Moral character and virtue الأخلاق

وَإِنَّكَ لَعَلَىٰ خُلُقٍ عَظِيمࣲ‏

truly you have a strong character––

وَٱلۡمُطَلَّقَٰتُ يَتَرَبَّصۡنَ بِأَنفُسِهِنَّ ثَلَٰثَةَ قُرُوٓءࣲۚ وَلَا يَحِلُّ لَهُنَّ أَن يَكۡتُمۡنَ مَا خَلَقَ ٱللَّهُ فِيٓ أَرۡحَامِهِنَّ إِن كُنَّ يُؤۡمِنَّ بِٱللَّهِ وَٱلۡيَوۡمِ ٱلۡأٓخِرِۚ وَبُعُولَتُهُنَّ أَحَقُّ بِرَدِّهِنَّ فِي ذَٰلِكَ إِنۡ أَرَادُوٓاْ إِصۡلَٰحࣰ اۚ وَلَهُنَّ مِثۡلُ ٱلَّذِي عَلَيۡهِنَّ بِٱلۡمَعۡرُوفِۚ وَلِلرِّجَالِ عَلَيۡهِنَّ دَرَجَةࣱۗ وَٱللَّهُ عَزِيزٌ حَكِيمٌ

Divorced women must wait for three monthly periods before remarrying, and, if they really believe in God and the Last Day, it is not lawful for them to conceal what God has created in their wombs: their husbands would do better to take them back during this period, provided they wish to put things right. Wives have [rights] similar to their [obligations], according to what is recognized to be fair, and husbands have a degree [of right] over them: [both should remember that] God is almighty and wise

وَلۡتَكُن مِّنكُمۡ أُمَّةࣱ يَدۡعُونَ إِلَى ٱلۡخَيۡرِ وَيَأۡمُرُونَ بِٱلۡمَعۡرُوفِ وَيَنۡهَوۡنَ عَنِ ٱلۡمُنكَرِۚ وَأُوْلَٰٓئِكَ هُمُ ٱلۡمُفۡلِحُونَ

Be a community that calls for what is good, urges what is right, and forbids what is wrong: those who do this are the successful ones

كُنتُمۡ خَيۡرَ أُمَّةٍ أُخۡرِجَتۡ لِلنَّاسِ تَأۡمُرُونَ بِٱلۡمَعۡرُوفِ وَتَنۡهَوۡنَ عَنِ ٱلۡمُنكَرِ وَتُؤۡمِنُونَ بِٱللَّهِۗ وَلَوۡ ءَامَنَ أَهۡلُ ٱلۡكِتَٰبِ لَكَانَ خَيۡرࣰ ا لَّهُمۚ مِّنۡهُمُ ٱلۡمُؤۡمِنُونَ وَأَكۡثَرُهُمُ ٱلۡفَٰسِقُونَ

[Believers], you are the best community singled out for people: you order what is right, forbid what is wrong, and believe in God. If the People of the Book had also believed, it would have been better for them. For although some of them do believe, most of them are lawbreakers

يُؤۡمِنُونَ بِٱللَّهِ وَٱلۡيَوۡمِ ٱلۡأٓخِرِ وَيَأۡمُرُونَ بِٱلۡمَعۡرُوفِ وَيَنۡهَوۡنَ عَنِ ٱلۡمُنكَرِ وَيُسَٰرِعُونَ فِي ٱلۡخَيۡرَٰتِۖ وَأُوْلَٰٓئِكَ مِنَ ٱلصَّٰلِحِينَ

who believe in God and the Last Day, who order what is right and forbid what is wrong, who are quick to do good deeds. These people are among the righteous

