Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this systematic review, results demonstrated that moral injury was associated with professional and personal wellbeing and mental health outcomes, such as depression and anxiety.

2. Moral injury was also associated with burnout, compassion fatigue, and stress in healthcare workers.

Evidence Rating Level: 1 (Excellent)

Achieving a work-life balance may be difficult for healthcare workers due to significant work stressors. Moral injury — the experience of a moral transgression, either by yourself or those around you, and the resulting consequences — is a topic that is becoming more relevant in healthcare following the fast-paced and highly intense environment of the COVID-19 pandemic. Moral injury may be a surrogate for wellbeing. However, it has not been extensively studied in healthcare settings. As a result, the objective of the present study aimed to review the association between moral injury and wellbeing in healthcare workers.

Of 248 identified records, 18 studies were included from various databases from inception to December 2022. Studies were included if they evaluated the association between moral injury and professional or personal wellbeing in healthcare professionals. Studies were excluded if they were conceptual, did not measure moral injury, or used inappropriate statistical methodology. The review was performed using PRISMA guidelines. The risk of bias was assessed using the Joanna Briggs Institute’s (JBI) critical appraisal and bias assessment tools. The primary outcome was overall wellbeing.

The results demonstrated that moral injury was associated with professional and personal wellbeing and several mental health outcomes, including depression, anxiety, and trauma responses. There were also associations between moral injury and burnout, compassion fatigue, and stress. However, the temporal relationship between moral injury and wellbeing was unclear. Despite these results, the study was limited by the variability in the definition of moral injury, which may have affected the synthesis of the results. Nonetheless, the present study added significant information exploring the link between moral injury and the wellbeing of healthcare professionals.

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