“Ruptured selves: moral injury and wounded identity”

Support for clinicians with moral loss after the pandemic

“…• Moral identity for clinicians refers to a self-conception that develops from belonging to a community of practitioners who share a framework of values and principles which shape their overall commitment to caring for patients 10 • Moral distress occurs when an individual is required to act contrary to deeply held professional values 11 • Moral injury refers to a disorienting and painful experience that follows violation of deeply held moral commitments. 10 It is a more sustained form of moral distress, originally described in the military veteran literature…”

“…29 In the absence of a clinical ethicist, some of the benefits of facilitated ethics discussion can be achieved through other avenues such as clinician mentors or "buddies" who partner with colleagues and regularly check wellbeing, 10 peer support groups, and professional supervision. 28 These types of discussions nurture a supportive moral community of colleagues 10 to assist clinicians to make sense of and re-orient their professional moral identity to care for patients. 9 10 28 The types of questions that can help clinicians to process and heal from experiences of moral loss, distress, and injury are underpinned by a disposition of empathic curiosity 30 and of availability.…”

“…9 10 28 The types of questions that can help clinicians to process and heal from experiences of moral loss, distress, and injury are underpinned by a disposition of empathic curiosity 30 and of availability. 10 The facilitator needs to convey genuine curiosity about the clinician's experience and their capacity to understand and make sense of past moral challenges in their clinical practice (box 2). Importantly, the questions and focus of the facilitated ethics dialogue should be pitched at the level of the moral loss clinicians have experienced during the covid pandemic.…”

“…Moral identity for clinicians refers to a self-conception that develops from belonging to a community of practitioners who share a framework of values and principles which shape their overall commitment to caring for patients10…”

“…Moral injury refers to a disorienting and painful experience that follows violation of deeply held moral commitments 10. It is a more sustained form of moral distress, originally described in the military veteran literature…”