ٱلَّذِينَ يَتَّبِعُونَ ٱلرَّسُولَ ٱلنَّبِيَّ ٱلۡأُمِّيَّ ٱلَّذِي يَجِدُونَهُۥ مَكۡتُوبًا عِندَهُمۡ فِي ٱلتَّوۡرَىٰةِ وَٱلۡإِنجِيلِ يَأۡمُرُهُم بِٱلۡمَعۡرُوفِ وَيَنۡهَىٰهُمۡ عَنِ ٱلۡمُنكَرِ وَيُحِلُّ لَهُمُ ٱلطَّيِّبَٰتِ وَيُحَرِّمُ عَلَيۡهِمُ ٱلۡخَبَٰٓئِثَ وَيَضَعُ عَنۡهُمۡ إِصۡرَهُمۡ وَٱلۡأَغۡلَٰلَ ٱلَّتِي كَانَتۡ عَلَيۡهِمۡۚ فَٱلَّذِينَ ءَامَنُواْ بِهِۦ وَعَزَّرُوهُ وَنَصَرُوهُ وَٱتَّبَعُواْ ٱلنُّورَ ٱلَّذِيٓ أُنزِلَ مَعَهُۥٓ أُوْلَٰٓئِكَ هُمُ ٱلۡمُفۡلِحُونَ

who follow the Messenger- the unlettered prophet they find described in the Torah that is with them, and in the Gospel- who commands them to do right and forbids them to do wrong, who makes good things lawful to them and bad things unlawful, and relieves them of their burdens, and the iron collars that were on them. So it is those who believe him, honour and help him, and who follow the light which has been sent down with him, who will succeed.’

(And lo! thou art of a tremendous nature) [68:4]. Abu Bakr al-Harithi informed us> �Abd Allah ibn Muhammad ibn Muhammad ibn Hayyan> Ahmad ibn Ja�far> ibn Nasr al-Jamal> Jarir ibn Yahya> Husayn ibn �Ulwan al-Kufi> Hisham ibn �Urwah> his father> �A�ishah who said: �No one had a better character than the Messenger of Allah, Allah bless him and give him peace. Never did anyone among his Companions, or household, call him except that he said: �I am at your service!� this is why Allah, glorious and majestic is He, revealed (And lo! thou art of a tremendous nature)�.

And assuredly you possess a magnificent nature a magnificent religion.

Divorced women shall wait by themselves before remarrying for three periods qurū’in is the plural of qar’ of purity or menstruation — these are two different opinions — which begin from the moment of divorce. This stipulation applies to those who have been sexually penetrated but not to those otherwise on account of His saying there shall be no waiting period for you to reckon against them Q. 3349. The waiting period for immature or menopausal women is three months; pregnant women on the other hand must wait until they give birth as stated in the sūrat al-Talāq Q. 654 while slavegirls must wait two months according to the Sunna. And it is not lawful for them to hide what God has created in their wombs of child or menstruation if they believe in God and the Last Day. Their mates their spouses have a better right to restore them to bring them back even if they refuse in such time that is d

And divorced women shall wait (as regards their marriage) for three menstrual periods, and it is not lawful for them to conceal what Allah has created in their wombs, if they believe in Allah and the Last Day. And their husbands have the better right to take them back in that period, if they wish for reconciliation. And they (women) have rights (over their husbands as regards living expenses) similar (to those of their husbands) over them (as regards obedience and respect) to what is reasonable, but men have a degree (of responsibility) over them. And Allah is All-Mighty, All-Wise (228) The 'Iddah (Waiting Period) of the Divorced Woman This Ayah contains a command from Allah that the divorced woman, whose marriage was consummated and who still has menstruation periods, should wait for three (menstrual) periods (Quru') after the divorce and then remarry if she wishes. The Meaning of Al

Let there be a community of you inviting to the good. This is an allusion to peoples who stand up for God in God. They are not taken aback by the blame of any blamer nor cut off from God by relying on any causes. They have seen the shortcomings of their own souls and immersed their lives in gaining God's approval. They act for God, give counsel for God's religion, and call God's creatures to God. Their trade has profited them and they do not regret their handshake. This is the description of a people who stand through the Real's making them stand and who have been freed from their own power and strength and disengaged from their own desires and aims. They are outside the circle of deeds and states, free of the captivity of choice and self- determination. They know God, they call upon God, and they strive in God's religion. They do not think about people or their blame. In their hearts th

(Ye are the best community that hath been raised up for mankind�) [3:110]. �Ikrimah and Muqatil said: �This was revealed about [�Abd Allah] Ibn Mas�ud, Ubayy ibn Ka�b, Mu�adh ibn Jabal and Salim, the client of Abu Hudhayfah. Malik ibn al-Dayf and Wahb ibn Yahudha, both of them Jews, had said to them: �Our religion is better than that to which you call us; and we are also more virtuous and better than you�. And Allah, exalted is He, revealed this verse as a response to them�.

