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

Psychoanalytic Perspectives on Moral Injury in Nurses on the Frontlines of the COVID-19 Pandemic.

OBJECTIVE: To raise awareness of the potential for moral injury in nurses working on the frontlines of COVID-19 patient care and to present aspects of mental functioning that may increase the likelihood of psychological distress. Approaches that draw on psychoanalytic thinking to support frontline nurses' mental health are explained. METHOD: This article draws on recent work that is available from multiple sources, including published journal articles on moral injury, recent reports from news services highlighting the crisis state of the pandemic and effects on nurses, established literature on the structural model of the mind, and recent webinars and online lectures addressing mental health crisis interventions. The author draws on expertise from years of training in the Adult Psychoanalytic Training Program at the Michigan Psychoanalytic Institute and graduation as an academic analyst.…

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Moral Injury: An Integrative Review.

Individuals who are exposed to traumatic events that violate their moral values may experience severe distress and functional impairments known as "moral injuries." Over the last decade, moral injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about moral injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about moral injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how moral injury might and might not respond to evidence…

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Moral Injury, Spiritual Care and the Role of Chaplains: An Exploratory Scoping Review of Literature and Resources.

This scoping review considered the role of chaplains with regard to 'moral injury'. Moral injury is gaining increasing notoriety. This is due to greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the 'soul' that are far more difficult to heal-if at all. As part of a larger research program exploring moral injury, a scoping review of literature and other resources was implemented utilising Arksey and O'Malley's scoping method (Int J Soc Res Methodol 8(1):19-32, 2005) to focus upon moral injury, spirituality (including religion) and chaplaincy. Of the total number of articles and/or resources noting the term 'moral injury' in relation to spiritual/religious issues (n = 482), the results revealed 60 resources that specifically noted moral injury and cha…

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Role of morality in the experience of guilt and shame within the armed forces.

Objective: Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces. Method: A search of the literature pertaining to guilt, shame and morality within military samples was conducted. Results: Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-t…

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Moral injury: a mechanism for war-related psychological trauma in military family members.

Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral probl…

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Moral injury and moral repair in war veterans: a preliminary model and intervention strategy.

Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. To stimulate a critical examination of moral injury, we review the available literature, define terms, and offer a working conceptual framework and a set of intervention strategies designed to repair moral injury.

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Ethical dilemmas in nursing: An integrative review.

Aims: To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. Background: The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. Design: This study is an integrative review of published research from 2000 to 2017. Methods: The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matr…

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Understanding the moral distress of nurses witnessing medically futile care.

Purpose/objectives: To explore the topic of moral distress in nurses related to witnessing futile care. Data sources: Literature related to moral distress and futility; analysis of narratives written by 108 nurses attending one of two national continuing education courses on end-of-life care regarding their experiences in the area. Data synthesis: Nurses were invited to share a clinical situation in which they experienced moral distress related to a patient receiving care that they considered futile. Nurses described clinical situations across care settings, with the most common conflict being that aggressive care denies palliative care. Conflicts regarding code status, life support, and nutrition also were common. Patients with cancer were involved quite often, second only to geriatric patients and patients with dementia. The instances created strong emotional responses from nurses, inc…

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Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review.

Introduction: Healthcare clinicians are often at risk of psychological distress due to the nature of their occupation. Military healthcare providers are at risk for additional psychological suffering related to unique moral and ethical situations encountered in military service. This scoping review identifies key characteristics of moral distress and moral injury and how these concepts relate to the military healthcare clinician who is both a care provider and service member. Methods: A scoping review of moral distress and moral injury literature as relates to the military healthcare clinician was conducted on the basis of the Joanna Briggs Institute scoping review framework. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid), PsycInfo, 2 U.S. Defense Department sources, conference papers index, and dissertation abstracts. Re…

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Encountering children and child soldiers during military deployments: the impact and implications for moral injury.

Background: During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Objective: This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings t…

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Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review.

Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these cohorts have not been systematically explored, nor have the unique circumstances that may exist across countries been explored. Here, we sought to identify and compare, across the globe, potentially morally injurious or distressful events (PMIDEs) in HCWs and PSP during the COVID-19 pandemic. A scoping review was conducted to identify and synthesize global knowledge on PMIDEs in HCWs and select PSP. Six databases were searched, including MEDLINE, EMBASE, Web of Science, PsychInfo, CINAHL, and Global Health. A total of 1,412 articles were retrieve…

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Pharmacy Workplace Wellbeing and Resilience: Themes Identified from a Hermeneutic Phenomenological Analysis with Future Recommendations.

This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents' written comments along with a blend of the researchers' understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to phar…

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A Practical Approach to Hospital Visitation During a Pandemic: Responding With Compassion to Unjustified Restrictions.

During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals' policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-of-life care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. A family-centered approach to care has been unilaterally relinquished to a secondary and nonessential role during the current crisis. This phenomenon violates a foundational public health principle, namely, to apply the least restrictive means to achieve good for the many. Instead, there has been widespread adoption of utilitarian and paternalistic approaches. In man…

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Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers.

Background: Public Safety Personnel (e.g., firefighters, paramedics, and police officers) are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger. Objective: This scoping review was designed to identify the extant empirical research regardi…

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The Impact of Wartime Child Casualties on Adult Professionals.

Objective: Between 2005 and 2022, more than 315,000 grave violations were verified against children in wartime, including killing, physical maiming, exploitation, and forced displacement. While the resulting harm to children is widely recognized, the profound toll on professionals who witness and respond to these tragedies remains under examined. This article explores the psychological and occupational impacts of exposure to child casualties during wartime on healthcare providers, military personnel, journalists, and mortuary affairs workers. Method: Google Scholar, PsycINFO, PsychNET, and PubMed were searched for literature examining the impact of pediatric death and injury on healthcare professionals, service members, journalists, and mortuary affairs workers in wartime settings. Supplementary searches were conducted to identify supportive evidence from literature addressing impacts in…

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Narrative Medicine: The Power of Shared Stories to Enhance Inclusive Clinical Care, Clinician Well-Being, and Medical Education.

The COVID-19 pandemic exacerbated the problem of secondary trauma and moral injury for health care workers. This reality, together with the epidemic of social isolation and loneliness, has brought the mental health of health care practitioners and patients to the forefront of the national conversation. Narrative medicine is an accessible, diversity-honoring, low-cost, underutilized pedagogical framework with potentially revolutionary benefits for enhancing patient care, supporting the underserved, mitigating clinician burnout, and improving team dynamics. Herein, the authors review the literature on these benefits and then discuss methods for integrating narrative medicine into clinical care and medical education at the undergraduate and graduate levels as well as continuing medical education.

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Addressing Postpandemic Clinician Mental Health : A Narrative Review and Conceptual Framework.

Previous pandemics have seen high psychiatric morbidity among health care workers. Protecting clinician mental health in the aftermath of coronavirus disease 2019 (COVID-19) requires an evidence-based approach to developing and deploying comprehensive clinician mental health support. In a narrative review of 96 articles addressing clinician mental health in COVID-19 and prior pandemics, 7 themes emerged: 1) the need for resilience and stress reduction training; 2) providing for clinicians' basic needs (food, drink, adequate rest, quarantine-appropriate housing, transportation, child care, personal protective equipment); 3) the importance of specialized training for pandemic-induced changes in job roles; 4) recognition and clear communication from leadership; 5) acknowledgment of and strategies for addressing moral injury; 6) the need for peer and social support interventions; and 7) norm…

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Moral Injury in Health Care: Identification and Repair in the COVID-19 Era.

Frontline health-care workers experienced moral injury long before COVID-19, but the pandemic highlighted how pervasive and damaging this psychological harm can be. Moral injury occurs when individuals violate or witness violations of deeply held values and beliefs. We argue that a continuum exists between moral distress, moral injury, and burnout. Distinguishing these experiences highlights opportunities for intervention and moral repair, and may thwart progression to burnout.

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Mapping global evidence on compassion fatigue among healthcare workers during COVID-19: insights and implications for future preparedness - a scoping review.

