Moral injury

وَلَا تَأۡكُلُوٓاْ أَمۡوَٰلَكُم بَيۡنَكُم بِٱلۡبَٰطِلِ وَتُدۡلُواْ بِهَآ إِلَى ٱلۡحُكَّامِ لِتَأۡكُلُواْ فَرِيقࣰ ا مِّنۡ أَمۡوَٰلِ ٱلنَّاسِ بِٱلۡإِثۡمِ وَأَنتُمۡ تَعۡلَمُونَ

Do not consume your property wrongfully, nor use it to bribe judges, intending sinfully and knowingly to consume parts of other people’s property

وَإِذَا قِيلَ لَهُ ٱتَّقِ ٱللَّهَ أَخَذَتۡهُ ٱلۡعِزَّةُ بِٱلۡإِثۡمِۚ فَحَسۡبُهُۥ جَهَنَّمُۖ وَلَبِئۡسَ ٱلۡمِهَادُ

When he is told, ‘Beware of God,’ his arrogance leads him to sin. Hell is enough for him: a dreadful resting place

ثُمَّ أَنتُمۡ هَٰٓؤُلَآءِ تَقۡتُلُونَ أَنفُسَكُمۡ وَتُخۡرِجُونَ فَرِيقࣰ ا مِّنكُم مِّن دِيَٰرِهِمۡ تَظَٰهَرُونَ عَلَيۡهِم بِٱلۡإِثۡمِ وَٱلۡعُدۡوَٰنِ وَإِن يَأۡتُوكُمۡ أُسَٰرَىٰ تُفَٰدُوهُمۡ وَهُوَ مُحَرَّمٌ عَلَيۡكُمۡ إِخۡرَاجُهُمۡۚ أَفَتُؤۡمِنُونَ بِبَعۡضِ ٱلۡكِتَٰبِ وَتَكۡفُرُونَ بِبَعۡضࣲۚ فَمَا جَزَآءُ مَن يَفۡعَلُ ذَٰلِكَ مِنكُمۡ إِلَّا خِزۡيࣱ فِي ٱلۡحَيَوٰةِ ٱلدُّنۡيَاۖ وَيَوۡمَ ٱلۡقِيَٰمَةِ يُرَدُّونَ إِلَىٰٓ أَشَدِّ ٱلۡعَذَابِۗ وَمَا ٱللَّهُ بِغَٰفِلٍ عَمَّا تَعۡمَلُونَ

Yet here you are, killing one another and driving some of your own people from their homes, helping one another in sin and aggression against them. If they come to you as captives, you still pay to set them free, although you had no right to drive them out. So do you believe in some parts of the Scripture and not in others? The punishment for those of you who do this will be nothing but disgrace in this life, and on the Day of Resurrection they will be condemned to the harshest torment: God is not unaware of what you do

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ لَا تُحِلُّواْ شَعَٰٓئِرَ ٱللَّهِ وَلَا ٱلشَّهۡرَ ٱلۡحَرَامَ وَلَا ٱلۡهَدۡيَ وَلَا ٱلۡقَلَٰٓئِدَ وَلَآ ءَآمِّينَ ٱلۡبَيۡتَ ٱلۡحَرَامَ يَبۡتَغُونَ فَضۡلࣰ ا مِّن رَّبِّهِمۡ وَرِضۡوَٰنࣰ اۚ وَإِذَا حَلَلۡتُمۡ فَٱصۡطَادُواْۚ وَلَا يَجۡرِمَنَّكُمۡ شَنَـَٔانُ قَوۡمٍ أَن صَدُّوكُمۡ عَنِ ٱلۡمَسۡجِدِ ٱلۡحَرَامِ أَن تَعۡتَدُواْۘ وَتَعَاوَنُواْ عَلَى ٱلۡبِرِّ وَٱلتَّقۡوَىٰۖ وَلَا تَعَاوَنُواْ عَلَى ٱلۡإِثۡمِ وَٱلۡعُدۡوَٰنِۚ وَٱتَّقُواْ ٱللَّهَۖ إِنَّ ٱللَّهَ شَدِيدُ ٱلۡعِقَابِ

so, you who believe, do not violate the sanctity of God’s rites, the Sacred Month, the offerings, their garlands, nor those going to the Sacred House to seek the bounty and pleasure of their Lord––but when you have completed the rites of pilgrimage you may hunt. Do not let your hatred for the people who barred you from the Sacred Mosque induce you to break the law: help one another to do what is right and good; do not help one another towards sin and hostility. Be mindful of God, for His punishment is severe

وَتَرَىٰ كَثِيرࣰ ا مِّنۡهُمۡ يُسَٰرِعُونَ فِي ٱلۡإِثۡمِ وَٱلۡعُدۡوَٰنِ وَأَكۡلِهِمُ ٱلسُّحۡتَۚ لَبِئۡسَ مَا كَانُواْ يَعۡمَلُونَ

