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

Pastoral Narrative Disclosure: The Development and Evaluation of an Australian Chaplaincy Intervention Strategy for Addressing Moral Injury.

This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in m…

matched on Morals (mesh), moral injury (text)

Experiences and impact of moral injury in U.K. veterinary professional wellbeing.

Background: Veterinary professionals (VPs) are often exposed to distressing and ethically challenging events in their line of work, yet little is known about whether they may experience moral injury and the impact potentially morally injurious events (PMIEs) may have on their wellbeing. This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of U.K. VPs. Method: Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an anonymous online questionnaire to 90 U.K. VPs between December 2020 and May 2021. Results: Exposure to PMIEs was reported by almost all VPs (89.0%), with acts of omission most frequently reported. Experiences of PMIEs were significantly associated with symptoms of PTSD (p < 0.01) and experiencing a betrayal event was significantly associated with PTSD symptoms (p<0.05). Howev…

matched on Morals (mesh), moral injury (text)

Warnings against romanticising moral injury.

Interest in the concept of moral injury among researchers, clinicians and policy makers can have undesirable consequences that are rarely considered. It can lead to misunderstanding of post-traumatic stress disorder, risks of primary and secondary gains for affected individuals and tertiary gains for third parties. This editorial calls for critical assessment of this sensitive matter.

matched on Morals (mesh), moral injury (text)

Moral wounds run deep: exaggerated midbrain functional network connectivity across the default mode network in posttraumatic stress disorder.

Background: A moral injury occurs when a deeply held moral code has been violated, and it can lead to the development of symptoms of posttraumatic stress disorder (PTSD). However, the neural correlates that differentiate moral injury and PTSD remain largely unknown. Intrinsic connectivity networks such as the default mode network (DMN) appear to be altered in people with PTSD who have experienced moral injury. However, brainstem, midbrain and cerebellar systems are rarely integrated into the intrinsic connectivity networks; this is a critical oversight, because these systems display marked differences in people with PTSD and are thought to underlie strong moral emotions such as shame, guilt and betrayal. Methods: We conducted an independent component analysis on data generated during script-driven memory recall of moral injury in participants with military- or law enforcement-related PTS…

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Examining the Interaction Between Potentially Morally Injurious Events and Religiosity in Relation to Alcohol Misuse Among Military Veterans.

Given the disproportionate rate of alcohol misuse among veterans and related outcomes as compared to the general population, the examination of predictors of alcohol misuse in this population is imperative. Potentially morally injurious events (PMIEs), defined as severe transgressions of a moral code, have been positively associated with alcohol misuse. Exposure to PMIEs may challenge one's religious beliefs, which may, in turn, influence the strength of the association between PMIEs and alcohol misuse among military veterans. The goal of the current study was to examine the potential moderating role of religiosity in the association between PMIEs and alcohol misuse (i.e., alcohol consumption, drinking behaviors, adverse reactions to drinking, and alcohol-related problems). Participants were 496 military veterans in the community (Mage = 37.80 years, SD = 11.42; 70.5% male). The results …

matched on Morals (mesh), moral injury (text)

Exposure to combat incidents within military and civilian populations as possible correlates of potentially morally injurious events and moral injury outcomes among Israeli combat veterans.

Objectives: Exposure to potentially morally injurious events (PMIEs) is considered a necessary but insufficient determinant of moral injury (MI) outcomes. However, a question remains regarding possible acts and the necessary features of PMIEs that should be considered transgressive and might lead to MI psychopathological outcomes. We aim to examine the links between exposure to combat incidents within civilian Palestinian populations (CPPs), PMIEs and MI-related outcomes of posttraumatic stress disorder (PTSD) symptoms (PTSS), trauma-related guilt and shame. We also aim to explore the mediating roles of subjective perceptions of PMIEs in the relationship between exposure to combat incidents within CPP and MI-related outcomes among combat veterans. Method: A volunteer sample of 716 Israeli combat veterans responded to self-report questionnaires in a cross-sectional design study. Results: …

matched on Morals (mesh), moral injury (text)

"If I die, they do not care": U.K. National Health Service staff experiences of betrayal-based moral injury during COVID-19.

