Finding the Courageous Heart of Heroes: Healing Trauma and Moral Injury in Healthcare
Moral injury has been identified in the military and with first responders for some time now. Did you know that healthcare workers are one of the largest populations facing this kind of emotional, mental, and spiritual wound? Healthcare workers experience moral injury when they witness or participate in an event that violates their moral code.
A friend I met through a non-profit gave testimony to this reality several years ago. She was working as a nurse at a Denver metro hospital. When she was first assigned there, she didn’t have any qualms about providing abortions. However one day after a D & C she was tallying body parts and realized that she could not do this again. She went to her supervisor and asked for a transfer to another department. The supervisor refused. My friend quit on moral grounds when she realized that her beliefs as a Christian were not compatible with performing abortions.
Are there ways to measure moral injury damages?
The MIDS is a self-report measure that assesses exposure to potentially morally injurious events (PMIEs). It can uncover the possible impacts of moral injury. The MIDS is designed to apply to a broad range of populations and types of PMIEs.
After recognizing the most distressing PMIE(s), respondents state how much problems from the PMIE(s) have impacted them in the past month. The scale comprehensively assesses morally injurious emotional, cognitive, religious/spiritual, social, and behavioral conditions. It ranges from milder moral distress to more severe moral injury.
What can I do to recover from moral injury?
The treatment for moral injury is not the same as trauma. Cognitive Behavioral Therapy (CBT) may work if you go to the third wave of CBT practices. Try tools from Acceptance and Commitment Therapy (ACT) or mindfulness. When you have violated your moral code, it is best not to change your thinking about your morals and values. Instead you can learn to pay attention to your feelings and decide what you can change.
The process in therapy could look like realigning yourself with your core beliefs. When a you want to re-engage with goodness in their family system, the therapist can help you break this down into small steps. For example, you can commit to giving your child a hug before bedtime.
After a trauma you are likely to have unprocessed feelings. A therapist can help you decide which feelings don’t serve you anymore, such as shame or disgust. In one case study a client decided they wanted to retain a sense of guilt which they associated with knowing what’s right and wrong. To them, guilt was an appropriate and helpful moral compass. It was a signal and kept them human. This is a good time to use the tools of ACT or mindfulness to process the guilt in/about the trauma.
Making amends can be another way of treating moral injury. This is one of the 12 steps of recovery in AA and Celebrate Recovery. Returning to my nurse friend’s story, we met in the context of a volunteer organization that was promoting medical care for moms with unexpected pregnancies. She came there after leaving her job as a nurse; completely changing directions in patient care to align with her pro-life values. Serving others who were damaged by moral injury is a way of making amends.
This brief discussion of moral injury in health care workers is just a starting point to living true to your values. In collaborating with a therapist, you can identify your values during a session. You can take those values as being core to your identity and your treatment plan goal. It's a way of taking steps to become the person God created you to be.
If you think you’ve experienced moral injury whether as a healthcare worker, frontline first responder or in the military, you can sort through things with a mental health professional. For confidentiality, call your trauma therapist in Denver at 720-577-5985 to schedule a free 15-minute consultation or book a consultation here.