You [Prophet] see many of them rushing into sin and hostility and consuming what is unlawful. How evil their practices are

لَوۡلَا يَنۡهَىٰهُمُ ٱلرَّبَّٰنِيُّونَ وَٱلۡأَحۡبَارُ عَن قَوۡلِهِمُ ٱلۡإِثۡمَ وَأَكۡلِهِمُ ٱلسُّحۡتَۚ لَبِئۡسَ مَا كَانُواْ يَصۡنَعُونَ

Why do their rabbis and scholars not forbid them to speak sinfully and consume what is unlawful? How evil their deeds are

(And eat not up your property among yourselves in vanity�) [2:188]. Said Muqatil ibn Hayyan: �This verse was revealed about Imra' al-Qays ibn 'Abis al-Kindi and 'Abdan ibn Ashu' al-Hadrami. It so happened that these two men came to the Prophet, Allah bless him and give him peace, with a dispute regarding a piece of land. Imra' al-Qays had the land and 'Abdan was reclaiming it. And so Allah, exalted is He, revealed this verse, and the land was given to 'Abdan without a judgment pronouncement�.

(O ye who believe! Profane not Allah�s monuments�) [5:2]. Said Ibn �Abbas: �This was revealed about al-Hutam whose full name is Sharih ibn Dubay�ah al-Kindi. This man went from al-Yamamah to Medina to see the Prophet, Allah bless him and his Household and give him peace. When he arrived at Medina, he went in alone to speak with the Prophet, Allah bless him and give him peace. He said: �What do you call people for?� he said: �To testify that there is no god but Allah, to establish the prayer and to pay the poor due�. The man said: �This is good, except that I have chiefs without whose consultation I cannot take any decision. It may be that I embrace Islam and bring them with me�. And then he left. Before this, the Prophet, Allah bless him and give him peace, had said to his Companions: �A man will enter in on you and will speak with the tongue of the devil�. When the man left, the Messeng

Consume not your goods between you that is to say do not let one consume the goods of the other in deception that which is illicit according to the Law such as theft and extortion; and do not proffer them the regulation of these goods or any bribes to the judges that you may consume as a result of any arbitration a portion of other people’s goods embroiled in sin while you are aware that you are in error.

And when it is said to him ‘Fear God’ in your actions he is seized by vainglory pride and rage in his sin the one he was commanded to avoid committing. So Hell shall be enough it suffices for him — how evil a cradling a resting place it is!

Then there you are killing one another and expelling a party of you from their habitations conspiring tazzāharūna the original ta’ has been assimilated with the zā’; a variant reading has it without the assimilation that is tazāharūna assisting one another against them in sin in disobedience and enmity injustice and if they come to you as captives a variant reading for usārā has asrā you ransom them a variant reading for tafdūhum has tufādūhum that is to say you deliver them from captivity with money etc. and this ransoming was one of the things to which they were pledged; yet their expulsion was forbidden you muharramun ‘alaykum ikhrājuhum is semantically connected to wa-tukhrijūna ‘and expelling’ and the statement that comes in between is parenthetical that is expulsion was forbidden you in the same way that non-ransoming was forbidden you. Qurayza had allied themselves with the Aws an

And (remember) when We took your covenant (saying): Shed not the blood of your (people), nor turn out your own people from their dwellings. Then, (this) you ratified and (to this) you bore witness (84)After this, it is you who kill one another and drive out a party of you from their homes, assist (their enemies) against them, in sin and transgression. And if they come to you as captives, you ransom them, although their expulsion was forbidden to you. Then do you believe in a part of the Book and reject the rest? Then what is the recompense of those who do so among you, except disgrace in the life of this world, and on the Day of Resurrection they shall be consigned to the most grievous torment. And Allah is not unaware of what you do (85)Those are they who have bought the life of this world at the price of the Hereafter. Their torment shall not be lightened nor shall they be helped (86)

حَدَّثَنَا أَحْمَدُ بْنُ يُونُسَ، حَدَّثَنَا أَبُو شِهَابٍ، عَنِ ابْنِ عَوْنٍ، عَنْ مُجَاهِدٍ، عَنْ عَبْدِ الرَّحْمَنِ بْنِ أَبِي لَيْلَى، عَنْ كَعْبِ بْنِ عُجْرَةَ، قَالَ أَتَيْتُهُ يَعْنِي النَّبِيَّ صلى الله عليه وسلم فَقَالَ ‏"‏ ادْنُ ‏"‏‏.‏ فَدَنَوْتُ فَقَالَ ‏"‏ أَيُؤْذِيكَ هَوَامُّكَ ‏"‏‏.‏ قُلْتُ نَعَمْ‏.‏ قَالَ ‏"‏ فِدْيَةٌ مِنْ صِيَامٍ أَوْ صَدَقَةٍ أَوْ نُسُكٍ ‏"‏‏.‏ وَأَخْبَرَنِي ابْنُ عَوْنٍ عَنْ أَيُّوبَ قَالَ صِيَامُ ثَلاَثَةِ أَيَّامٍ، وَالنُّسُكُ شَاةٌ، وَالْمَسَاكِينُ سِتَّةٌ‏.‏