Objective: The COVID-19 pandemic brought unparalleled pressure, stress, and a dramatic change in practice to health care systems across the world. National Health Service (NHS) staff have reported higher levels of burnout, stress, and other mental health issues that they relate directly to the impact of the pandemic. Burnout is often used as a "catch-all" term for psychological distress in the workplace, and it has been suggested that, during the pandemic, experience of "burnout" may be influenced by "moral injury": the distress that can arise from actions, or lack of action, that are seen to violate one's ethical code. This study investigates NHS staff experiences of burnout and betrayal-based moral injury, in which a trusted authority betrays "what is right." Method: Sixteen NHS staff members were interviewed in relation to their experiences during the COVID-19 pandemic, and data were …

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Moral injury events and behavioral health outcomes among American veterans.

Among American veterans, the behavioral health impact of potentially morally injurious experiences (PMIEs) has recently garnered attention. There is heterogeneity in the types of experiences that are classified as PMIEs, and different PMIEs may be differentially associated with various outcomes. We aimed to explore heterogeneity in PMIEs among veterans, and whether PMIE classes are differentially associated with several behavioral health outcomes (i.e., symptoms of posttraumatic stress disorder, depression, anxiety, and anger). Data were from a survey study of veteran health attitudes and behavior (N=1004). We employed a Latent Class Analysis approach to identify sub-groups of participants with similar PMIE response patterns on the Moral Injury Events Scale and to determine the relationship between class membership and behavioral health outcomes. A 4-class solution best fit our data, wit…

matched on Morals (mesh), moral injury (text)

Moral injury among U.S. combat veterans with and without PTSD and depression.

Background: Questions persist about how often potentially morally injurious events (PMIEs) are associated with posttraumatic stress disorder (PTSD) and depression. Methods: This study examined the overlap of morally injurious events with probable PTSD and depression in a nationally representative sample of U.S. combat veterans (n = 1,321, mean age 59.1, 93.7% male). Results: Most veterans with probable PTSD (72.2%), probable depression (72.4%), and probable PTSD and/or depression (68.4%), endorsed experiencing PMIEs; 31.1-35.3% of these participants endorsed perpetration, 45.1-50.4% endorsed witnessing others, and 52.6-55.7% endorsed betrayal. The prevalence of PMIEs among veterans without current probable PTSD and/or depression was 33.7%, 32.3%, and 31.5%, respectively; 7.9-9.1% of these participants endorsed perpetration-based PMIEs, 19.2-20.3% witnessing, and 19.8-21.8% endorsed betra…

matched on Morals (mesh), moral injury (text)

Moral Injury and the Absurd: The suffering of moral paradox.

Drawing upon qualitative and construct validity evidence within MI research and the oral histories of combat-exposed Veterans, this paper explores the role of moral paradox (MP) as a precondition of moral injury (MI). Research is recommended to clearly delineate MP as a causative factor leading to more intractable cases of MI in the definitional literature, beyond the recognized impact of perpetration and betrayal-based conditions. Veteran stories collected during the normal course of providing spiritual care to combat-exposed Veterans and used by permission will provide insight into the theoretical concepts and interrelations of MP; proposed here as: circumstances in which moral obligations and/or ethical values come into conflict, forcing a choice between sides, none of which can be honored without violating the other. Acquainted with religious traditions that elucidate the perplexity …

matched on Morals (mesh), moral injury (text)

Moral injury as a unique predictor of suicidal ideation in a veteran sample with a substance use disorder.

Objective: Suicide among military veterans accounts for 22.2% of all suicide deaths in the United States per year, and veterans with a substance use disorder (SUD) are at an even higher risk for death by suicide. This prevalence has led to increased efforts to identify and investigate both potential risks and protective factors for veterans. This study examines relationships between depression symptomology, exposure to potentially morally injurious events, posttraumatic stress disorder (PTSD) diagnosis, and suicidal ideation, with the primary aim of examining exposure to moral injurious events as a risk factor for suicide in veterans with SUD. Method: An inpatient sample of 40 veterans with an active SUD admitted for suicidal ideation was evaluated to examine differences in suicidal ideation, depression symptomology, and exposure to morally injurious events in participants with and witho…

matched on Morals (mesh), moral injury (text)

Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis.

Moral injury merits further study to clarify its identification, prevalence, assessment and intersection with psychosocial and psychiatric problems. The present study investigated the screening potential of the Brief Moral Injury Screen (BMIS) in a sample of post-9/11 veterans (N = 315) and comparatively evaluated how this tool, the Moral Injury Events Scale (MIES), and the Moral Injury Questionnaire-Military Version (MIQ-M) relate to psychiatric diagnoses and mental illness symptom severity. Those who endorsed failing to prevent or doing something morally wrong had the highest symptomatology scores on measures of posttraumatic stress disorder, depression, suicidality, alcohol abuse and drug abuse, followed by those who reported solely witnessing a moral injury event. Posttraumatic stress disorder and depressive symptoms correlated most strongly with scores on the MIQ-M; suicidality, alc…

matched on Morals (mesh), moral injury (text)

Patterns of distress associated with exposure to potentially morally injurious events among Canadian Armed Forces service members and Veterans: A multi-method analysis.

