A Review of Interventional and Preventative Studies for Moral Distress and Moral Injury Among Healthcare Workers

Moral Distress (MD) is highly prevalent among healthcare workers (HCWs), particularly in high-stress settings such as intensive care units (ICUs). Through this review, we aim to synthesize the proposed efficacy of current treatment and preventative measures, with a particular focus on identifying gaps in the literature to guide future research directions.

While intervention research has been conducted with HCWs to address MD, there remains a significant gap in research on moral injury (MI) specific interventions, especially randomized controlled trials (RCTs) that measure pre- and post-outcomes of MI treatment. Significant methodological concerns around measurement, sample size, control groups, and overreliance on cross sectional studies are discussed as limitations that cause a lack of generalizability and knowledge of sustained efficacy.

Given that potentially morally injurious events (PMIEs) often give rise to experiencing MD, and an individual’s response to MD can create MI, future research must prioritize measuring MI alongside MD, and clearly articulate which construct is being studied to not conflate the two. Future studies should critically evaluate sampling methods to include diverse healthcare roles and discuss the sociocultural factors that could play a role in the results of the intervention. Ultimately, system-level changes will be essential for supporting and retaining HCWs due to the nature of high rates of PMIEs within medical systems.