  • Jansen TL, Hanssen I. Patient participation: causing moral stress in psychiatric nursing? Scand J Caring Sci. 2017;31(2):388–394. doi: 10.1111/scs.12358
  • Ando M, Kawano M. Responses and results to ethical problems by psychiatric nurses in Japan. Arch Psychiatr Nurs. 2016;30(5):527–530. doi: 10.1016/j.apnu.2016.04.012
  • Hamaideh SH. Moral distress and its correlates among mental health nurses in Jordan. Int J Ment Health Nurs. 2014;23(1):33–41. doi: 10.1111/inm.12000
  • Wojtowicz B, Hagen B. A guest in the house: nursing instructors’ experiences of the moral distress felt by students during inpatient psychiatric clinical rotations. Int J Nurs Educ Scholarsh. 2014;11(1):2013–2086. doi: 10.1515/ijnes-2013-0086
  • Wojtowicz B, Hagen B, Van Daalen-Smith C. No place to turn: nursing students’ experiences of moral distress in mental health settings. Int J Ment Health Nurs. 2014;23(3):257–264. doi: 10.1111/inm.12043
  • Weimand BM, Sällström C, Hall-Lord ML, et al. Nurses’ dilemmas concerning support of relatives in mental health care. Nurs Ethics. 2013;20(3):285–299. doi: 10.1177/0969733012462053
  • Musto L, Schreiber RS. Doing the best I can do: moral distress in adolescent mental health nursing. Issues Ment Health Nurs. 2012;33(3):137–144. doi: 10.3109/01612840.2011.641069
  • Deady R, McCarthy J. A study of the situations, features, and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress. Perspect Psychiatr Care. 2010;46(3):209–220. doi: 10.1111/j.1744-6163.2010.00260.x
  • Ohnishi K, Ohgushi Y, Nakano M, et al. Moral distress experienced by psychiatric nurses in Japan. Nurs Ethics. 2010;17(6):726–740. doi: 10.1177/0969733010379178
  • Sturm BA. Issues of ethics and care in psychiatric home care: multidisciplinary perspectives revealed through ethnographic research. Home Health Care Manag Pract. 2007;19(2):94–103. doi: 10.1177/1084822306294454
  • Austin W, Rankel M, Kagan L, et al. To stay or to go, to speak or stay silent, to act or not to act: moral distress as experienced by psychologists. Ethics Behav. 2005;15(3):197–212. doi: 10.1207/s15327019eb1503_1
  • Vanderheide R, Moss C, Lee S. Understanding moral habitability: a framework to enhance the quality of the clinical environment as a workplace. Contemp Nurse. 2013;45(1):101–113. doi: 10.5172/conu.2013.45.1.101
  • Kelly B. Preserving moral integrity: a follow-up study with new graduate nurses. J Adv Nurs. 1998;28(5):1134–1145. doi: 10.1046/j.1365-2648.1998.00810.x
  • Weaver K, Morse J, Mitcham C. Ethical sensitivity in professional practice: concept analysis. J Adv Nurs. 2008;62(5):607–618. doi: 10.1111/j.1365-2648.2008.04625.x
  • Čartolovni A, Stolt M, Scott PA, et al. Moral injury in healthcare professionals: a scoping review and discussion. Nurs Ethics. 2021;28(5):590–602. doi: 10.1177/0969733020966776
  • Brunn H, Huniche L, Stenager E, et al. Hospital ethics reflection groups: a learning and development resource for clinical practice. BMC Med Ethics. 2019;20(1):75. doi: 10.1186/s12910-019-0415-5
  • Carse A, Rushton CH. Harnessing the promise of moral distress: a call for re-orientation. J Clin Ethics. 2017;28(1):15–29. doi: 10.1086/JCE2017281015
  • Epstein EG, Haizlip J, Liaschenko J, et al. Moral distress, mattering, and secondary traumatic stress in provider burnout: a call for moral community. AACN Adv Crit Care. 2020;31(2):146–157. doi: 10.4037/aacnacc2020285
  • Stutzer K, Rodrigues AM. Moral resilience for critical care nurses. Crit Care Nurs Clin North Am. 2020;32(3):383–393. doi: 10.1016/j.cnc.2020.05.002
  • Hauhio N, Leino-Kilpi H, Katajisto J, et al. Nurses’ self-assessed moral courage and related socio-demographic factors. Nurs Ethics. 2021;28(7–8):1402–1415. doi: 10.1177/0969733021999763
  • Numminen O, Katajisto J, Leino-Kilpi H. Development and validation of nurses’ moral courage scale. Nurs Ethics. 2019;26(7–8):2438–2455. doi: 10.1177/0969733018791325
  • Berdida DJE, Grande RAN. Moral distress, moral resilience, moral courage, and moral injury among nurses in the Philippines during the COVID-19 pandemic: a mediation analysis [published online ahead of print, 2023 Jul 13]. J Relig Health. 2023; 10.1007/s10943-023-01873–w. doi: 10.1007/s10943-023-01873-w
  • Rushton CH. Moral resilience: a capacity for navigating moral distress in critical care. AACN Adv Crit Care. 2016;27(1):111–119. doi: 10.4037/aacnacc2016275
  • Nash WP. Commentary on the special issue on moral injury: unpacking two models for understanding moral injury. J Trauma Stress. 2019;32(3):465–470. doi: 10.1002/jts.22409
  • Nash WP, Steenkamp M, Conoscenti L. The stress continuum model: a military organizational approach to resilience and recovery. In: Southwick S, Litz B, Charney D Friedman M editors, et al. Resilience and mental health: challenges across the lifespan. Cambridge: Cambridge University Press; 2011. p. 238–252. doi: 10.1017/CBO9780511994791.018

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