Narrated Ka`b bin 'Ujra:I came to the Prophet (ﷺ) and he said to me, "Come near." So I went near to him and he said, "Are your lice troubling you?" I replied, "Yes." He said, "(Shave your head and) make expiation in the form of fasting, Sadaqa (giving in charity), or offering a sacrifice." (The sub-narrator) Aiyub said, "Fasting should be for three days, and the Nusuk (sacrifice) is to be a sheep, and the Sadaqa is to be given to six poor persons

حَدَّثَنَا عَلِيُّ بْنُ عَبْدِ اللَّهِ، حَدَّثَنَا سُفْيَانُ، عَنِ الزُّهْرِيِّ، قَالَ سَمِعْتُهُ مِنْ، فِيهِ عَنْ حُمَيْدِ بْنِ عَبْدِ الرَّحْمَنِ، عَنْ أَبِي هُرَيْرَةَ، قَالَ جَاءَ رَجُلٌ إِلَى النَّبِيِّ صلى الله عليه وسلم فَقَالَ هَلَكْتُ‏.‏ قَالَ ‏"‏ مَا شَأْنُكَ ‏"‏‏.‏ قَالَ وَقَعْتُ عَلَى امْرَأَتِي فِي رَمَضَانَ‏.‏ قَالَ ‏"‏ تَسْتَطِيعُ تُعْتِقُ رَقَبَةً ‏"‏‏.‏ قَالَ لاَ‏.‏ قَالَ ‏"‏ فَهَلْ تَسْتَطِيعُ أَنْ تَصُومَ شَهْرَيْنِ مُتَتَابِعَيْنِ ‏"‏‏.‏ قَالَ لاَ‏.‏ قَالَ ‏"‏ فَهَلْ تَسْتَطِيعُ أَنْ تُطْعِمَ سِتِّينَ مِسْكِينًا ‏"‏‏.‏ قَالَ لاَ‏.‏ قَالَ ‏"‏ اجْلِسْ ‏"‏‏.‏ فَجَلَسَ فَأُتِيَ النَّبِيُّ صلى الله عليه وسلم بِعَرَقٍ فِيهِ تَمْرٌ ـ وَالْعَرَقُ الْمِكْتَلُ الضَّخْمُ ـ قَالَ ‏"‏ خُذْ هَذَا، فَتَصَدَّقْ بِهِ ‏"‏‏.‏ قَالَ أَعَلَى أَفْقَرَ مِنَّا، فَضَحِكَ النَّبِيُّ صلى الله عليه وسلم حَتَّى بَدَتْ نَوَاجِذُهُ قَالَ ‏"‏ أَطْعِمْهُ عِيَالَكَ ‏"‏‏.‏

Narrated Abu Huraira:A man came to the Prophet (ﷺ) and said, "I am ruined!" The Prophet (ﷺ) said, "What is the matter with you?" He said, "I had sexual relation with my wife (while I was fasting) in Ramadan." The Prophet (ﷺ) said, "Have you got enough to manumit a slave?" He said, "No." The Prophet (ﷺ) said, "Can you fast for two successive months?" The man said, "No." The Prophet (ﷺ) said, "Can you feed sixty poor persons?" The man said, "No." Then the Prophet (ﷺ) said to him, "Sit down," and he sat down. Afterwards an 'Irq, i.e., a big basket containing dates was brought to the Prophet (ﷺ) and the Prophet (ﷺ) said to him, "Take this and give it in charity." The man said, "To poorer people than we?" On that, the Prophet (ﷺ) smiled till his premolar teeth became visible, and then told him, "Feed your family with it." (See Hadith No. 157, Vol)

حَدَّثَنَا قُتَيْبَةُ، حَدَّثَنَا أَبُو صَفْوَانَ، عَنْ يُونُسَ بْنِ يَزِيدَ، عَنِ ابْنِ شِهَابٍ، عَنْ أَبِي سَلَمَةَ، عَنْ عَائِشَةَ، قَالَتْ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ لاَ نَذْرَ فِي مَعْصِيَةٍ وَكَفَّارَتُهُ كَفَّارَةُ يَمِينٍ ‏"‏ ‏.‏ قَالَ وَفِي الْبَابِ عَنِ ابْنِ عُمَرَ وَجَابِرٍ وَعِمْرَانَ بْنِ حُصَيْنٍ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ لاَ يَصِحُّ لأَنَّ الزُّهْرِيَّ لَمْ يَسْمَعْ هَذَا الْحَدِيثَ مِنْ أَبِي سَلَمَةَ ‏.‏ قَالَ سَمِعْتُ مُحَمَّدًا يَقُولُ رَوَى غَيْرُ وَاحِدٍ مِنْهُمْ مُوسَى بْنُ عُقْبَةَ وَابْنُ أَبِي عَتِيقٍ عَنِ الزُّهْرِيِّ عَنْ سُلَيْمَانَ بْنِ أَرْقَمَ عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ عَنْ أَبِي سَلَمَةَ عَنْ عَائِشَةَ عَنِ النَّبِيِّ صلى الله عليه وسلم ‏.‏ قَالَ مُحَمَّدٌ وَالْحَدِيثُ هُوَ هَذَا ‏.‏

