The Causes and Impacts of Moral Harms in Healthcare Workers: A Quantitative and Qualitative Meta-Synthesis

Moral injury defines the psychological, emotional, behavioural, social and spiritual impacts of exposure to an event which transgresses a persons' deeply held moral beliefs, with shame and guilt, loss of trust (in the self and/or others), and existential conflict attributed as key consequences. Spurred on by the COVID-19 pandemic, interest in moral injury in the context of healthcare has grown, including its pervasiveness, sources and wider impacts for the workforce. Several quantitative syntheses have been conducted, to date, though these primarily cover broad sample types that span beyond healthcare (e.g., Williamson et al., 2018), or are focused on specific fields, specialities, professions or settings within healthcare (e.g., Webb et al., 2023). Thus, the aim of this systematic review is to summarise and assess the quality of existing research relating to the impacts and causes of moral distress and moral injury in healthcare workers, globally. Whilst originally planned as part of a larger umbrella review, the lack of existing reviews related to the impacts of moral harms in healthcare samples warrants a change of approach, beginning with an initial lower-level systematic review. The specific questions guiding this review are as follows: i) What are the causes of moral injury in healthcare staff? ii) What are the psychological, physical, social, behavioural and functional outcomes associated with PMIE exposure and/or moral injury symptomology in healthcare workers?