The pandemic affected most people’s lives and workdays in various ways. However, for those of us in healthcare, emergency services, or education, it brought numerous new demands and stressors.
Although the term “moral injury” is relatively new in Australia, it has already proven to be a valuable diagnostic tool for recognizing and treating workplace mental ill health in the US and UK, particularly in industries heavily impacted by the pandemic.
What is Moral Injury?
Moral injury occurs when people experience a discrepancy between the moral code they hold, in relation to how they operate within their workplace, which negatively impacts their psychological wellbeing and mental health.
The term moral injury was originally associated with the military in the US, but since the pandemic it has extended to people working in high stress health care roles during the Covid-19 response, whether as nurses, doctors, teachers, ambulance drivers or workers
It comes into play when we’re forced to operate in a certain way – perhaps due to the requirements of a role or the specific environment we’re working – that puts us at odds with our values – in opposition to our moral code.
This creates a cognitive dissonance between a person’s ideals and their behaviour in the workplace. Over the past two years, we have increasingly observed this dissonance among clients working in healthcare and emergency services.
Recognising Moral Injury
Understanding moral injury is valuable because it allows us to help clients who may be experiencing symptoms without realising there is a term for it.
For clients, learning about moral injury can be reassuring, as it shows that their experiences are common among peers in similar roles. It helps them understand that there is nothing inherently wrong with them and that they are not alone in feeling this way.
This reassurance boosts clients’ confidence, showing them that there is an explanation for what they are going through and a way to seek support to recover from their symptoms.
How does it arise in the workplace?
Moral injury can arise from a specific incident or an ongoing situation. For instance, during the peak of the pandemic, healthcare staff faced the difficult task of deciding who would have access to limited ICU beds, which conflicted with their moral obligation to provide the best care for all patients.
Due to the immense pressure created by the pandemic, hospital professionals worldwide had to prioritize which patients would receive optimal treatment based on available resources, while others were treated as best as possible under the circumstances.
The cumulative impact of these decisions and events can indeed exacerbate symptoms over time. Moral injury exists on a continuum and can manifest in various ways, from minor symptoms requiring minimal intervention to severe psychological impacts that might lead someone to leave their profession.
What are the symptoms of moral injury?
According to Phoenix Australia’s online resource, Moral Stress Amongst Healthcare Workers During Covid-19: A Guide to Moral Injury, the symptoms of moral injury can manifest as various emotions or uncertainties, including:
- Guilt or shame: Feeling unable to do what you believe you should be able to do.
- Displaced anger: Directing frustration towards an organisation, which then affects your relationships with those close to you.
- Low self-esteem: Feeling that you are not performing your job adequately.
- Disconnection: Experiencing a sense of detachment from personal relationships or colleagues.
- Career uncertainty: Questioning whether you are in the right profession.
- Avoidance: Not wanting to go to work.
Moral Injury and Recovery
Moral injury can lead to profound existential and spiritual crises, especially for those with a religious background or strong faith. Such individuals might begin to question their beliefs when faced with distressing circumstances.
Is Recovery Possible?
The encouraging news is that recovery from moral injury is possible. There is always potential for post-traumatic growth and resilience, particularly when addressing moral injury at both individual and organisational levels.
Our best outcomes have been achieved by implementing interventions across three levels:
Individuals: Providing personalized support and therapy.
Teams: Facilitating group interventions and peer support.
Organisations: Promoting systemic changes and supportive policies.
Being part of a team that strives to do their best for their colleagues is important in navigating difficult circumstances. Knowing that an organisation is supportive can make a significant difference for workers.
When organisations appreciate the work we do, communicate clearly about decisions, and offer practical guidance and support during difficult times, we are more likely to stay in our professions and recover from moral injury and other workplace-related stress symptoms.
For organisations, this might involve developing a comprehensive response plan or wellbeing plan and working with teams and individuals to understand what needs to change. This holistic support can empower people to continue doing what they love.