Narrated 'Aishah:That the Messenger of Allah (ﷺ) said: "There is no vowing for disobedience, and its atonement is the atonement of an oath

حَدَّثَنَا أَبُو إِسْمَاعِيلَ التِّرْمِذِيُّ، - وَاسْمُهُ مُحَمَّدُ بْنُ إِسْمَاعِيلَ بْنِ يُوسُفَ حَدَّثَنَا أَيُّوبُ بْنُ سُلَيْمَانَ بْنِ بِلاَلٍ، حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي أُوَيْسٍ، عَنْ سُلَيْمَانَ بْنِ بِلاَلٍ، عَنْ مُوسَى بْنِ عُقْبَةَ، وَمُحَمَّدِ بْنِ عَبْدِ اللَّهِ بْنِ أَبِي عَتِيقٍ، عَنِ الزُّهْرِيِّ، عَنْ سُلَيْمَانَ بْنِ أَرْقَمَ، عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ، عَنْ أَبِي سَلَمَةَ، عَنْ عَائِشَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ لاَ نَذْرَ فِي مَعْصِيَةِ اللَّهِ وَكَفَّارَتُهُ كَفَّارَةُ يَمِينٍ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ غَرِيبٌ وَهُوَ أَصَحُّ مِنْ حَدِيثِ أَبِي صَفْوَانَ عَنْ يُونُسَ ‏.‏ وَأَبُو صَفْوَانَ هُوَ مَكِّيٌّ وَاسْمُهُ عَبْدُ اللَّهِ بْنُ سَعِيدِ بْنِ عَبْدِ الْمَلِكِ بْنِ مَرْوَانَ وَقَدْ رَوَى عَنْهُ الْحُمَيْدِيُّ وَغَيْرُ وَاحِدٍ مِنْ جِلَّةِ أَهْلِ الْحَدِيثِ ‏.‏ وَقَالَ قَوْمٌ مِنْ أَهْلِ الْعِلْمِ مِنْ أَصْحَابِ النَّبِيِّ صلى الله عليه وسلم وَغَيْرِهِمْ لاَ نَذْرَ فِي مَعْصِيَةِ اللَّهِ وَكَفَّارَتُهُ كَفَّارَةُ يَمِينٍ ‏.‏ وَهُوَ قَوْلُ أَحْمَدَ وَإِسْحَاقَ وَاحْتَجَّا بِحَدِيثِ الزُّهْرِيِّ عَنْ أَبِي سَلَمَةَ عَنْ عَائِشَةَ ‏.‏ وَقَالَ بَعْضُ أَهْلِ الْعِلْمِ مِنْ أَصْحَابِ النَّبِيِّ صلى الله عليه وسلم وَغَيْرِهِمْ لاَ نَذْرَ فِي مَعْصِيَةٍ وَلاَ كَفَّارَةَ فِي ذَلِكَ ‏.‏ وَهُوَ قَوْلُ مَالِكٍ وَالشَّافِعِيِّ ‏.‏

Narrated 'Aishah:That the Prophet (ﷺ) said: "There is no vowing in disobedience to Allah, and its atonement is the atonement of an oath

حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي شَيْبَةَ، حَدَّثَنَا مُحَمَّدُ بْنُ مُصْعَبٍ، عَنِ الأَوْزَاعِيِّ، عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ، عَنْ هِلاَلِ بْنِ أَبِي مَيْمُونَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ رِفَاعَةَ الْجُهَنِيِّ، قَالَ كَانَ النَّبِيُّ ـ صلى الله عليه وسلم ـ إِذَا حَلَفَ قَالَ ‏ "‏ وَالَّذِي نَفْسُ مُحَمَّدٍ بِيَدِهِ ‏"‏ ‏.‏

It was narrated that Rifa'ah Al - Juhani said:"When the Prophet (ﷺ) took an oath he would say: 'By the One in Whose Hand is the soul of Muhammad

