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Moral injury in healthcare professionals: A scoping review and discussion

?artolovni, Anto; Stolt, Minna; Scott, P. Anne; Suhonen, Riitta


Minna Stolt

P. Anne Scott

Riitta Suhonen


Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.


?artolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (in press). Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics,

Journal Article Type Review
Acceptance Date Sep 27, 2020
Online Publication Date Jan 11, 2021
Deposit Date Jan 16, 2021
Publicly Available Date Oct 27, 2022
Journal Nursing Ethics
Print ISSN 0969-7330
Electronic ISSN 1477-0989
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Keywords COVID-19; Ethics; Moral conflict; Moral injury; Moral integrity; Pandemic
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