First Advisor

Tori Crain

Date of Award

Spring 6-11-2026

Document Type

Thesis

Degree Name

Bachelor of Science (B.S.) in Psychology and University Honors

Department

Psychology

Language

English

Subjects

moral injury, emergency department, healthcare workers, Job Demand-Resource model, Industrial Organizational Psychology

DOI

10.15760/honors.1854

Abstract

Moral injury (MI) is an emerging construct for understanding clinician distress in high-acuity healthcare settings, yet its application to Emergency Department (ED) clinicians remains limited. MI refers to psychological distress resulting from exposure to, or participation in, situations that conflict with deeply held moral or ethical standards, often due to systemic or organizational constraints. Although prior research has examined MI in heterogeneous healthcare samples, the ED remains underexamined despite its unique combination of high patient acuity, throughput pressure, and resource limitations.

This review synthesizes literature on MI among healthcare workers with a focus on ED clinicians, drawing on Industrial-Organizational psychology frameworks, particularly the Job Demands–Resources model. Predictors are organized into structural factors, organizational factors, and situational factors. Across studies, moral injury is associated with psychological outcomes including guilt, shame, anxiety, and depression, as well as behavioral outcomes such as burnout, disengagement, and turnover intentions. At the organizational level, these outcomes are linked to staffing instability and reduced quality of care.

Overall, MI is conceptualized as a multilevel occupational phenomenon shaped by systemic constraints, underscoring the need for ED-specific research and organizational- and systems-level interventions.

Persistent Identifier

https://archives.pdx.edu/ds/psu/44788

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