حَدَّثَنَا أَبُو كُرَيْبٍ، مُحَمَّدُ بْنُ الْعَلاَءِ حَدَّثَنَا عَبْدَةُ بْنُ سُلَيْمَانَ، عَنْ مُحَمَّدِ بْنِ عَمْرٍو، حَدَّثَنَا أَبُو سَلَمَةَ، عَنْ أَبِي هُرَيْرَةَ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ أَكْمَلُ الْمُؤْمِنِينَ إِيمَانًا أَحْسَنُهُمْ خُلُقًا وَخِيَارُكُمْ خِيَارُكُمْ لِنِسَائِهِمْ خُلُقًا ‏"‏ ‏.‏ قَالَ وَفِي الْبَابِ عَنْ عَائِشَةَ وَابْنِ عَبَّاسٍ ‏.‏ قَالَ أَبُو عِيسَى حَدِيثُ أَبِي هُرَيْرَةَ هَذَا حَدِيثٌ حَسَنٌ صَحِيحٌ ‏.‏

Abu Hurairah narrated that The Messenger of Allah said:“The most complete of the believers in faith, is the one with the best character among them. And the best of you are those who are best to your women.”

حَدَّثَنَا أَحْمَدُ بْنُ الْحَسَنِ بْنِ خِرَاشٍ الْبَغْدَادِيُّ، حَدَّثَنَا حَبَّانُ بْنُ هِلاَلٍ، حَدَّثَنَا مُبَارَكُ بْنُ فَضَالَةَ، حَدَّثَنِي عَبْدُ رَبِّهِ بْنُ سَعِيدٍ، عَنْ مُحَمَّدِ بْنِ الْمُنْكَدِرِ، عَنْ جَابِرٍ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم قَالَ ‏"‏ إِنَّ مِنْ أَحَبِّكُمْ إِلَىَّ وَأَقْرَبِكُمْ مِنِّي مَجْلِسًا يَوْمَ الْقِيَامَةِ أَحَاسِنَكُمْ أَخْلاَقًا وَإِنَّ أَبْغَضَكُمْ إِلَىَّ وَأَبْعَدَكُمْ مِنِّي مَجْلِسًا يَوْمَ الْقِيَامَةِ الثَّرْثَارُونَ وَالْمُتَشَدِّقُونَ وَالْمُتَفَيْهِقُونَ ‏"‏ ‏.‏ قَالُوا يَا رَسُولَ اللَّهِ قَدْ عَلِمْنَا الثَّرْثَارُونَ وَالْمُتَشَدِّقُونَ فَمَا الْمُتَفَيْهِقُونَ قَالَ ‏"‏ الْمُتَكَبِّرُونَ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى وَفِي الْبَابِ عَنْ أَبِي هُرَيْرَةَ ‏.‏ وَهَذَا حَدِيثٌ حَسَنٌ غَرِيبٌ مِنْ هَذَا الْوَجْهِ ‏.‏ وَرَوَى بَعْضُهُمْ هَذَا الْحَدِيثَ عَنِ الْمُبَارَكِ بْنِ فَضَالَةَ عَنْ مُحَمَّدِ بْنِ الْمُنْكَدِرِ عَنْ جَابِرٍ عَنِ النَّبِيِّ صلى الله عليه وسلم وَلَمْ يَذْكُرْ فِيهِ عَنْ عَبْدِ رَبِّهِ بْنِ سَعِيدٍ وَهَذَا أَصَحُّ ‏.‏ وَالثَّرْثَارُ هُوَ الْكَثِيرُ الْكَلاَمِ وَالْمُتَشَدِّقُ الَّذِي يَتَطَاوَلُ عَلَى النَّاسِ فِي الْكَلاَمِ وَيَبْذُو عَلَيْهِمْ ‏.‏