Objective: This study describes patterns of distress associated with exposure to potentially morally injurious experiences (PMIEs) in a Canadian military sample. Method: Thematic analysis was performed on interviews from PMIE-exposed military members and Veterans. Participants also completed structured diagnostic interviews, and measures of trauma exposure and psychopathology. Multiple regression examined associations among these variables. Information on pharmacological treatment and past diagnoses are reported. Results: Eight qualitative themes were identified: changes in moral attitudes, increased sensitivity and reactivity to moral situations, loss of trust, disruptions in identity, disruptions in spirituality, disruptions in interpersonal relatedness, rumination, and internalizing and externalizing emotions and behaviors. Self-report data revealed that degree of PMIE exposure was me…

matched on Morals (mesh), moral injury (text)

The impact of moral injury on the wellbeing of UK military veterans.

Background: Experiences of potentially morally injurious events (PMIEs) have been found to negatively impact the mental health of US personnel/veterans, yet little is known about the effect of PMIEs on the mental health of the UK Armed Forces (AF). This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of UK AF veterans. Method: Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an online questionnaire to 204 UK veterans. Subjects were classified as having experienced a morally injurious event (n = 66), a non-morally injurious traumatic event (n = 57), a 'mixed' event (n = 31), or no event (n = 50). Results: Potentially morally injurious experiences were associated with adverse mental health outcomes, including likely anxiety disorders and suicidal ideation, compared to those who repor…

matched on Morals (mesh), moral injury (text)

Military moral injury: A concept analysis.

Moral injury is the current term describing the breaching or violation of one's moral code and has gained international research attention due to suicide linkages in military populations (Jamieson et al., Invisible wounds and suicide: Moral injury and veteran mental health. International Journal of Mental Health Nursing, 29, 105-109, 2020). Moral injury's core features are spiritual/existential conflict, shame, guilt and self-condemnation. To date, research focuses on the core features of moral injury and or the nature of events that exposed individuals to moral injury. Walker and Avant (Strategies for Theory Construction in Nursing, Prentice Hall New York, 2011) concept analysis model was used to examine the literature. The aim of this study is to enhance understanding of the defining attributes, antecedents, consequences and empirical referents of moral injury and systematically analys…

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Gender differences in prevalence and outcomes of exposure to potentially morally injurious events among post-9/11 veterans.

Our goal was to identify gender differences in the prevalence and outcomes of exposure to potentially morally injurious events (PMIEs) in a sample of U.S. military veterans. In a national sample of post-9/11 veterans (n = 7200) weighted to reflect the larger population of newly separated U.S. veterans, we conducted gender-stratified analyses of the prevalence of exposure to PMIEs and their associations with psychological and functional problems. Veterans reported exposures stemming from witnessing (27.9%), perpetrating (18.8%), and being betrayed (41.1%). Women more frequently reported witnessing- and betrayal-based PMIEs, but no gender differences were observed for perpetration-based PMIEs. Psychological distress was associated with witnessing and betrayal among women and with witnessing, betrayal, and perpetration among men. Whereas betrayal was most consistently associated with functi…

matched on Morals (mesh), moral injury (text)

Moral Injury and Social Well-Being: A Growth Curve Analysis.

Moral injury (MI) may occur in the context of committing transgressions (i.e., self-directed MI reactions), witnessing transgressions, or being the victims of others' transgressions (i.e., other-directed MI reactions) that violate an individual's moral principles. Veterans with MI may experience impaired social well-being (SWB). Studies on MI and veterans' SWB have focused almost exclusively on social support and used cross-sectional data. The present study used growth curve analyses to examine the associations between self- and other-directed MI reactions and veterans' levels of social support, social functioning, social activities, and social satisfaction over the first 18 to 21 months of their transition to civilian life (N = 9,566). The results demonstrated declines in all SWB outcomes, with self- and other-directed MI reactions having differential effects. Higher versus lower levels…

matched on Morals (mesh), moral injury (text)

A model for treating COVID-19-related guilt, shame, and moral injury.

