Moral Injury in Mental Health Nursing-A Qualitative Descriptive Study in Switzerland

Moral injury (MI) is the damage done to one's conscience or moral compass when one perpetrates, witnesses, or fails to prevent acts that transgress one's own moral beliefs. There are numerous associations between MI and various mental health outcomes, including burnout, depression, anxiety, sleep disorders, and increased job turnover. However, there has been no research or official study investigating MI in mental health nurses (MHNs) in Switzerland. This study aimed to examine and describe the spectrum and impact of MI in Swiss MHN. Demographic data and descriptions of MI in mental health nursing were collected from 19 problem-focused interviews between September and November 2023. The data were analysed descriptively and using qualitative content analysis strategies, respectively. Participants highlighted specific potentially morally injurious events (PMIEs) such as coercive measures, power plays, and sanctioning behaviour prevalent in mental health nursing. As they caused violations of moral values, with intense emotional responses ranging from anger to guilt, shame, helplessness, and powerlessness, MIs could be identified. They resulted in long-term consequences such as job changes, sleep disturbances, anxiety, panic attacks, sensory crises, and substance abuse. The results emphasise the impact of MI on the well-being and practice of MHN in Switzerland. Participants perceived MI as expressing intense emotions and dissatisfaction, challenging their moral principles in the context of their daily work. Participants confronted with MI reported increased risks for negative health outcomes. The identification of causes of MI emphasises the need for targeted interventions in the psychiatric setting.