TY - JOUR T1 - Moral injury and the COVID-19 pandemic: reframing what it is, who it affects and how care leaders can manage it JF - BMJ Leader JO - BMJ Leader SP - 224 LP - 227 DO - 10.1136/leader-2020-000295 VL - 4 IS - 4 AU - Suzanne Shale Y1 - 2020/12/01 UR - http://bmjleader.bmj.com/content/4/4/224.abstract N2 - The term moral injury has achieved widespread circulation among care leaders during the pandemic, and has been influential in prompting care providers to give fresh consideration to the psychological support available to staff.1 2 The notion of moral injury that has come to prominence is one that some label ‘occupational moral injury’. This arises during work such as armed combat or emergency response when people carry out, fail to prevent, or become aware of, human actions that violate deep moral commitments. Occupational moral injury is often associated with psychological distress, and moral responses including guilt, anger and disgust.3 Here I draw attention to a broader notion of moral injury found in moral philosophy. In this version, a moral wound can be experienced by anyone. It arises from sources that include injustice, cruelty, status degradation and profound breaches of moral expectations. The moral-philosophical version of moral injury associates it with moral and psychological anguish, and feelings such as bewilderment, humiliation and resentment. According to this formulation of moral injury, it could affect patients, service users, families and loved ones as well as care staff.Experiences of moral injury among the wider public, as well as staff, will call for attention from care leaders long after the pandemic surge.Prior to the pandemic, care leaders did not commonly use the term ‘moral injury’. They most likely use it now to refer to ‘occupational moral injury’. However, many will recognise moral injury in the moral-philosophical sense from their ordinary experience of leadership. This is because it is conceptually grounded in recognisable moral behaviours. Care leaders may already possess an implicit understanding of how this type of moral injury arises, and tacit knowledge of what to do about it. By making the implicit explicit, this commentary aims to support care leaders to … ER -