حَدَّثَنَا هِشَامُ بْنُ عَمَّارٍ، حَدَّثَنَا عَبْدُ الْمَلِكِ بْنُ مُحَمَّدٍ الصَّنْعَانِيُّ، حَدَّثَنَا الأَوْزَاعِيُّ، عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ، عَنْ هِلاَلِ بْنِ أَبِي مَيْمُونَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ رِفَاعَةَ بْنِ عَرَابَةَ الْجُهَنِيِّ، قَالَ كَانَتْ يَمِينُ رَسُولِ اللَّهِ ـ صلى الله عليه وسلم ـ التَّى يَحْلِفُ بِهَا أَشْهَدُ عِنْدَ اللَّهِ ‏ "‏ وَالَّذِي نَفْسِي بِيَدِهِ ‏"‏ ‏.‏

It was narrated that Rifa'ah bin 'Arabah A-Juhani said:"The swearing of the Messenger of Allah (ﷺ) when he took an oath and I bear witness before Allah was: 'By the One in Whose Hand is my soul

ومنها : مشابهة اليهود والنصارى في اتخاذ المساجد والسرج عليها ومنها : محادة الله ورسوله ومناقضة ما شرعه فيها ومنها : التعب العظيم مع الوزر الكثير والإثم العظيم ومنها : إماتة السنن وإحياء البدع

تجنبت إتيان الحبيب تأثما % إلا أن هجران الحبيب هو الإثم

| فصل وأما الإثم والعدوان فهما قرينان قال الله تعالى وتعاونوا على

فالإثم ما كان محرم الجنس كالكذب والزنا وشرب الخمر ونحو ذلك والعدوان ما كان محرم القدر والزيادة

والعرب تقول في وصف الرجل بالصدق والوفاء : طاهر الثياب وتقول للغادر والفاجر : دنس الثياب وقال أبي بن كعب : لا تلبسها على الغدر والظلم والإثم ولكن البسها وأنت بر طاهر

التحرج الخروج من حرج المخالفة وبناء تفعل يكون للدخول في الشيء كتمنى إذا دخل في الأمنية وتولج في الأمر : دخل فيه ونحوه وللخروج منه كتحرج وتحوب وتأثم إذا أراد الخروج من الحرج والحوب : هو الإثم

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies.: Objective: At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress

Measuring moral distress and moral injury: A systematic review and content analysis of existing scales.: Background: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. Method: We identified psychometric studies describing t

Prevalence, Predictors, and Experience of Moral Suffering in Nursing and Care Home Staff during the COVID-19 Pandemic: A Mixed-Methods Systematic Review.: (1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual's moral beliefs and elicits adverse emotional responses. (2) Method: A systematic re

Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties.: Background: An increasing number of professionals are challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distress in di

Ethics education to support ethical competence learning in healthcare: an integrative systematic review.: Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the avail

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review.: Objective: To evaluate the influence of the ethical climate on workers' health among healthcare professionals. Method: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. Results: Among the 2644 studies, 20 were included for a

"I Don't Want to Go to Work": A Mixed-Methods Analysis of Healthcare Worker Experiences from the Front- and Side-Lines of COVID-19.

During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 …

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An unheard voice: infection prevention professionals reflect on their experiences during the covid-19 pandemic.

Background: The COVID-19 pandemic required a shift away from the evidence-based practices known to infection prevention professionals' (IPP). Relaying these guidelines to beleaguered front line staff contributed to the experience of moral distress and burnout among IPPs. Methods: A mixed methods design was used to explore the experiences of IPPs during the COVID-19 pandemic. An electronic survey was sent to a convenience sample from the Wisconsin APIC membership. A subset of this sample completed additional semi-structured interviews. Results: A total of 61 IPPs responded to the survey, 18 agreed to interviews with 11 completions. Most respondents identified as female (n=58, 95.0%) and White (n=55, 90.1%). More than half of the respondents (n=39, 63.9 %) reported they experienced moral distress (MD). Themes from one-on-one interviews included: Feeling depleted, challenges to IPP role, va…

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The COVID-19 Pandemic Crisis and Patient Safety Culture: A Mixed-Method Study.

The COVID-19 pandemic has put inordinate pressure on frontline healthcare workers (HCWs) and hospitals. HCWs are under chronic emotional stress, affected by burnout, moral distress and interpersonal issues with peers or supervisors during the pandemic. All of these can lead to lower levels of patient safety. The goal of this study was to examine patient safety culture values in a COVID-19 frontline hospital. Patient safety represents action, while patient safety culture represents the beliefs, values and norms of an organization that support and promote patient safety. Patient safety culture is a prerequisite for patient safety. A cross-sectional study on healthcare workers (228, response rate of 81.43%) at a COVID-19 frontline hospital was conducted using the Hospital Survey on Patient Safety Culture (HOSPSC), which had PSC dimensions, single question dimensions and comments. Our resear…

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Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis.

Background: Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs. Materials and methods: Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems expe…

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Healthcare is a Team Sport: Stress, Resilience, and Correlates of Well-Being Among Health System Employees in a Crisis.

