The Moral Injury Workbook

A lifeline for healthcare workers in the midst of moral pain during the COVID-19 crisis

On the front line of the COVID-19 response are thousands of healthcare providers working in strained systems with limited resources. Difficult decisions will be part of the experience of working under these circumstances. The moral dilemmas that providers may face in this crisis will undoubtedly lead to moral distress and emotional pain.

Providers may have to make decisions about life and death, determining who gets life-saving equipment and attention and who does not. Working long and stressful hours may lead to accidental mistakes, oversights, or inaction. Providers working in overburdened or under-resourced systems may experience a sense of being thwarted in their effort to keep their oath and live their values. For providers who hold values such as service, caring, or protection, these potentially morally injurious events may have lasting consequences. Anger, guilt, and shame may plague those suffering from these seemingly impossible situations. If providers become mired in this moral pain, they may find their personal and professional lives become increasingly burdened by moral injury.

The Moral Injury Workbook was developed to facilitate healing for people who have experienced a variety of moral violations and addresses a wide range of moral emotions—from guilt and shame to contempt and anger. It offers a step-by-step program to help readers move beyond their moral pain, reconnect with a fuller sense of self, and re-engage with deeply held values.

This workbook is a lifeline for healthcare providers in the midst of moral pain. Oriented toward and guided by values of caring and compassion, the content of this workbook may be meaningfully applied to and engaged in the personal and professional practices of all who read it. The six core processes of acceptance and commitment therapy (ACT) are broadly addressed in the workbook to apply to a range of moral injuries. They may be used in service of the healing needed by those suffering in the presence and aftermath of this pandemic.

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