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Cited by 143Posttraumatic Stress Disorder ResearchEthics in medical practiceOccupational Health and Performance

The DOI matches its Crossref record; 116 of the 116 references it cites were found in a registry or an index.

Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers

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Lentz, Liana M., Smith-MacDonald, Lorraine, Malloy, David, Carleton, R. Nicholas, Brémault-Phillips, Suzette·2021·Frontiers in Psychology
DOI 10.3389/fpsyg.2021.639781PMC PMC8044342
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Abstract

Background: Public Safety Personnel (e.g., firefighters, paramedics, and police officers) are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger. Objective: This scoping review was designed to identify the extant empirical research regarding the construct of moral injury, its associated constructs, and how it relates to moral distress in firefighters, paramedics, and police officers. Methods: A systematic literature search of peer-reviewed research was conducted using databases MEDLINE, EMBASE, APA PsychInfo, CINHAL PLUS, Web of Science, SCOPUS, and Google Scholar. Included studies were selected based on the inclusion criteria before being manually extracted and independently screened by two reviewers. Results: The initial database search returned 777 articles, 506 of which remained after removal of duplicates. Following review of titles, abstracts, and full texts, 32 studies were included in the current review. Participants in the articles were primarily police officers, with fewer articles focusing on paramedics and firefighters. There were two studies that included mixed populations (i.e., one study with police officers, firefighters, and other emergency service workers; one study with paramedic and firefighter incident commanders). Most studies were qualitative and focused on four topics: values, ethical decision-making, organizational betrayal, and spirituality. Conclusion: Public safety organizations appear to recognize the experience of moral distress or moral injury among public safety personnel that results from disconnects between personal core values, formal and informal organizational values, vocational duties, and expectations. Further research is needed to better understand moral distress or moral injury specific to public safety personnel and inform training and treatment in support of public safety personnel mental health.

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Research works printed but not linked: 10

  1. Baumeister, 1995, The need to belong., Psychol. Bull., 117, 497, 10.1037/0033-2909.117.3.497 · DOI · Paper page
  2. Buechner, 2016, Are moral injury and PTSD distinct syndromes: conceptual differences and clinical implications, Veteran and Family Reintegration, 47
  3. 2019, Glossary of Terms: A Shared Understanding of the Common Terms Used to Describe Psychological Trauma (Version 2.0).
  4. Ford, 2010, The Relationship Between Spirituality and Marital Satisfaction in Christian Heterosexual Marriages.
  5. Johnson, 2011, Developing moral resilience amidst moral complexity, Proceedings of the Fort Leavenworth Ethics Symposium: Exploring the Professional Military Ethic, Symposium Report, 275
  6. Patton, 1999, A Qualitative Study of Spirituality with Veteran Law Enforcement Officers.
  7. Shay, 1994, Achilles in Vietnam.
  8. 2015, Table 13-10-0098-01 Mental Health Characteristics and Suicidal Thoughts.
  9. Tick, 2012, War and the Soul: Healing our Nation’s Veterans from Post-Tramatic Stress Disorder.
  10. Tovar, 2011, Vicarious traumatization and spirituality in law enforcement., FBI L. Enforc. Bull., 80

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Metadata

Authors
Lentz, L. M., Smith-MacDonald, L., Malloy, D., Carleton, R. N., & Brémault-Phillips, S.
Affiliations
  • Western University (CA)
  • University of Regina (CA)
Corresponding author
Lentz, Liana M.
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2021-03-31
Volume
12
Pages
639781-639781
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2021.639781
PMC
PMC8044342
OpenAlex
W3150699884
Cited by
143
References
116
Citations by year
2026: 34 · 2025: 34 · 2024: 18 · 2023: 29 · 2022: 23 · 2021: 5
FWCI
2.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • oURspace (University of Regina) (submittedVersion, cc-by)
Funders
Canadian Institutes of Health Research
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Performance
Keywords
moral injury, moral distress, public safety personnel, firefighters, paramedics, police officers, ethical decision-making, personal values, spirituality, guilt and shame, workplace mental health, trauma exposure

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