Molendijk Tine
Department of Military Management Studies, Faculty of Military Sciences, Netherlands Defense Academy, Utrecht, The Netherlands.
Centre for International Conflict Analysis and Management (CICAM), Radboud University Nijmegen, Nijmegen, The Netherlands.
Eur J Psychotraumatol. 2025 Dec;16(1):2541485. doi: 10.1080/20008066.2025.2541485. Epub 2025 Aug 25.
Moral injury has garnered increasing attention in recent decades, extending from the military to professions like healthcare and policing. Defined as psychological, social and spiritual suffering resulting from moral transgressions, moral injury is now recognised as a multidimensional phenomenon. A growing body of empirical and theoretical research is establishing a foundational understanding of its psychological, moral and contextual dimensions. Their findings underscore the need to broaden the understanding of moral injuries sustained in the workplace, as well as work-related mental health more generally, by incorporating ethics- and context-informed approaches. This applies to both research and practice. However, the actual practical implications of their findings remain unexplored. This contribution makes a start in addressing the gap between emerging moral injury research and its practical implementation. It seeks to identify potential interventions and caution against approaches that may inadvertently exacerbate harm. Drawing on recent interdisciplinary literature, this contribution synthesises key findings and translates them into practical recommendations. It proposes individual, organisational and wider societal levels of intervention, as such with particular attention to ethics-informed and context-sensitive strategies. Research findings point to several promising interventions, including resilience training, ethics education, and moral case deliberation, targeted at both frontline practitioners and leadership. Organisational approaches such as Just Culture initiatives and practices of transformative recognition are also suggested. Conversely, the paper identifies potential pitfalls in popular responses such as the uncritical use of positive psychology or 'integritism', which may inadvertently reinforce moral distress. Adequately addressing moral injury in high-impact professions requires a comprehensive, multi-level approach. Cross-disciplinary collaboration is likely to be beneficial, involving mental health professionals, ethicists, chaplains and organisational specialists, to address the various dimensions of moral injury. This contribution has offered several research-informed suggestions for interventions, which nevertheless require further theoretical development and empirical examination.
近几十年来，道德伤害受到了越来越多的关注，其范围已从军事领域扩展到医疗保健和警务等职业。道德伤害被定义为道德违规行为导致的心理、社会和精神痛苦，现在被认为是一种多维度现象。越来越多的实证和理论研究正在对其心理、道德和背景维度建立基本认识。他们的研究结果强调，需要通过纳入基于伦理和背景的方法，拓宽对工作场所遭受的道德伤害以及更广泛的与工作相关的心理健康的理解。这适用于研究和实践。然而，他们研究结果的实际应用仍未得到探索。本论文开始着手填补新兴的道德伤害研究与其实际应用之间的差距。它试图确定潜在的干预措施，并对可能无意中加剧伤害的方法提出警示。借鉴近期的跨学科文献，本论文综合了关键研究结果，并将其转化为实际建议。它提出了个人、组织和更广泛社会层面的干预措施，特别关注基于伦理的和对背景敏感的策略。研究结果指出了几种有前景的干预措施，包括针对一线从业者和领导层的复原力训练、伦理教育和道德案例审议。还建议采用诸如公正文化倡议和变革性认可实践等组织方法。相反，本文指出了一些常见应对方式中的潜在陷阱，比如不加批判地使用积极心理学或“道德至上主义”，这可能会无意中加剧道德困扰。在高影响力职业中充分应对道德伤害需要一种全面的、多层次的方法。跨学科合作可能会有所助益，涉及心理健康专业人员、伦理学家、牧师和组织专家，以应对道德伤害的各个维度。本论文提供了一些基于研究的干预建议，但这些建议仍需要进一步的理论发展和实证检验。
