Moral Injury Guide for Healthcare Workers

After more than two years of working through the COVID-19 pandemic, many healthcare workers continue to face unprecedented levels of exhaustion, stress and frustration. As well as the sheer volume of work and the relentless demand for services,  during the pandemic, our healthcare workers have been confronted with a range of moral stressors that can challenge their personal sense of right and wrong or professional ethics.  Severe or ongoing moral stressors can lead to moral injury. 


The enormous pressure placed on the healthcare system in parts of the world most severely impacted by the COVID-19 pandemic has raised awareness internationally of the potential for moral injury amongst healthcare workers.


By definition, moral injury refers to the psychological, social and spiritual impact of events involving betrayal or transgression of one’s own deeply held moral beliefs and values occurring in high stakes situations. In relation to healthcare, moral injury describes the challenges faced by workers who know what care their patients need but are unable to deliver that care due to obstructions that are beyond their control.


While moral emotions are likely to be felt more keenly by healthcare workers who are on the ‘frontline’ of the pandemic, healthcare workers who are not on the frontline of treating COVID-19 patients are also having to deal with moral stressors each day when they face barriers to providing their usual standard of care.


These circumstances can range from issues such as insufficient hospital beds, and insufficient equipment or access to equipment, to healthcare workers being forced to decide who receives life-saving treatment and who does not. We’ve seen reports of a range of responses to these working conditions from healthcare workers that involve moral emotions such as shame, guilt and demoralisation.


Moral injury reflects an enduring impact on an individual’s self-image and world view, resulting from exposure to extreme moral stress.


As Australian healthcare workers continue to battle COVID-19 and the system remains under stress, we’re sharing our Moral Stress Amongst Healthcare Workers During COVID-19: A Guide to Moral Injury. This guide to supporting those facing moral injury during COVID-19 was developed as a practical resource to help healthcare workers and organisations better understand the range of moral emotions arising from the COVID-19 pandemic and develop organisational and individual strategies to mitigate risks of lasting harm from moral injury.


The guide, available to download here, was created by Phoenix Australia in collaboration with the Canadian Centre of Excellence – PTSD