Jabir narrated that the Messenger of Allah said:"Indeed the most beloved among you to me, and the nearest to sit with me on the Day of Judgment is the best of you in character. And indeed, the most disliked among you to me, and the one sitting furthest from me on the Day of Judgement are the Thartharun, and the Mutashaddiqun and the Muthafaihiqun." They said: "O Messenger of Allah! We know about the Thartharun, and the Mutashaddiqun, but what about the Muthafaihiqun?"' He said:"The arrogant

حَدَّثَنَا عَبْدَانُ، عَنْ أَبِي حَمْزَةَ، عَنِ الأَعْمَشِ، عَنْ أَبِي وَائِلٍ، عَنْ مَسْرُوقٍ، عَنْ عَبْدِ اللَّهِ بْنِ عَمْرٍو ـ رضى الله عنهما ـ قَالَ لَمْ يَكُنِ النَّبِيُّ صلى الله عليه وسلم فَاحِشًا وَلاَ مُتَفَحِّشًا وَكَانَ يَقُولُ ‏ "‏ إِنَّ مِنْ خِيَارِكُمْ أَحْسَنَكُمْ أَخْلاَقًا ‏"‏‏.‏

Narrated `Abdullah bin `Amr:The Prophet (ﷺ) never used bad language neither a "Fahish nor a Mutafahish. He used to say "The best amongst you are those who have the best manners and character." (See Hadith No. 56 (B) Vol

حَدَّثَنَا عَلِيُّ بْنُ عَيَّاشٍ، حَدَّثَنَا أَبُو غَسَّانَ، قَالَ حَدَّثَنِي مُحَمَّدُ بْنُ الْمُنْكَدِرِ، عَنْ جَابِرِ بْنِ عَبْدِ اللَّهِ ـ رضى الله عنهما ـ عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ كُلُّ مَعْرُوفٍ صَدَقَةٌ ‏"‏‏.‏

Narrated Jabir bin `Abdullah:The Prophet (ﷺ) said, Enjoining, all that is good is a Sadaqa

حَدَّثَنَا عُمَرُ بْنُ حَفْصٍ، حَدَّثَنَا أَبِي، حَدَّثَنَا الأَعْمَشُ، قَالَ حَدَّثَنِي شَقِيقٌ، عَنْ مَسْرُوقٍ، قَالَ كُنَّا جُلُوسًا مَعَ عَبْدِ اللَّهِ بْنِ عَمْرٍو يُحَدِّثُنَا إِذْ قَالَ لَمْ يَكُنْ رَسُولُ اللَّهِ صلى الله عليه وسلم فَاحِشًا وَلاَ مُتَفَحِّشًا، وَإِنَّهُ كَانَ يَقُولُ ‏ "‏ إِنَّ خِيَارَكُمْ أَحَاسِنُكُمْ أَخْلاَقًا ‏"‏‏.‏

Narrated Masruq:We were sitting with `Abdullah bin `Amr who was narrating to us (Hadith): He said, "Allah's Messenger (ﷺ) was neither a Fahish nor a Mutafahhish, and he used to say, 'The best among you are the best in character (having good manners)

حَدَّثَنَا قُتَيْبَةُ بْنُ سَعِيدٍ، حَدَّثَنَا سُفْيَانُ، عَنِ ابْنِ الْمُنْكَدِرِ، حَدَّثَهُ عُرْوَةُ بْنُ الزُّبَيْرِ، أَنَّ عَائِشَةَ، أَخْبَرَتْهُ‏.‏ أَنَّهُ، اسْتَأْذَنَ عَلَى النَّبِيِّ صلى الله عليه وسلم رَجُلٌ فَقَالَ ‏"‏ ائْذَنُوا لَهُ فَبِئْسَ ابْنُ الْعَشِيرَةِ ‏"‏‏.‏ أَوْ ‏"‏ بِئْسَ أَخُو الْعَشِيرَةِ ‏"‏‏.‏ فَلَمَّا دَخَلَ أَلاَنَ لَهُ الْكَلاَمَ‏.‏ فَقُلْتُ لَهُ يَا رَسُولَ اللَّهِ قُلْتَ مَا قُلْتَ، ثُمَّ أَلَنْتَ لَهُ فِي الْقَوْلِ‏.‏ فَقَالَ ‏"‏ أَىْ عَائِشَةُ، إِنَّ شَرَّ النَّاسِ مَنْزِلَةً عِنْدَ اللَّهِ مَنْ تَرَكَهُ ـ أَوْ وَدَعَهُ ـ النَّاسُ اتِّقَاءَ فُحْشِهِ ‏"‏‏.‏