During the unprecedented COVID-19 pandemic, people around the world have faced a myriad of heart-rending and ethically difficult scenarios (e.g., not being able to tend to a sick or dying loved one) that may lead to subsequent guilt, shame, or moral injury. Trauma-informed guilt reduction therapy is a brief intervention that helps clients accurately appraise their role in a stressful event (such as those experienced during the COVID-19 pandemic) and find positive ways to express important values going forward. Future studies of trauma-informed guilt reduction therapy with those affected by COVID-19 will be helpful for clarifying its effectiveness with this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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The effects of nonconventional palliative and end-of-life care during COVID-19 pandemic on mental health-Junior doctors' perspective.

The COVID-19 pandemic has changed the way doctors approach palliative and end-of-life care, which has undoubtedly affected the mental health of patients, families, and health care professionals. Given these circumstances, doctors working on the front line are vulnerable to moral injury and compassion fatigue. This is a reflection of 2 junior doctors experiencing firsthand demands of caring for patients during the outbreak. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Psychological trauma and moral injury in religious leaders during COVID-19.

Religious leaders are at risk of psychological trauma and moral injury during the COVID-19 pandemic. This article highlights potentially traumatic or morally injurious experiences for religious leaders and provides evidence-based recommendations for mitigating their impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Moral and mental health challenges faced by maternity staff during the COVID-19 pandemic.

The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level. (PsycInfo Database Record (c) 2020…

matched on Morals (mesh), moral injury (text)

Moral decision making, religious strain, and the experience of moral injury.

Objective: Moral injury is the lasting psychological, spiritual, and behavioral effects of having perpetrated acts that transgress moral boundaries. Contemporary models of moral injury in military veterans examine the role of transgressive acts, moral appraisals of these acts, and the symptoms of moral injury. However, little research has examined potential pathways between these elements. The current study examined appraisals of one's acts and religious strain as potential mediators of the link between transgressive acts and symptoms of moral injury. Further, given the inherent importance of moral cognitions in the appraisal process, we tested whether the acts to appraisals link was moderated by altruism in military veterans. Method: An online survey, distributed using crowdsourcing software, was completed by military veterans. The survey included measures of transgressive acts, apprais…

matched on Morals (mesh), moral injury (text)

Examining the Factor Structure of the Moral Injury Events Scale in a Veteran Sample.

Introduction: Interest in moral injury has burgeoned over the last decade as an increasing number of professionals recognize that current conceptualizations of trauma are not sufficient to explain some of the challenges that military service members face. The Moral Injury Events Scale (MIES) was the first instrument developed to measure exposure to military events that could produce moral injury (Nash et al., 2013). Two previously published validation studies that focused on service members still in uniform reveal some discrepancies regarding the scale's factor structure. Bryan and colleagues (2016) documented a three-factor solution (i.e., transgressions-others, transgressions-self, and betrayal), while Nash and colleagues (2013) noted a two-factor solution (i.e., perceived transgressions and perceived betrayals). Materials and methods: With an interest in further scale validation, the …

matched on Morals (mesh), moral injury (text)

Associations Among Exposure to Potentially Morally Injurious Experiences, Spiritual Injury, and Alcohol Use Among Combat Veterans.

Potentially morally injurious experiences (PMIEs) are events that may violate deeply held values or belief systems. Combat engagement places service members at a heightened risk for PMIE exposure. Exposure to PMIEs may elicit internal conflict between moral beliefs and experiences and, if unresolved, conflict may manifest as feelings of guilt, shame, and spiritual or existential crisis. Further, distress caused by these experiences may promote harmful behaviors (e.g., excessive alcohol use), which may serve as attempts to cope with PMIEs veterans have witnessed or participated in. The present study examined a sequential mediation model in which combat exposure was associated with alcohol use (i.e., alcohol consumption, dependence symptoms, and alcohol-related problems) via PMIE exposure and spiritual injury (e.g., alienation from and/or anger towards respective higher power) in a communi…

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Commentary on the Special Issue on Moral Injury: Advances, Gaps in Literature, and Future Directions.

We contextualize and provide commentary on articles in the current issue that address the nature, measurement, and consequences of exposure to potentially morally injurious events (PMIEs) and moral injury (MI). PMIEs involve acts of commission or omission of oneself and others and can include perpetration of, and failure to prevent, harm; MI includes "the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations" (Litz et al., 2009). New and informative research aims to characterize types of PMIEs among military service members and veterans, including in multinational samples. There are also ongoing efforts to devise outcome scales that reliably capture broad MI outcome themes. Further, several new measures of MI assess emotional, cognitive, and beh…

matched on Morals (mesh), moral injury (text)