Executive summary: While the COVID-19 pandemic has added stressors to the lives of healthcare workers, it is unclear which factors represent the most useful targets for interventions to mitigate employee distress across the entire healthcare team. A survey was distributed to employees of a large healthcare system in the Southeastern United States, and 1,130 respondents participated. The survey measured overall distress using the 9-item Well-Being Index (WBI), work-related factors, moral distress, resilience, and organizational-level factors. Respondents were also asked to identify major work, clinical, and nonwork stressors. Multivariate regression was used to evaluate associations between employee characteristics and WBI distress score. Overall, 82% of employees reported high distress (WBI ≥ 2), with nurses, clinical support staff, and advanced practice providers reporting the highest a…

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First Responder Resiliency ECHO: Innovative Telementoring during the COVID-19 Pandemic.

The First Responder ECHO (Extension for Community Outcomes) program was established in 2019 to provide education for first responders on self-care techniques and resiliency while establishing a community of practice to alleviate the enormous stress due to trauma and substance misuse in the community. When the SARS-CoV-2 (COVID-19) pandemic hit the United States (US) in March 2020, a tremendous strain was placed on first responders and healthcare workers, resulting in a program expansion to include stress mitigation strategies. From 31 March 2020, through 31 December 2020, 1530 unique first responders and frontline clinicians participated in the newly expanded First Responder Resiliency (FRR) ECHO. The robust curriculum included: psychological first aid, critical incident debriefing, moral distress, crisis management strategies, and self-care skills. Survey and focus group results demonst…

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Adapting RISE: meeting the needs of healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has placed extraordinary stresses on healthcare workers. Combined with disruptions to daily life outside of work, health care professionals experience a high prevalence of anxiety, depression, acute stress reaction, burnout, and PTSD. Top leaders at Johns Hopkins Medicine appreciated the mission-critical importance of maintaining the well-being and resilience of its essential workers. In March 2020 they asked the Johns Hopkins RISE (Resilience in Stressful Events) peer support program to help organize support for all staff. RISE made several adjustments, including adding virtual encounters to the usual in-person support, training additional peer responders, and rounding proactively on active units. Communication was broadened to reach less visible and lower wage workers. RISE collaborated actively with hospital epidemiology and infection control and began reporting …

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Burnout among healthcare providers during COVID-19: Challenges and evidence-based interventions.

Burnout is a major occupational problem among healthcare providers, especially during the Covid-19 pandemic. The frontline health workforce is experiencing a high workload and multiple psychosocial stressors which may affect their mental and emotional health, leading to burnout symptoms. Moreover, sleep deprivation and a critical lack of psychosocial support may aggravate such symptoms amidst Covid-19. From an ethical viewpoint, healthcare providers may experience moral distress while safeguarding patient welfare and autonomy. Moreover, social injustice and structural inequities may affect their emotional health while tackling a high volume of new cases and mortality. Global evidence indicates the need for adopting multipronged evidence-based approaches to address burnout during this pandemic, which may include increasing the awareness of work-related stress and burnout, promoting mindfu…

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Impact of a pediatric quality of life program on providers' moral distress.

Purpose: To evaluate the impact of the introduction of a new pediatric palliative care program on the pattern of moral distress in pediatric healthcare providers (HCPs). Study design and methods: We used a before and after cross-sectional survey design to study the impact of the Pediatric Quality of Life (QoL) Program on the moral distress of pediatric HCPs at a single center. Moral distress is measured in both intensity and frequency. The sample came from lists of all pediatric providers (nurses, physicians, social workers, therapists, dieticians, chaplains, administrators) serving the inpatient and outpatient pediatric areas of a southeastern academic tertiary medical center. Results: The intensity of moral distress from situations focused on "individual responsibility" and "not in the best interest of the patient" were similar before and after program implementation, but the intensity…

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The Impact of PPE Availability on Moral Distress Among EMTs During the COVID-19 Pandemic and Strategies: A Review and a Logic Model.

Background and aims: The COVID-19 pandemic has placed an unprecedented strain on healthcare systems worldwide, with frontline healthcare workers, including Emergency Medical Technicians (EMTs), facing numerous challenges. One of the most significant issues has been the availability and adequacy of personal protective equipment (PPE). This study explores the relationship between PPE availability and moral distress among EMTs during the COVID-19 pandemic and proposes a logic model to address it. Methods: In this narrative review, a goal-based search was conducted in several databases, and related articles were selected, and the desired relationships and strategies were extracted from them. Finally, a logic model was presented. Results: Inadequate PPE availability on EMTs can lead to heightened moral distress, psychological strain, and ethical dilemmas, affecting their well-being and the qu…

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Peer Interdependence in Bullying Victimization, Self-Compassion, and Moral Disengagement: A Dyadic Analysis of Early Adolescents.