Narrated Aisha:A man asked permission to see the Prophet. He said, "Let Him come in; What an evil man of the tribe he is! (Or, What an evil brother of the tribe he is). But when he entered, the Prophet (ﷺ) spoke to him gently in a polite manner. I said to him, "O Allah's Apostle! You have said what you have said, then you spoke to him in a very gentle and polite manner? The Prophet (ﷺ) said, "The worse people, in the sight of Allah are those whom the people leave (undisturbed) to save themselves from their dirty language

ونحن نقول متى باتت مهاجرة لفراش عاشقها الذي هو بعلها لعنتها الملائكة حتى تصبح قالوا والعشق يصفي العقل ويذهب الهم ويبعث على حسن اللباس وطيب المطعم ومكارم الأخلاق ويعلي الهمة ويحمل على طيب الرائحة وكرم العشرة وحفظ الأدب والمروءة وهو بلاء الصالحين ومحنة العابدين وهو ميزان العقول وجلاء الأذهان وهو خلق الكرام كما قيل

ومن قائل قال المروءة سخاوة النفس وحسن الخلق

غالبا بالمخالطة ويسلم منها في الخلوة وهي أربعة الغيبة والنميمة والرياء والسكوت عن الأمر بالمعروف والنهي عن المنكر ومسارقة الطبع من الأخلاق الرديئة والأعمال الخبيثة التي يوجبها الحرص على الدنيا

وهذه إشارة إلى فائدة أخرى في العزلة وهو بقاء الستر على الدين والمروءة والأخلاق والفقر وسائر العورات

حقيقتها هي منزلة الإحسان إلى الناس وكف الأذى عنهم واحتمال أذاهم فهي استعمال حسن الخلق معهم فهي في الحقيقة نتيجة حسن الخلق واستعماله والفرق بينها وبين المروءة : أن المروءة أعم منها فالفتوة نوع من أنواع المروءة فإن المروءة استعمال ما يجمل ويزين مما هو مختص بالعبد أو متعد إلى غيره وترك ما يدنس ويشين مما هو مختص أيضا به أو متعلق بغيره و الفتوة إنما هي استعمال الأخلاق الكريمة مع الخلق

الأدب الثاني حسن الخلق معهن واحتمال الأذى منهن ترحما عليهن لقصور عقلهن

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Efficacy of cultivating human strengths and virtues on well-being: A one-stage meta-analytic structural equation modeling approach.: Mental health research emphasizes the importance of fostering character strengths to promote well-being. However, whether the strengths supposedly developed by these interventions actually mediate their effects on well-being is still unknown. The included studies were RCTs of strength-based interventions on well-being. Among 83,908 reviewed abstracts, five strengths met the strict inclusion criteria to be meta-analyzed. We included 114 RCTs with a total of 20,853 participants. A One-Stage Meta-A

Feelings of shame, embarrassment and guilt and their neural correlates: A systematic review.: This systematic review aimed to provide a comprehensive summary of the current literature on the neurobiological underpinnings of the experience of the negative moral emotions: shame, embarrassment and guilt. PsycINFO, PubMed and MEDLINE were used to identify existing studies. Twenty-one functional and structural magnetic resonance imaging and positron emission tomography studies were reviewed. Although studies differed considerably in methodology, their findings highlight both shared and distin

