Moral Injury: Understanding the causes, processes, and consequences in the UK Ambulance Service

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Moral injury (MI) is psychological distress that arises from "perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations"1. MIs have been associated with stressful occupational events including loss of life to vulnerable people, and a lack of social support following exposure to an event2. MI is distinct from, albeit related to, PTSD, where PTSD is a clinical condition experienced by those who have been harmed by others, whereas MI is the psychological reaction to being involved in the perpetration of moral and traumatic transgressions linked to shame1. MIs have almost exclusively been studied in US military samples, where they have been linked to PTSD, depression, and suicidality3.Through partnership with North West Ambulance Service (NWAS), the PhD candidate will develop a theoretical framework of MI. The student will build on the conceptual framework of military MI developed by Litz1. Although this framework outlines potential causes and consequences of MI, it does not explain the psychological process of MI and how it manifests over time due to the limited, and largely quantitative, research conducted within the military domain. We have added colour codes to the framework to help structure understanding of MI. The student will use this framework as an initial guide to develop their research, whilst seeking to adapt and extend these conceptual ideas by drawing on rich qualitative data to produce a more robust theoretical framework of MI, beyond the military domain.