Poster Presentation The 26th International Nursing Philosophy Conference 2023

Moral injury as a serious concern among nurses - A literature review (#25)

Bojan Stoiljkovic 1 2 , Sepali Guruge 3
  1. Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
  2. School of Community and Health Studies, Centennial College, Toronto, ON, Canada
  3. Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada

Profound moral distress during which one’s deeply held moral norms are challenged can lead to moral injury which in turn can affect one’s existential, behavioral, emotional, and spiritual wellbeing. As part of the nature and constraints of their daily work, nurses constantly juggle between doing what is best for their patients and what is expected of them by their employers. During and in the aftermath of the COVID-19 pandemic, conditions arising from shortages in human and material resources exposed nurses to moral injuries which can contribute to poor mental health, drive their decision to leave the profession, and even lead to higher suicide levels. This critical review of the literature examined the topic of moral injury among nurses before, during, and after the COVID-19 pandemic. A search of Medline, CINAHL Plus Full Text, Health Source: Nursing/Academic Edition, and Nursing & Allied Health Premium was conducted for relevant peer-reviewed articles published in English. A total of 101 articles published from 2014 to 2023 were reviewed using thematic analysis. The key five themes derived are: 1) the complexity of the antecedents of moral injury in nurses; 2) a lack of consensus concerning whether or not moral injury is an individual or systemic issue; 3) a lack of effective assessment tools and treatment for moral injury among nurses; 4) inequitable experiences of moral injury among nurses of diverse racialized and ethnic backgrounds; and 5) the use of the terms “moral injury” and “moral distress” interchangeably in the discourse surrounding the topic. This paper might be of interest to practicing nurses, nurse leaders, and to global health care researchers who seek to better understand the causes and impacts of moral injury. The paper may also help policymakers develop frameworks that can reduce at a systemic level, the pervasiveness of moral injury among nurses.