Moral disengagement plays a critical role in adolescents' social adjustment, and growing evidence suggests that peer characteristics may be linked to its development. However, limited research has explored how best friend's adverse experiences and emotion regulation strategies relate to adolescents' moral strategies. Bullying victimization and self-compassion, as salient adverse experiences and emotion regulation processes during adolescence, have been associated with moral disengagement, but the interpersonal patterns of these associations remain unclear. To address this gap, the present study applied the actor-partner interdependence model in a six-month longitudinal design to examine how adolescents' own (actor effects) and best friend's (partner effects) bullying victimization experiences and self-compassion were associated with their moral disengagement over time. The study sample i…

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Educating Early Adolescents for a Sustainable Future With Digital Civic Learning: Moral Self-Concept as a Developmental Catalyst Linking Civic Competencies and Civic Purpose.

Education for sustainable development (ESD) is increasingly recognized as a developmental imperative in a world facing ecological, social, and political challenges. While many approaches to ESD emphasize knowledge and competencies, emerging research suggests that sustainable action in youth requires the integration of cognitive, emotional, and identity-based developmental processes. We propose that Digital Civic Learning (DCL) serves as a developmentally appropriate educational approach that can scaffold this process in early adolescence. Using a sample of 149 4th and 5th graders in Mid-Western United States, we examined how civic competencies, namely civic knowledge, skills, and dispositions, relate to civic purpose and further investigated the mediating role of moral self-concept. Our findings underscore the importance of nurturing moral self-concept so that enhanced civic competencies…

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From inspiration to restoration: Moral elevation as a catalyst for improving intergroup relations in contexts of conflict.

Existing research examining the creation of positive and prosocial interpersonal relations has established moral elevation as an approach-oriented emotion to be associated with a range of positive and prosocial outcomes. In this article and with the goal to identify emotional mechanism for improving intergroup relations in contexts of conflict, we examined the effects of moral elevation on enhancing intergroup relations. Across four experimental studies (Ns = 1,131), conducted in four understudied countries directly affected or threatened by intergroup conflict, we demonstrated that induced moral elevation elicits important cognitive and emotional shifts toward adversarial groups, resulting in improved intergroup relations. Specifically, we show that inducing moral elevation through stories of outgroup moral exemplars (individuals who have risked their life to save the life of an outgrou…

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Impulsivity and Emotional Dysregulation in Distress and Self-Perceived Pornography Addiction in Romanian Adults: Advancing the Dysregulation Pathway of "The Pornography Problems Due to Moral Incongruence Model".

"The Pornography Problems Due to Moral Incongruence (PPMI)" is a popular theoretical model addressing negative outcomes of pornography use, through two pathways: (1) the dysregulation pathway and (2) the moral incongruence pathway. The morality pathway has been studied extensively, though the dysregulation pathway has remained underdeveloped. The current study aimed to further investigate the dysregulation pathway from the PPMI model by examining impulsivity and emotional dysregulation. This research was conducted on a sample of 1620 Romanian participants (69.1% females), aged between 18 and 74 years (M = 26.87; SD = 9.15). They completed questionnaires designed to assess dimensions of impulsivity (e.g., "negative urgency," "positive urgency," "sensation seeking," "lack of premeditation," and "lack of perseverance"), emotional dysregulation, distress, and self-perceived addiction to porn…

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Moral and rational pathways to pro-environmental behavior among high school students: An integrated TPB-NAM model.

Adolescence is an important period for the development of pro-environmental behavior (PEB), but it remains unclear how subjective norm, personal norm, and perceived behavioral control relate to pro-environmental behavioral intention and self-reported PEB in structured school contexts. This study tested a context-sensitive framework integrating the Theory of Planned Behavior and the Norm Activation Model (TPB-NAM) to explain high school students' PEB. Survey data from 415 high school students in Lanzhou, China, were analyzed using structural equation modeling and mediation analysis. The integrated model showed better overall fit than single-path alternatives and explained substantial variance in intention and self-reported PEB (47.2% and 72.8%, respectively). In the moral pathway, awareness of consequences predicted ascription of responsibility, which predicted personal norm; personal nor…

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"It's Okay, Everyone Else Is Doing It": Moral Disengagement and Peer Delinquency.

Introduction: Adolescence is a developmental period during which moral cognition and peer environments change in ways that shape trajectories of antisocial behavior into adulthood. Although moral disengagement (MD) and peer delinquency (PD) are established risk factors for persistent offending, they are typically studied in isolation. The present study investigates the joint development of MD and PD across adolescence and early adulthood, and tests whether changes in one process forecast subsequent changes in the other. Methods: Self-reported survey data of MD and PD from 1,354 U.S. justice-involved youth (86.41% male; baseline Mage = 16.04; 41.5% Black, 33.5% Hispanic, 20.2% White, 4.8% Other) in the Pathways to Desistance study were analyzed using an autoregressive latent trajectory framework across 11 waves that spanned 7 years from 2000 to 2010. Results: MD and PD exhibited coordinat…

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"It's My Moral Responsibility to Protect Others!" Examining the Effects of Moral Framing and Message Format on Influenza Vaccination Attitude and Intention.