Gender differences in self-conscious emotional experience: a meta-analysis.: The self-conscious emotions (SCE) of guilt, shame, pride, and embarrassment are moral emotions, which motivate adherence to social norms and personal standards and emerge in early childhood following the development of self-awareness. Gender stereotypes of emotion maintain that women experience more guilt, shame, and embarrassment but that men experience more pride. To estimate the magnitude of gender differences in SCE experience and to determine the circumstances under which these gender diffe

A meta-analytic investigation of the antecedents, theoretical correlates, and consequences of moral disengagement at work.: Moral disengagement refers to a set of cognitive tactics people employ to sidestep moral self-regulatory processes that normally prevent wrongdoing. In this study, we present a comprehensive meta-analytic review of the nomological network of moral disengagement at work. First, we test its dispositional and contextual antecedents, theoretical correlates, and consequences, including ethics (workplace misconduct and organizational citizenship behaviors [OCBs]) and non-ethics outcomes (turnover inte

Cognitive loopholes of crime: Mapping the Codevelopment of moral disengagement within perceptions of risks and rewards.

Prior research has examined individuals' perceptions of punishments (PP) and rewards (PR) for crime, as well as their use of moral disengagement (MD), to understand why adolescents and young adults commit crimes. However, the joint development of these cognitions as a broader risk-perception mechanism remains understudied. This paper explores the independent and relational development of these processes in justice-involved youth. Data from 1,170 male participants (42.1% Black, 34.0% Hispanic, 19.2% White, 4.6% Other) in the Pathways to Desistance study were analyzed using a three-variable autoregressive latent trajectory model. MD, PP, and PR were measured across 11 waves and 7 years, allowing for the simultaneous examination of individual trajectories and their bidirectional relationships from adolescence to young adulthood. Although PP increased and MD and PR decreased across adolescen…

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Long-term impact of COVID-19 pandemic: Moral tensions, distress, and injuries of healthcare workers.

Given the longevity of the COVID-19 pandemic, it is important to address the perceptions and experiences associated with the progression of the pandemic. This narrative can inform future strategies aimed at mitigating moral distress, injury, and chronic stress that restores resilience and well-being of HCWs. In this context, a longitudinal survey design was undertaken to explore how health care workers are experiencing the COVID-19 pandemic over time. A qualitative design was employed to analyze the open ended survey responses using a thematic analysis approach. All physicians and staff at an academic health science centre in Toronto, Ontario, Canada were invited to participate in the survey. The majority of survey respondents were nurses and physicians, followed by researchers/scientists, administrative assistants, laboratory technicians, managers, social workers, occupational therapist…

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Moral injury and substance use among United States healthcare workers.

Moral injury (i.e., perpetrating, witnessing, failing to prevent, or being a victim of acts that transgress one's moral beliefs, values, or ethics) has largely been studied in military-connected populations and is associated with a range of adverse psychological sequelae. Emerging literature suggests that healthcare workers also experience moral injury, particularly in the context of the ongoing COVID-19 pandemic. However, it is not known if moral injury contributes to substance use among healthcare workers or whether these effects might differ by gender, race/ethnicity, or occupational level. In March 2022, we collected self-reported pilot data from a diverse sample of US healthcare workers (N = 200) We examined the cross-sectional relationships between moral injury and several measures of substance use (i.e., current non-medical use of prescription drugs [NMUPD], current cannabis use, …

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Exposure to moral stressors and associated outcomes in healthcare workers: prevalence, correlates, and impact on job attrition.

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs' self-reported job attrition intentions. Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed. Results: Moral stressors with the highest reported frequency and …

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Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19.

Background: Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied. Objectives: To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout. Methods: This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables. Results: Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral in…

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Multi-professional perspectives to reduce moral distress: A qualitative investigation.

Background: Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research objective: The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. Participants & research context: Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior t…

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Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study.

Purpose: The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral distress as perceived by medical doctors working at emergency departments in Stockholm during the pandemic, with the purpose of investigating causes of moral distress and methods to manage moral distress. Methods: Semi-structured interviews were conducted with twelve doctors working at two emergency departments. A questionnaire was developed based on previous research and the interviews were analysed qualitatively through thematic analysis. Results: The themes "The factors that precipitated moral distress", "Experience of workplace support" and "Coping strategies" as well as seven subthemes and 15 codes were identified. The informants reported o…

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No Need for Parental Involvement in the Vaccination Choice of Adolescents.

