Addressing moral injury in practice: suggestions for organisational, political and societal interventions

Abstract

Background: Moral injury has garnered increasing attention in recent decades, extending from the military to professions like healthcare and policing. Defined as psychological, social and spiritual suffering resulting from moral transgressions, moral injury is now recognised as a multidimensional phenomenon. A growing body of empirical and theoretical research is establishing a foundational understanding of its psychological, moral and contextual dimensions. Their findings underscore the need to broaden the understanding of moral injuries sustained in the workplace, as well as work-related mental health more generally, by incorporating ethics- and context-informed approaches. This applies to both research and practice. However, the actual practical implications of their findings remain unexplored.Objective: This contribution makes a start in addressing the gap between emerging moral injury research and its practical implementation. It seeks to identify potential interventions and caution against approaches that may inadvertently exacerbate harm.Approach: Drawing on recent interdisciplinary literature, this contribution synthesises key findings and translates them into practical recommendations. It proposes individual, organisational and wider societal levels of intervention, as such with particular attention to ethics-informed and context-sensitive strategies.Results: Research findings point to several promising interventions, including resilience training, ethics education, and moral case deliberation, targeted at both frontline practitioners and leadership. Organisational approaches such as Just Culture initiatives and practices of transformative recognition are also suggested. Conversely, the paper identifies potential pitfalls in popular responses such as the uncritical use of positive psychology or 'integritism', which may inadvertently reinforce moral distress.Conclusions: Adequately addressing moral injury in high-impact professions requires a comprehensive, multi-level approach. Cross-disciplinary collaboration is likely to be beneficial, involving mental health professionals, ethicists, chaplains and organisational specialists, to address the various dimensions of moral injury. This contribution has offered several research-informed suggestions for interventions, which nevertheless require further theoretical development and empirical examination.

Keywords: Daño moral; Moral injury; cultura de justicia; entrenamiento en resiliencia; ethics; ethics in high-risk professions; just culture; organisational ethics; psychological trauma; resilience training; trauma psicológico; ética; ética en profesiones de alto riesgo; ética organizacional.