Moral Injury during COVID-19. St Emlyn’s

Ed – We have previously covered the concept of moral injury on the blog and podcast, largely in respect to the experience of managing patients with traumatic injury. In 2020 the concept has been used to describe some of the experiences clinicians are experiencing during the COVID-19 pandemic. Esther Murray is a well recognised expert in the field of moral injury in relation to healthcare and we are therefore delighted to bring you this video featuring her that explains why this such an important concept to understand at this time. What I especially like in the video is that it does not simply describe moral injury but also talks about how it can be recognised in colleagues, how we might prevent it and what can be done when it occurs. It’s worth a few minutes of your time. Over to you Esther……


I was invited by colleagues from the London Transformation and Learning Collaborative (LTLC) to make some short videos on moral injury and the other psychosocial impacts of COVID-19. They wanted to make educational resources which would stimulate reflection, start conversations about moral injury and feel less like a tick box exercise. Now that moral injury is something we’re talking about more and more, and, as Shay describes, the failures in leadership at the highest levels (i.e. regionally and nationally) in high stakes situations are occurring on a daily basis, we wanted to create a resource that addressed the real life consequences of the current situation. 

We chose this interview format so that staff could ask questions about moral injury amongst other things, and we could have real conversations. Personally, I wanted to get across the idea that although most of us will recover from all of this, none of us will be unchanged by it. That’s not necessarily a bad thing though, and realising that we have the ability to get through really hard situations is important. It isn’t fair or appropriate to behave as if someone, somewhere has the key to being able to cope with this pandemic – actually healthcare professionals and AHPs are humans who have all these strengths already, of course.

The best support we can offer right now is honest, open conversations so that people feel heard and validated in their experience. That is what will help them get through. Once we are through it, there will be different work to do. Whenever I have spoken about moral injury, there have always been people in the audience who have breathed a huge sigh of relief because there is a name for the way they are feeling. It’s no different now. We really need to find ways to talk about how we’re feeling, both the good and the bad, so that we can bear it. It’s silence that will do the harm, not talking.

So we had some good, long and wide-ranging conversations about what exactly moral injury is, what it looks like in people, what we’re worried about, why losing out on shared cake for birthdays turned out to be such a heartbreaking thing, why some people are really thriving in this situation.  This is the first of a series of videos on the topic and we hope you’ll find it useful.  

Esther Murray @EM_HealthPsych

Libby Thomas @LibbyLilias

Lucy Brock @lucybrock

Clare Leon-Villapalos @cleonvillapalos

The video was put together by the LTLC-Critical Care programme, This is an HEE and NHSEI initiative aimed at supporting the cross-skilling of the London NHS workforce to manage existing and spikes in critical care as a result of Covid-19, and the longer-term permanent expansion of critical care capacity. Whilst it has been created and developed in London for critical care, all of its content and materials are much more widely applicable to healthcare and are freely available nationally through the e-Learning for Health hub. For further information see the program page at tinyurl.com/ltlc2020 

References/Further Reading

  1. Walton M, Murray E, Christian M. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. https://doi.org/10.1177/2048872620922795
  2. Simon Carley, “Moral Injury in Emergency and Pre-hospital care. Esther Murray on St Emlyn’s podcast,” in St.Emlyn’s, August 30, 2018, https://www.stemlynsblog.org/moral-injury-in-emergency-and-pre-hospital-care-esther-murray-on-st-emlyns-podcast/.
  3. Shale S. Moral injury and the COVID-19 pandemic: reframing what it is, who it affects and how care leaders can manage it. BMJ Leader 2020;4:224-227. https://bmjleader.bmj.com/content/4/4/224
  4. Esther Murray, Charlotte Krahé, Danë Goodsman. Are medical students in prehospital care at risk of moral injury? Emergency Medicine Journal 2018;35:590-594.https://emj.bmj.com/content/35/10/590
  5. Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182–191. https://doi.org/10.1037/a0036090
  6. Wendy Dean, MD, Breanne Jacobs, MD, MA, Rita A. Manfredi, MD. Moral Injury: The Invisible Epidemic in COVID Health Care Workers. Ann Emerg Med. 2020 Oct; 76(4): 385–386.Published online 2020 Jun 23. doi: 10.1016/j.annemergmed.2020.05.023
Click above for the moral injury podcast with Esther Murray from 2018


Cite this article as: Esther Murray, "Moral Injury during COVID-19. St Emlyn’s," in St.Emlyn's, January 3, 2021, https://www.stemlynsblog.org/moral-injury-during-covid-19-st-emlyns/.

Posted by Esther Murray

Dr Esther Murray CPsychol AFBPsS SFHEA Esther is a health psychologist and her work explores the concept of moral injury in medicine. She has published, and presented on the topic at national and international conferences. Esther also delivers training on moral injury and the psychological impact of emergency response work to London Ambulance Service’s Advanced Paramedic Practitioners, the Counter Terrorism Specialist Firearms Officers of the Metropolitan Police and is a regular contributor to London HEMS Clinical Governance Days. Esther has recorded podcasts for WEM, St Emlyns, The College of Paramedics and for the London Advanced Paramedics and East of England Ambulance Service, she also delivers wellbeing workshops at the Royal London Hospital for staff in theatres and at the Royal College of Emergency Medicine and the Intensive Care Society.

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