UC Irvine

This project seeks to: (1) better understand the concept of occupational moral injury (MI) as it relates to moral distress (MD) and burnout (BO), and (2) improve the understanding of occupational MI in healthcare settings, such that healthcare systems may better develop strategies for MI assessment, prevention, and mitigation. Based on Walker and Avant's (2019) methodology, this concept analysis of occupational MI in healthcare describes the antecedents, defining attributes, and consequences of MI in relation to MD and to the oft associated phenomenon of BO. Our findings reveal a highly interconnected network of related concepts that can intensify each other and that are not mutually exclusive. MI, MD, and BO have shared antecedents and overlapping consequences that can render their delineation challenging. MI, MD, and BO in healthcare contexts all share the attribute of capturing experiences of clinician distress with varying sources, intensity, and chronicity. MI and MD introduce ethical tones to clinician distress and capture the effects of moral dissonance related to constrained moral agency and disempowerment. We suggest 3 necessary and sufficient conditions for defining occupational MI in healthcare (2 ""moral"" antecedents and 1 ""injury"" consequence): (1) a clinician's often-appropriate commitment to the expected moral responsibilities, principles, and values of their profession, and (2) a recognition of suppressed moral agency and compromised integrity from a forced violation of those principled commitments, coupled with (3) the consequence of significant and profound distress from such recognized moral violation. In short, MI in healthcare captures the injury of possessing moral responsibility while lacking commensurate moral agency. Better understanding the avoidable antecedents that drive MI is critical for guiding targeted pre-exposure mitigation efforts and solutions that proactively address this problem. We emphasize the need for preventative actions directed toward avoidable drivers of MI.