Background: Compassion fatigue (CF) is a critical occupational hazard for healthcare workers (HCWs), intensified by the COVID-19 pandemic, with implications for well-being, retention, and quality of care. We aimed to map the global evidence on CF prevalence, risk factors, effects, interventions, and research gaps among HCWs during the COVID-19 pandemic. Methods: A scoping review of 56 studies from 21 countries (2020-2025) was conducted following PRISMA-ScR guidelines. Seven databases were searched, and findings were synthesised narratively with attention to occupational, demographic, and systemic determinants of CF. Results: Compassion fatigue prevalence ranged from 20 to 87%. It was most pronounced among nurses, women, frontline staff, early-career professionals, and those in under-resourced or rural settings. Key risk factors included high workload, long shifts, repeated exposure to de…

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Mapping the conceptualisation, contributing factors and interventions of moral distress among healthcare providers in Africa: a scoping review.

Moral distress is the psychological discomfort experienced by healthcare providers when prevented from acting on their ethical values. Although extensively studied in high-income settings, it remains relatively unexplored in Africa, where chronic resource limitations and systemic constraints shape clinical practice. This scoping review mapped African literature examining how moral distress is conceptualised and discussed, its drivers and interventions implemented to address it with a particular focus on the balance between individual and organisational perspectives. A systematic search of databases identified papers on moral distress and related concepts among healthcare providers in Africa. Data extracted included: publication year, geographical focus, study design, participants, healthcare setting, conceptual framing, definitions, factors contributing to moral distress and descriptions…

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Cultivating kindness in healthcare facilities: a quadruple approach to the quadruple aim.

The importance of physician well-being has been increasingly recognised in the last decade with an improved understanding of the prevalence and drivers of occupational and moral distress in healthcare workers. High rates of burnout have significant costs at both the individual and organisational level, with follow-on effects impacting staff turnover and patient care. Healthcare facilities have a responsibility to prioritise physician well-being and should adopt a structured and comprehensive approach to this aspect of healthcare delivery. Kindness is a significant factor impacting professional fulfilment and can reduce stress and burnout in healthcare workers. Acts of kindness and prosocial behaviours have widespread benefits, impacting the giver, receiver and even observer of the kind act. Moreover, kindness in the delivery of healthcare not only has a profound impact on patient satisfa…

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Experiences of Healthcare Workers in Long-Term Care during COVID-19: A Scoping Review.

Background: Although healthcare workers (HCWs) in long-term care (LTC) have experienced significant emotional and psychological distress throughout the pandemic, little is known about their unique experiences. Objective: This scoping review synthesizes existing research on the experiences of HCWs in LTC during the COVID-19 pandemic. Method: Following Arksey and O'Malley's framework, data published between March 2020 to June 2022, were extracted from six databases. Results: Among 3808 articles screened, 40 articles were included in the final analysis. Analyses revealed three interrelated themes: carrying the load (moral distress); building pressure and burning out (emotional exhaustion); and working through it (a sense of duty to care). Conclusion: Given the impacts of the pandemic on both HCW wellbeing and patient care, every effort must be made to address the LTC workforce crisis and ev…

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Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers.

Purpose of review: We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW. Recent findings: The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting menta…

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Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis.

Objective: Pandemics negatively impact healthcare workers' (HCW's) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW's mental health and well-being interventions through pandemics reporting mental health outcomes was conducted addressing two questions: (1) What mental health support interventions have been reported in recent pandemics, and have they been effective in improving the mental health and well-being of HCWs? (2) Have any mobile apps been designed and implemented to support HCWs' mental health and well-being during pandemics? Design: A narrative evidence synthesis was conducted using Cochrane criteria for synthesising and presenting findings when systematic review and pooling data for statistical analysis are not suitable due to the heterogeneity of the s…

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The Use of Expressive Writing in Healthcare Professionals: A Systematic Review of Quantitative Studies.

Background: Healthcare professionals are exposed to high emotional demands, including repeated contact with suffering, death, moral distress, and organizational pressure. These factors are associated with psychological distress, burnout, and secondary traumatic stress. Expressive Writing (EW) has been proposed as a psychological intervention, but evidence of its effectiveness among healthcare professionals remains heterogeneous. Objectives: To examine the effects of EW on psychological health, psychophysical well-being, and professional satisfaction among healthcare professionals. Methods: A systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA 2020 guidelines. Searches were performed in PubMed, CINAHL, CENRAL, CENTRAL Scopus, Embase, and PsycINFO from database inception to January 2025. Quantitative studies involv…

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