Vaccinations serve a dual purpose: safeguarding the vaccinated individuals while also preventing potential transmission to others. However, the pro-vaccine message has primarily emphasized the personal health risks and harms of not getting vaccinated, while rarely highlighting the moral responsibility of getting vaccinated to protect others. Guided by the Model of Intuitive Morality and Exemplars (MIME) along with the narrative persuasion framework, the current study conducted a 2 (moral framing: vaccination to protect oneself vs. protect others) X 2 (message format: statistical vs. narrative) between-subject online experiment to examine the effects of moral framing and message format on vaccination decision-making. The results revealed that individuals exposed to a pro-vaccine message framing vaccination as a moral responsibility to protect others from harm reported significantly higher…

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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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The Development of a Moral Compass: Exploring Age and Gender Differences in Moral Foundations In Early and Mid-Adolescence.

Introduction: The Moral Foundations Theory (MFT) identifies innate moral foundations that drive moral judgment, and are assumed to mature at different phases throughout development. However, core developmental aspects of moral foundations, such as normative age and gender differences from an MFT perspective, remain relatively unexplored, particularly in pre-adulthood. Therefore, the present study investigates age and gender differences in moral foundations during adolescence, a sensitive phase for moral identity development. Methods: Cross-sectional data was collected from 2022 to 2024 in a wide variety of elementary and secondary schools in Flanders, Belgium. A total of 778 adolescents (Mage = 13.14, SDage = 1.76, age range = 10-17 years, 55.4% boys, 44.6% girls) completed 30 moral foundation vignettes. Results: Regression analysis revealed normative decreases in all moral foundations w…

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Stay hungry for morality: the inhibitory effect of high moral identity and moral elevation on moral licensing.

Moral licensing, a phenomenon where initial moral behavior can lead to later immoral behavior, challenges the sustainability of moral behavior over short-term periods. In the framework of moral self-regulation, current research examined the inhibitory effects of high moral identity and moral elevation on moral licensing. Across three studies we consistently found that recalling past moral behavior can trigger moral licensing (Study 1, 2, 3). Moreover, moral licensing shows individual differences (Study 2). Specifically, those with high moral identity are more likely to show moral consistency, while those with low moral identity are more likely to show moral licensing. Finally, we found that moral licensing of people with low moral identity can be inhibited by moral elevation (Study 3). We argue that both high moral identity and moral elevation emphasize a higher ideal moral self, which m…

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Dissecting the Predictors of Cyber-Aggression Through an Explainable Machine Learning Model.

The general aggression model (GAM) suggests that cyber-aggression stems from individual characteristics and situational contexts. Previous studies have focused on limited factors using linear models, leading to oversimplified predictions. This study used the light gradient boosting machine (LightGBM) to identify and rank the importance of various risk and protective factors in cyber-aggression. The SHAP (SHapley Additive exPlanations) technique estimated each variable's predictive effects, and two-dimensional partial dependence (PD) Plots examined interactions among predictors. Among 30 potential factors, the top five were attitudes toward violence, revenge motivation, anti-bullying attitudes, moral disengagement, and anger rumination. PD analysis showed significant interactions between protective factors (anti-bullying attitudes and moral reasoning) and risk factors (attitudes toward vi…

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Paragons of character-Character strengths and well-being of moral, creative, and religious exemplars.

Objective: Which traits best describe individuals who are recognized as exemplary in different domains? And can self-rated positively valued personality traits distinguish such individuals from the general population? Background: The study of exemplary individuals' personality traits traditionally focused on general and broad traits. Using character strengths, which are narrower and designed to describe desirable behavior, could provide new insights. Method: In this study, we examined 204 outstanding individuals-exemplars who received or were nominated for a public award recognizing their exemplary behavior (e.g., a Carnegie Rescuers Award; n = 119), individuals holding a patent (n = 62), and individuals living in a religious order (n = 23). We compared these exemplars to comparison samples matched based on demographic variables. All participants completed self-report questionnaires asse…

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Diminishing Psychological Reactance Through Self-Transcendent Media Experiences: A Self-Report and Psychophysiological Investigation.

Health communication scholars have provided ample evidence demonstrating the ways in which freedom-threatening language used in persuasive health messages evokes freedom-threat perceptions, state psychological reactance, and intentions to engage in behaviors opposite of those recommended by the health message. This study examined a novel mitigation strategy for diminishing these outcomes. We examined whether prior exposure to entertainment portrayals of moral virtue (versus a neutral video) can dampen audiences' psychological reactance, intentions to consume alcohol, and defensive message processing via their psychophysiological responses to a subsequent, freedom-threatening excessive alcohol consumption public service announcement (PSA). The results revealed that participants who viewed entertainment portrayals of moral virtue (N = 50 college-aged participants) self-reported higher leve…

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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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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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