Parental decision making is necessary for contracting medical interventions that require personal risk-benefit evaluation, and for overseeing matters of education. In the nineteenth century, exemptions from obligatory vaccination were granted for religious and conscientious reasons. Then and today, religion and moral values play marginal roles in vaccine hesitancy and denialism. Rather, the key values invoked by vaccine hesitants and denialists are liberty and pluralism. Neither is compatible with limiting adolescents' choice. Because vaccination does not require assessment of personal medical risks, because it does not need to occur within the sphere of the doctor-patient relationship, and because the risk involved is within the range of their daily activities, adolescents have the right to free access to vaccination without legal requirement of parental involvement. Drawing on the deve…

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Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure.

Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic f…

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Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

Objective: Moral injury (MI) research has been expanded to populations beyond the military in recent years. A key barrier to further research into MI in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This article addresses this barrier by adapting two existing military measures and exploring their psychometrics in a general civilian sample: the Moral Injury Events Scale-Civilian (MIES-C) and Expressions of Moral Injury Scale-Military (EMIS-C). Method: A sample of civilian women (n = 192) and men (n = 88) completed the above measures, and additional scales designed to capture theoretically supported primary and secondary markers of MI (guilt, shame, anger; depression, posttraumatic stress symptoms, anxiety). Results: Confirmatory factor analyses found that the factor structure of the MIES-C and EMIS-C replicated well wit…

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Religious coping and delinquent behaviors: Moderated mediation roles of religion affiliation and prosocial moral reasoning.

Religion has been shown to have a positive impact for developing adolescents; however, the processes underlying this relation are not well known. In his almighty prosocial theory, Anazonwu (Conceptualizing and testing almighty prosociality theory for a more peaceful world, SCOA Heritage Nigeria, 2017) proposed that the activation of learnt prosocial moral reasoning through religion enabled performance of prosocial peace behavior that will benefit society. Thus, religion coping enhances the development of prosocial reasoning which in turn propagate prosocial acts while reducing delinquent behaviors. Similarly, developmental system theory (Lerner, Developmental science, developmental systems, and contemporary theories of human development, John Wiley & Sons, 2006) assumed that in every individual three mechanisms: plasticity (potential to change), context (environment), and developmental r…

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Health care workers' qualitative descriptions of ethically challenging situations evoking moral distress during Covid-19.

Background: The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective: To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design: This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context: In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations: The study receive…

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A mixed-methods analysis of moral injury among healthcare workers during the COVID-19 pandemic.

During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury…

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The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic.

Background: Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic. Methods: HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the …

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Conscientious objection: a global health perspective.

Conscientious objection is a critical topic that has been sparsely discussed from a global health perspective, despite its special relevance to our inherently diverse field. In this Analysis paper, we argue that blanket prohibitions of a specific type of non-discriminatory conscientious objection are unjustified in the global health context. We begin both by introducing a nuanced account of conscience that is grounded in moral psychology and by providing an overview of discriminatory and non-discriminatory forms of objection. Next, we point to the frequently neglected but ubiquitous presence of moral uncertainty, which entails a need for epistemic humility-that is, an attitude that acknowledges the possibility one might be wrong. We build two arguments on moral uncertainty. First, if epistemic humility is necessary when dealing with values in theory (as appears to be the consensus in bio…

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Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers.

Aim: To refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity. Background: Healthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues. Moral resilience is a resource that may mitigate negative consequences. To better understand mechanisms for doing so, a valid and reliable measurement tool is necessary. Design: Cross-sectional survey. Methods: Participants (N = 1297) had completed ≥1 items on the RMRS as part of the baseline survey of a larger longitudinal study. Item analysis, confirmatory factor analyses, reliability analyses (Cronbach's alpha), and correlations were used to establish reliability and validity of the revised RMRS. Results: Item and confirmatory factor…

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War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms.

This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANO…

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Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers.

Goal: Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies. Methods: Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,…

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Moral distress and psychological status among healthcare workers in a newly established paediatric intensive care unit.

