Shao Rongqing, Wang Yu, Worthington Roger
School of Humanities and Social Sciences, Harbin Medical University, Harbin, 150081, China.
Department of Integrated Traditional Chinese and Western Medicine, Heilongjiang Academy of Chinese Medical Sciences, Harbin, 150036, China.
BMC Health Serv Res. 2025 Apr 7;25(1):507. doi: 10.1186/s12913-025-12628-6.
Moral injury - the betrayal of one's moral and professional values - is a negative factor affecting physicians' wellbeing. However, few studies have examined moral injury and its predictors in healthcare professionals. Therefore, this study aimed to explore the prevalence, associated factors, and predictors of moral injury in Chinese physicians.
This study was a cross-sectional survey conducted from September 14 to October 27, 2023, in mainland China. A total of 549 physicians completed the online self-administered questionnaire through the WeChat app. The 10-item Moral Injury Symptom Scale-Health Professional (MISS-HP) was used to assess the severity of moral injury symptoms, and the Moral Injury Events Scale (MIES) was used to measure exposure to potentially morally injurious events (PMIEs).
The results of the study showed a mean score of 42.07 (SD = 13.67) for the MISS - HP, and the prevalence of moral injury among the physicians was 31.6%. The multiple linear regression identified five main predictors of moral injury: exposure to PMIEs, job satisfaction, lack of organizational support, witnessing patient suffering or death, and mental health needs.
Chinese physicians reported experiencing different types of PMIEs and suffering from moral injury-related symptoms in their clinical practice. It helped to understand modifiable risk factors for moral injury, highlighting the need for systemic interventions. Healthcare institutions can mitigate moral injury and safeguard the wellbeing of healthcare workers by building peer-support networks, improving communication to address workload issues, and implementing recognition systems for ethics.
道德伤害——个人道德和职业价值观的背叛——是影响医生幸福感的一个负面因素。然而，很少有研究探讨医疗保健专业人员中的道德伤害及其预测因素。因此，本研究旨在探讨中国医生中道德伤害的患病率、相关因素和预测因素。
本研究是一项于2023年9月14日至10月27日在中国内地进行的横断面调查。共有549名医生通过微信应用程序完成了在线自填问卷。使用10项道德伤害症状量表-医疗保健专业人员（MISS-HP）评估道德伤害症状的严重程度，使用道德伤害事件量表（MIES）测量接触潜在道德伤害事件（PMIEs）的情况。
研究结果显示，MISS-HP的平均得分为42.07（标准差=13.67），医生中道德伤害的患病率为31.6%。多元线性回归确定了道德伤害的五个主要预测因素：接触PMIEs、工作满意度、缺乏组织支持、目睹患者痛苦或死亡以及心理健康需求。
中国医生报告在临床实践中经历了不同类型的PMIEs，并遭受与道德伤害相关的症状。这有助于了解道德伤害的可改变风险因素，凸显了系统性干预的必要性。医疗机构可以通过建立同伴支持网络、改善沟通以解决工作量问题以及实施道德认可系统来减轻道德伤害，保障医护人员的幸福感。
