What is Occupational Moral Injury?
Moral injury occurs when individuals experience psychological distress resulting from actions, or lack of actions, that violate their deeply held moral or ethical beliefs. In the context of the workplace, occupational moral injury (OMI)specifically addresses this phenomenon as it pertains to professional environments, particularly those involving high-stakes or ethically complex decisions, such as healthcare, law enforcement, social work, and corporate governance.
OMI can arise from situations such as:
Being compelled to act against personal values due to organizational policies.
Witnessing unethical behavior in the workplace without the ability to intervene.
Feeling powerless to provide adequate care or service due to systemic constraints, such as understaffing or budget cuts.
The Development of the Occupational Moral Injury Scale (OMIS)
Recognizing the need to measure OMI, researchers have developed the Occupational Moral Injury Scale (OMIS). This tool is designed to assess the extent and nature of moral injury in workplace settings, aiming to capture the emotional, psychological, and professional impacts of moral distress.
The OMIS typically evaluates dimensions such as:
Perceived transgressions: Instances where one feels they have acted or failed to act against their moral compass.
Witnessed moral violations: Observing others committing unethical actions.
Systemic contributions: Structural or organizational factors contributing to moral injury.
Validation of the Occupational Moral Injury Scale
For any psychometric tool, validation is crucial to ensure reliability and accuracy in measuring the intended construct. Validation involves assessing whether the scale consistently measures OMI across diverse groups and situations and whether it correlates appropriately with related constructs, such as burnout, depression, or job dissatisfaction.
What We Know So Far:
Preliminary Studies: Early research on OMIS has shown promise in distinguishing between moral injury and related phenomena like burnout or general workplace stress.
Reliability Testing: Initial studies suggest the scale has high internal consistency, meaning the items effectively measure the same overarching concept.
Content Validity: Expert panels have generally agreed that the items on the OMIS align with the theoretical framework of moral injury.
Construct Validity: Studies have found that higher OMIS scores correlate with outcomes such as emotional exhaustion, feelings of betrayal, and reduced job satisfaction.
However, further research is needed to assess its application across various occupational fields and cultures, as most studies have focused on specific professions, such as healthcare providers.
Why the OMIS Matters
The development of tools like the OMIS is essential for addressing OMI because it provides organizations and researchers with a way to identify and quantify the problem. This can lead to:
Improved Workplace Interventions: Understanding OMI can help organizations create policies that minimize systemic contributions to moral injury.
Enhanced Support Systems: Targeted mental health resources can be offered to those experiencing high levels of OMI.
Broader Cultural Shifts: Quantifying moral injury might compel industries to re-evaluate practices that contribute to ethical conflicts.
Next Steps in Research and Application
While the OMIS represents a critical step forward, future efforts should focus on:
Expanding Validation: Testing the scale in diverse industries and cultural contexts.
Longitudinal Studies: Understanding how OMI evolves over time and its long-term impact on employees.
Intersection with Other Constructs: Exploring how OMI interacts with other workplace issues, such as discrimination, harassment, and systemic inequities.
Conclusion
The Occupational Moral Injury Scale offers a promising tool for addressing the complex and often overlooked issue of moral injury in the workplace.
By validating and applying this scale, researchers and organizations can work toward healthier, more ethical workplaces where individuals can thrive without compromising their moral integrity.
The Occupational Moral Injury Scale (OMIS) and related tools like the Moral Injury Outcome Scale (MIOS) are designed to assess moral injury arising from exposure to potentially morally injurious events (PMIEs).
These events often challenge an individual's core moral beliefs or ethical standards. While OMIS specifically focuses on occupational settings, the broader moral injury scales aim to quantify distress resulting from moral conflicts.
The OMIS offers one of the first reliable, psychometrically validated tools for capturing the experience of moral injury in occupational settings. One of the strongest contributions of the OMIS is its ability to be used in any occupational setting, without the necessity for ad-hoc amendment which is currently seen in most other measures of MI. Our research suggests the OMIS is both reliable and valid (factorial, convergent and divergent) instrument, precise enough to capture key aspects of the moral injury construct whilst generalized enough in wording to allow its use across any occupational setting without requiring amendment. With consideration of limitations, the OMIS offers a valuable tool for clinicians and researchers seeking to explore moral injury presentation in occupational settings outside the military. The OMIS will help facilitate further research into and greater understanding of the moral injury construct as a whole.
Victoria Thomas, Boris Bizumic and Sara Quinn College of Health and Medicine, the Australian National University
Key features of these scales include:
1. Structure: These tools typically include items that assess the type and severity of PMIEs, as well as symptoms like guilt, shame, and betrayal. The MIOS, for instance, uses a two-page format that examines PMIE exposure, PTSD symptoms, and psychosocial outcomes through a Likert scale approach. It has separate subscales for shame-related and trust-violation symptoms, scored to reflect mild, moderate, or severe injury.
2. Validation: Tools like the MIOS have undergone initial validation. For example, studies on Australian samples established scoring thresholds correlating with functional impairments. However, these tools are still being refined to account for cultural and occupational differences in populations.
3. Applications: These scales are used in research and clinical contexts to measure the impact of moral injury in various groups, such as military personnel, healthcare workers, and emergency responders. The results can guide therapeutic interventions by identifying the severity of moral injury and its functional consequences, including interpersonal or professional challenges.
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