Introduction: Healthcare workers in intensive care units often experience moral distress, depression, and stress-related symptoms. These conditions can lower staff retention and influence the quality of patient care. This study aimed to evaluate the prevalence of moral distress and psychological status among healthcare workers in a newly established paediatric intensive care unit (PICU) in Hong Kong. Methods: A cross-sectional questionnaire survey was conducted in the PICU of the Hong Kong Children's Hospital; healthcare workers (doctors, nurses and allied health professionals) were invited to participate. The Revised Moral Distress Scale (MDS-R) Paediatric Version and Depression Anxiety and Stress Scale-21 items were used to assess moral distress and psychological status, respectively. Demographic characteristics were examined in relation to moral distress, depression, anxiety, and stre…

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Surprising pandemic experiences: A confrontation between principle-based and virtue ethics, and a plea for virtue ethics training for medical students and residents. A rudimentary outline of a four-step model.

Background: In past years, physicians have, with a certain continuity, reported increasing numbers of burnout, depression and compassion fatigue in their daily practice. These problems were attributed, not only but also, to a loss of public trust and an increase in violent behaviour of patients and family members towards medical professionals in all walks of life. Recently, however, during the breakout of the coronavirus disease 2019 (COVID-19) pandemic in 2020, there were public expressions of appreciation and respect for health care workers that almost universally have been assessed as indications of a re-establishment of public trust in physicians and appreciation for the medical professions' commitments. In other words, shared experiences of what society was in need of: the experience of a 'common good'. Those responses during the COVID-19 pandemic increased positive feelings among p…

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Moral uncertainty and distress about voluntary assisted dying prior to legalisation and the implications for post-legalisation practice: a qualitative study of palliative and hospice care providers in Queensland, Australia.

Objectives: There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design: The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collect…

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Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis.

Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects …

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The mediating roles of moral courage and moral resilience between nurses' moral distress and moral injury: An online cross-sectional study.

Aims: To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury. Background: There is a preponderance of nursing literature about moral distress, moral resilience, moral courage and moral injury. However, examining moral resilience and moral courage as mediators remain underreported during the COVID-19 pandemic and in the context of a developing nation. Design: Correlational, cross-sectional design compliant with the STROBE guidelines. Methods: A convenience sample of nurses (n = 412) from the Philippines were recruited using social media platforms (e.g., Facebook, Messenger, Twitter). Four self-report and validated scales (8-item Moral-Distress Appraisal Scale, 21-item Nurses' Moral Courage Scale, 17-item Rushton Moral Resilience Scale and 10-item Moral Injury Symptom Scale: Healthcare Professionals Version) were u…

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Burnout following moral injury and dehumanization: A study of distress among Italian medical staff during the first COVID-19 pandemic period.

Background: Italy was the first country outside Asia to deal with the early phase of the COVID-19 pandemic, and health care facilities and medical staff were not fully prepared. Research worldwide has documented the enormous effect of the COVID-19 pandemic on health care providers' mental health, including experiences of dehumanization, but less work has focused on factors which may influence the development of these outcomes in response to COVID-19-related stress. Objective: This study examined the association of dehumanization, self-efficacy, and alienation to burnout, depression, and PTSD among medical staff. Potential moderators included moral injury, professional role, COVID workload, and work in a critical care unit (CCU). Method: Participants were recruited through the Internet. The sample consisted of 270 medical staff members who completed a self-report survey online. Instrument…

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Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey.

Purpose: There is evidence for mental burden and moral distress among healthcare workers during the pandemic. However, there is scarcity of analyses regarding possible correlations of mental burden and moral distress in this context. This study provides data to quantify mental burden and possible associations with moral distress among physicians and nurses working in oncology in Germany. Methods: We conducted a cross-sectional online survey with physicians and nurses working in oncology in Germany between March and July 2021. Next to sociodemographic characteristics and working conditions, mental burden and moral distress were assessed using standardized instruments. Binary multivariate logistic regression using the enter method was performed in order to explore the relationship between mental burden and moral distress. Results: 121 physicians and 125 nurses were included in the study. P…

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